Frequently Asked Questions About the UCSD Emergency Medicine Residency Program

• 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 - PGY4s are responsible not only for teaching medical students and interns, but also are in charge of 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.

• 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 and El Centro.

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, Kahn, Killeen, Kwan (Fellowship Director)
• EMS: Drs. Farah, Noste (Fellowship Director), Sloane, Dunford, Donofrio, Staats
• Medical Toxicology: Drs. Clark, Cook, Kreshak, Lippi, Ly, Minns, O’Connell, Seltzer (Fellowship Director), Schneir, Simon, Tomaszewski, Villano
• Peds EM: Drs. Casas, Ishimine, McDaniel, Murray
• Undersea & Hyperbaric Medicine: Drs. Dilbarova, Grover, Jacoby, Killeen, Medak, Sadler (Fellowship Director), Smith, Snyder, Tomaszewski, Witucki, Van Hoesen

Non-ACGME Fellowship

• Anesthesia & Pain Management: Dr. Speaker
• Critical Care, Anesthesia: Dr. Michael Self
• Critical Care, Pulmonary:  Dr. Gabe Wardi
• Geriatric EM: Drs. Kreshak, Tolia, You
• Global Health: Dr. Bruno, Coffey, Noste
• Medical Education: Drs. Oyama, Rudolf 
• Palliative Care: Dr. Mason
• Research: Drs. Castillo, Chen, Coyne, Ford, Nene
• Sports Medicine (w/FamMed): Drs. Barash, Schabacker
• Ultrasound: Drs. Aminlari, Campbell, Desai, Liotta, Medak, Nadolski, Smyres, Subramony, Yu
• Wilderness Medicine: Dr. Coffey, Yu

Prior non-ACGME Fellowships

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

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

• >20 weeks 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.

While rotating at our UCSD ED, our PGY1s are currently scheduled for 10-hour long shifts and PGY2-4s are currently scheduled for 9-hour long shifts (8 hour shifts with 1 hour overlap for signout).  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.

PGY-1 residents present all cases to an attending physician and actively participate in resuscitations. Under appropriate supervision, they perform procedures for patients under their care, including point-of-care ultrasound, central venous catheter placement, and endotracheal intubation.

PGY-2 residents assume greater responsibility and focus on managing a higher volume of patients while developing efficiency and departmental flow. They are frequently assigned to the head of the bed for patients arriving by EMS who require emergent airway management, including endotracheal intubation or laryngeal mask airway placement.

PGY-3 and PGY-4 residents supervise junior residents and medical students, provide more advanced clinical guidance, and lead resuscitations for patients in cardiac arrest.  Both provide medical control after being trained on base hospital protocols.   With UCSD Hillcrest as a designated ECMO center, PGY3/4 residents will assist Attendings during ECMO.  PGY-4 residents assume the highest level of operational and clinical leadership in the emergency department, with responsibilities delegated and supervised by the attending emergency physician.  Senior residents are also expected to monitor and manage the waiting room, maintain awareness of hospital flow and throughput challenges, and work collaboratively with the attending physician and interdisciplinary team to identify and implement solutions. 

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.

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 favors 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, residents have the opportunity to tailor the curriculum to meet their interests through elective experiences throughout all four years.

• PayScales for the MedEd Salary Scale
• Additional stipends are paid directly to residents by the Office of Graduate Medical
  • Education. $200/month for meals
  • $950/year educational expenses
  • Housing stipend ($10,000) is built into salary
  • Chief Resident: PGY-IV salary plus $900/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.
•  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 House Staff Manual upon Program Director's approval.
• White lab coats and laundry services.
• DEM Benefits:
  • ACEP Membership for PGY1-4s
  • SAEM Membership for PGY1-4s
  • SAEM Membership for  PGY2s 
  • Rosh Review for PGY1-4s
  • 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.

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

Trauma training is one of the defining strengths of the UC San Diego Emergency Medicine residency. As the region's Level I Adult Trauma Center, we care for the highest-acuity trauma patients in San Diego County. Our curriculum is designed to provide residents with the full spectrum of trauma care—from prehospital management and emergency resuscitation to trauma critical care and postoperative management in the SICU.

Residents develop trauma skills across multiple clinical environments, including our tertiary referral center, community emergency departments, and our rural training site in El Centro, each providing a unique trauma population and practice experience.

Major trauma activations are managed by the multidisciplinary trauma team in our dedicated trauma resuscitation unit. Emergency medicine residents are embedded within the trauma service throughout residency, providing graduated responsibility during resuscitations while also participating in the ongoing care of critically injured patients. During the PGY-1 year, residents complete a dedicated two-week trauma rotation. During the PGY-3 and PGY-4 years, residents spend a total of six weeks as the Trauma Senior Resident, serving as trauma team captain for well over 100 major trauma resuscitations while gaining extensive experience in surgical critical care.

Residents interested in prehospital trauma may also participate in the Mercy Air Flight Physician Program. During the PGY-2 EMS rotation, all residents complete a one-week introduction to aeromedical medicine. Residents wishing to pursue advanced flight training may then