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Frequently Asked Questions About the UCSD Emergency Medicine Residency Program

What do you get out of the 4th year at UCSD?

  • The 4th year at UCSD gives our trainees the ability to get a “mini-fellowship” in a diverse range of EM subspecialties such as EMS, ultrasound, toxicology, and hyperbarics, which are all built into our curriculum. - Residents have time to develop their interest in a subspecialty and build their fellowship application.
  • More ELECTIVE time - four weeks EVERY year.  
  • Additional training in critical care and pediatrics, two areas that most EM physicians want more exposure to prior to entering practice
  • Added responsibility in the Emergency Department - PGY IV’s are responsible not only for teaching medical students and interns, but also are in charge in managing flow and throughput throughout the ED. Please see below for further delineation of the PGY roles by year.
  • PGY4s have dedicated teaching shifts in the emergency department where their role is to supervise and teach medical students, interns and off service residents.

What is the nature of the Emergency Department at UCSDMC?

The Department of Emergency Medicine (DEM) is a separate clinical department within the Medical Center. The Director of the DEM is responsible to both the hospital director and medical school dean.

How much Peds exposure do you get?

  • Residents spend a total of 16 weeks (PGY1=5, PGY2=5, PGY3=3, PGY4=3) at Rady Children’s Emergency Department - a dedicated pediatric ED where trainees get to learn from pediatric EM specialty trained attendings. These weeks are spread out longitudinally throughout the year so residents don’t miss out on any “season” of peds. .  
  • In addition, trainees will get pediatric exposure at the home institutional sites of UCSD Hillcrest and La Jolla as well as community sites at Palomar, Tri-City, and El Centro.

What is the actual physical presence of faculty in the ED? What are their backgrounds?

Full-time DEM faculty are present in both the UCSD Hillcrest and Jacobs Medical Center Emergency Departments 24 hours a day.

All of the DEM faculty are board certified in Emergency Medicine. Other board certifications include 

ACGME EM Fellowships

  • Clinical Informatics: Drs. Dameff, Killeen (Fellowship Director)
  • EMS: Drs. Farah, Khan, Noste (Fellowship Director), Sloane, Dunford, Donofrio
  • Medical Toxicology: Drs. Clark, Kreshak, Lasoff, Ly, Minns  (Fellowship Director), O’Connell, Ontiveros,  Schneir, Tomaszewski
  • Peds EM: Drs. Ishimine  (Fellowship Director), McDaniel, Murray, Schwartz 
  • Undersea & Hyperbaric Medicine: Drs. Grover, Jacoby, Hayden, Killeen, Medak, Sadler (Fellowship Director), Smith, Snyder, Tanaka, Tomaszewski, Witucki, Van Hoesen

Non-ACGME Fellowship

  • Anesthesia & Pain Management: Dr. Oswald
  • Critical Care, Pulmonary:  Dr. Gabe Wardi
  • Geriatric EM: Drs. Kreshak, Tolia, You
  • Global Health: Dr. Noste, Coffey
  • Medical Education: Dr. Frannie Rudolf 
  • Research: Drs. Coyne, Vilke, Castillo 
  • Sports Medicine (w/FamMed): Dr. Ilona Barash
  • Ultrasound: Drs. Campbell, Aminlari, Medak, Nadolski, Singh
  • Wilderness Medicine: Dr. Van Hoesen, Coffey

Prior non-ACGME Fellowships

  • Administration: Dr. Tolia
  • Ethics: Dr. Snyder
  • EM/IM trained: Drs. Tolia, You, Dunford, Guss, Jacoby

Is the UCSD ED unselected, or are some patients triaged out?

The vast majority of all ED visits are unselected. The following patients are triaged:

  • Second & Third trimester obstetric conditions are referred to the Labor and Delivery area.
  • Major burn victims are triaged by emergency physicians to the Burn Unit.
  • "Major trauma patients," as identified by the UCSD Base Hospital (Emergency Department) physician, are triaged to either the Trauma Unit or Operating Room. EM residents are active members of the trauma resuscitation team, including one and a half months as the resuscitation team captain. Patients that do not meet major trauma criteria are managed in the Emergency Department.

How long is a shift? How many shifts per month?

While rotating at our UCSD ED, our PGY1s are currently scheduled for 10-hour long shifts and PGY2-4s are currently scheduled 9-hour long shifts.  A resident will not be scheduled to work more than 60 scheduled hours per week seeing patients in the emergency department, and no more than 72 total hours per week.  

Is resident responsibility graded?

Yes. PGY-I residents must present all cases to either attending physicians, and PGY-III or PGY-IV residents. PGY-II residents are given more responsibility: they follow their patients independent of PGY III or IV supervision and present directly to EM faculty. The PGY-II resident is also assigned head of bed duties for patients that require emergent airway management, performing interventions such as endotracheal tube intubation or laryngeal mask airway insertion. Senior residents at the PGY-III and IV level have responsibilities that include the supervision of junior housestaff and students, and the provision of more specialized consultation. Senior residents are also Code Leaders that guide resuscitation for patients in cardiac arrest. PGY-IV residents are in charge of the Emergency Department, with responsibilities delegated by the on-duty DEM faculty physician.

When, how, and by whom are our residents supervised?

In the ED, all residents are supervised by DEM faculty and senior housestaff who are physically present 24 hours a day. Supervision on other services is provided by chief residents and faculty of those respective services.

Does our Emergency Department have hospital-to-ambulance or hospital-to-hospital communication systems?

UCSD Medical Center has both hospital-to-ambulance and hospital-to-hospital communication systems. Controlling over 1,000 calls per month, its Base Station is the busiest in San Diego County.

What is the proximity of the ED to X-ray? Who reads the films and when?

The Emergency Department has its own X-ray suite within the department which operates 24 hours/day. After hours, the main radiology suites (50 yards away) supply X-ray support, including computerized tomography and ultrasound. PGY-II and PGY-III radiology residents are in-house 24 hours/day and "wet-read" many Emergency Department films. ED residents are also encouraged to enter preliminary reads on plain film radiographs to help expedite patient care and dispositions.  Our ED techs transport the patients so you can focus on patient care.

What is the availability of general lab and arterial blood gases (ABG)?

All ED laboratory tests receive first priority (with Trauma ICU) in the central laboratory services of the hospital.

What provision is made for follow-up of admitted, discharged and clinic patients?

Admitted patients will be reviewed by residents and interesting cases discussed with faculty at follow-up conferences.

All patients discharged from the Emergency Department receive written instructions, ranging from medical instructions to outpatient clinic appointments to return visits to the ED. Follow-up of air medical patients is provided through monthly case conferences.

What are our general objectives for EM training and how do we hope to achieve them?

The UCSD Emergency Medicine residency is committed to training physicians to a level of knowledge at which they are able to independently evaluate and manage the wide range of illness and injury inherent to the specialty.

This residency's philosophy will favor an interest in education, research, and critical thinking. Graded teaching and research responsibilities are provided. Workshops and journal clubs will teach methodology. Hands-on care in the prehospital environment will generate an understanding of "roadside medicine." The program will foster the leadership roles that Emergency Medicine physicians must demonstrate both in the hospital and the community. A working understanding of EMS systems will derive from participation in city, county, state and national organizations. Finally, third and fourth year residents will have the opportunity to tailor the curriculum to meet their interests through elective experiences.

What is the salary and fringe benefits?

  • PayScales for the MedEd Salary Scale
  • Additional stipends are paid directly to residents by the Office of Graduate Medical Education. 
    • $200/month for meals
    • $750/year educational expenses
    • Housing stipend ($10,000) is built into salary
    • Chief Resident: PGY-IV salary plus $600/year
  • Fringe benefits include lab coats and lab coat laundry, meal funds, professional liability insurance for residency-related rotations, health insurance (including ophthalmology), and dental insurance. Funding for books, conferences, and other educational materials is available. The UCSD Housestaff Association provides various benefits for its members including disability insurance, financial planning referrals, legal services and referrals, and accounting service referrals.[LD6] 
  • Step 3 & License fees are reimbursed as a lump sum of $1,827.50 during PGY 2.
  •  Health, dental, vision insurance for resident and dependents at no cost. 
  • $50,000 life insurance plan for the resident with $100,000 double indemnity clause.
  • Disability and malpractice insurance provided by UC San Diego.
  • Four (4) weeks of paid vacation each year in two 2-week blocks.
  • Leave for illness, family medical emergencies, maternity/paternity per UC San Diego Internal Medicine House Staff Manual upon Program Director's approval.
  • Food allowance for meals while on night call.
  • White lab coats and laundry services.
  • DEM Benefits:
    • ACEP Membership for PG1-4s
    • SAEM Membership for PG1-4s
    • SAEM Membership for  PGY2s 
    • Rosh Review for PG1-4s
    • PGY4 attendance at ACEP Academic Assembly
    • PGY2 attendance at SAEM Academic Assembly
    • Research accepted at ACEP, SAEM are eligible for stipend to offset travel expenses to present abstract or paper for each qualifying unique scholarly work
  • Access to the library resources of UC San Diego  and the VA Medical Center onsite and via internet from offsite. 

Is the DEM involved in undergraduate, graduate, or postgraduate training?

Yes. The DEM faculty teach the "Introduction to Emergency Medicine" elective to first and second year UCSD medical students and the fourth year elective "Subinternship in Emergency Medicine."

In addition, all EM residents ART (UCSD’s version of ACLS), ATLS, PALS, and NRP providers by the completion of the residency. The DEM also conducts courses for nurses, other house officers, San Diego paramedics, lifeguards, the Coast Guard, Fire Department agencies, and the San Diego Police Department SWAT Team. Residents will be asked to participate in these training sessions as time permits.

Does the resident teach medical students and house officers?

All residents will actively participate in the didactic and clinical teaching of medical students and house officers. In addition, emergency medicine residents have the opportunity to use elective time specifically in medical education and teaching. The UCSD Medical School holds an annual Residency Transition Course (RTC) for graduating fourth year medical students in their spring semester and the Department of Emergency Medicine is highly involved in designing and implementing the curriculum for this course. Past emergency medicine residents have used elective time to take part in this course, and it has been a valuable experience for the resident seeking a career in academic medicine.

How often do residents meet with the faculty to evaluate the residency program?

Residents as a group meet with the residency director during a dedicated one hour period on a monthly basis to evaluate the total residency program, its goals and any challenges. Official minutes of each meeting are kept and sent out to the entire residency so those unable to attend can be ept up to date. Formal written evaluation of each resident occurs twice a year, and residents regularly meet with their assigned faculty advisor.

How is the resident's performance evaluated?

The resident's performance is evaluated by those supervising their activities and can be reviewed by the trainee in real time via Medhub, an online platform that tracks evaluations, procedures, and work hours. A electronic and verbal assessment is given to the program director on a monthly basis. Formal evaluation of each resident will include both written and oral examinations. A summary of these evaluations will be communicated in writing to the resident. On at least a semi-annual basis, discussions of these results will be held between the resident and the program director. Should deficiencies be identified, plans to remedy them will be documented in writing and placed on file, and the resident's progress and improvement will be monitored at least every three months. In addition, documents of the resident's management of emergency conditions (major trauma, medical and pediatric resuscitations and emergency procedures) will be kept and reviewed periodically by the program director. Finally, should impaired residents be identified, the program director will intervene appropriately on behalf of the impaired resident, the patient, the institution, the public, and the faculty involved.

How are the faculty evaluated?

At the end of each rotation, the resident completes an evaluation of the off service rotations and their  faculty. For EM faculty, annual, individual EM faculty members are formally evaluated by the director of the DEM, the residency program director, and the EM residents. Review include documentation of teaching ability, clinical knowledge, and scholarly contributions. Summaries of these evaluations will be communicated to each faculty member. The residency director is reviewed by the residents and the DEM Chairman.

How are the specific rotations evaluated?

Rotations are evaluated by the residents anonymously via MedHub and at meetings between the residents and the program director. In addition, the curriculum is continuously evaluated by both residents and faculty. The results of these evaluations are kept on file.

What is the trauma experience like at UCSD?

The trauma experience obtained at UCSD is unique among emergency medicine residencies. It has truly become one of the strengths of the program for its diversity and variety of experience. The training is designed to provide the full spectrum of trauma care, not just initial ED stabilization. Residents will experience being the first advanced trauma provider in the field, trauma care in the ED, participation as an integral team member in a dedicated trauma unit, and providing trauma critical care in the SICU after initial stabilization. As a UCSD resident, you can become a flight physician with Mercy Air. 90% of Mercy Air’s flights are to the scene of a major trauma. The Mercy Air experience begins during the PGY-2 year with a month long third-rider orientation. After orientation, residents can fly Mercy Air shifts every month for the remainder of the program. Experience will be obtained in initial stabilization of trauma patients in the ED on multiple rotations through community sites such as Palomar Hospital, which is a regional level I trauma center, and our rural site in El Centro, which receives a significant amount of trauma patients around Imperial County for initial stabilization. Each facility sees a somewhat different patient population of trauma patients. As a PGY-I resident you will rotate for a two-week dedicated trauma rotation in the trauma unit. You will be an integral team member during resuscitations and learn a highly structured approach to the multiple injured trauma patient. You will also learn the basics in post-resuscitation traumatic care on the inpatient unit. As a PGY-III and PGY-IV resident, you will rotate for six weeks in total on the trauma service as a trauma senior resident. This is a unique experience for an emergency medicine resident and, as such, our residents have a continuous presence as senior resident on the trauma service and will be trauma team captain for an average of well over 100 major trauma resuscitations during this time! Additionally, you will be responsible for the ongoing care of trauma patients in the SICU after stabilization or operative intervention as the trauma team runs the intensive care unit, which provides a unique critical care experience to our residents.

What is the clinical workload like in the various EDs integrated into the residency program?

Over the last several years, the population of San Diego has been steadily increasing. At the primary training site (UCSD Hillcrest Medical Center), we have been averaging from 100 – 130 patients per day , the majority of which are level 2 or 3 acute patients. At Hillcrest, the emergency department is divided into front and back pods. The front pod is the designated high acuity zone and is staffed by an attending, a senior resident, and a junior resident. There are 20 beds and an extra 7 hallway beds for overflow. The back pod designed for lower acuity patients but has full capabilities to perform resuscitations for cardiac arrest, intubations, reductions, and other high acuity procedures. The back pod is staffed by an attending and either a senior or junior resident. There are 16 rooms as well as 3 hallway beds for overflow. Intern residents are not designated to any pod and evaluate patients throughout the department.

At the other training sites there is typically one resident assigned per month and schedules are adjusted so little overlap occurs with residents from other services. Tri-City 48, 000 – 50,000 annually, Palomar between 42, 000 and 46, 000 per year, and Children’s Hospital approximately 96,600 ED visits per year. [LD8] The combined volume of all these ED’s integrated into the residency is over 200,000 patients per year drawing from the very diverse patient population of the entire County of San Diego. This provides a very rich clinical experience, a high degree of patient acuity, and a high per capita volume of patient pathology for each resident.

What education and training do residents receive in social emergency medicine?

The primary training site for residents is the Hillcrest Emergency Department. With no county hospital in San Diego, Hillcrest is the “de facto” county hospital and sees a diverse and underserved patient population. We are located in an LGBTQIA+ neighborhood. We are 20 minutes from the Mexico border as well as the busiest land crossing border in the western hemisphere (San Ysidro land Port of Entry). Residents work closely with social workers who are present 24 hours a day in the ED to manage complex social issues that affect our patient’s care. We are a referral hospital for charities receiving asylum seekers and receive education on how best to care for this population. Additionally there are:

  • Curriculum topics specifically designed to education on the impact of various social determinants of health
    • Asylum seekers
    • Border Health
    • Harm Reduction
    • Human Trafficking
    • Intimate Partner Violence
    • Trauma Informed Care
    • Quaterly “Social EM” journal clubs that are multidisciplinary often with our social work colleagues present or other Departments within UCSD or the County of San Diego.
  • Clinical and Community Outreach
    • An annual Clothing drives for donation to UCSD’s Street Team that reaches out to those experiencing homelessness in San Diego.
    • Our El Centro Regional Medical Center (ECRMC) cares for many populations that have multiple considerations for social determinants of health including those experiencing homelessness in Imperial County, Substance Use disorder, challenges with access to health care, lack of insurance, and human trafficking (both labor and sex).

What elective rotations have residents recently completed?

UCSD Electives

  • Administration
  • Clinical Informatics
  • Dermatology
  • Disaster Medicine
  • EKG
  • El Centro
  • EMS
  • Infectious Disease
  • Medical Education
  • Medical Spanish
  • Ophthalmology
  • Orthopedic Splinting
  • Pain Management - Nerve blocks
  • Pediatric Orthopedics & Radiology
  • Pediatric Resuscitation
  • Radiology
  • Reserach
  • Risk Management
  • Simulation Training
  • Sports Medicine
  • Teaching Elective
  • U/S Guided Procedures
  • Ventilator Management

 

Non-UCSD Electives

  • AAEM Congressional Elective
  • Emergency Medicine, Saipan
  • Emergency Medicine, Berlin, Germany
  • Emergency Medicine, Santa Cruz La Laguna Clinic, Guatemala
  • Emergency Medicine, St. John's Hospital Bangalore, India
  • Emergency Medicine, Hopi Indian Health Care Center, Polacca, Arizona
  • Emergency Medicine, Universidade Eduardo Mondlane, Mozambique
  • Emergency Medicine, Texas Medical Center, Houston, Texas
  • EMS, Argentina
  • EMS, Austere environment, Black Rock City, NV
  • EMS, Tanzania
  • General Medicine, Orota University Medical Center, Eritrea, Africa
  • Humanitarian relief, Greece
  • Hyperbarics, New Zealand
  • IHS Shiprock, EMS
  • ISTM Tactical Medicine
  • Leadership in Health and social justice
  • Mountain Medicine Diploma, New Mexico, Colorado
  • Obstetrics and Ultrasound, Phaplu Maternity Centre, Nepal
  • Primary Care, Yanamono Medical Clinic, Peru
  • Ultrasound, Calexico, Mexico
  • Ultrasound, Equadro
  • Ultrasound, Uganda
  • Wilderness Medicine, Enchanted Rock State Park, Fredericksburg, Texas
  • Wilderness Medicine, Himalayan Rescue


What are the global health international opportunities?

Dr. Noste works for a not for profit in Tanzania that does disaster response and capacity building and residents can be involved in this  

What processes are in place for Quality Assurance (QA)? How are cases reviewed to improve patient care? Are there opportunities for residents to get involved in clinical operations or administrative projects?”

UCSD EM residents are encouraged to participate and join the Quality Assurance (QA) committee, which is composed of faculty and resident members. The purpose of the QA committee is to review medical cases that are referred in by our own department and other departments in order to find opportunities to improve patient care on an individual provider and systemic level.

The Clinical Operations team is also very proactive at UCSD and is constantly searching for innovative ways to optimize systems operations. This includes the development of order sets through EPIC, coordination with consultant services to standardize patient management, and implement new initiatives to improve departmental throughput. 

We believe that resident involvement in committees such as QA and clinical operations provides an excellent exposure to opportunities to improve patient outcomes outside of direct clinical care. Residents can then take these skills and apply them to their future careers in either academic and community settings.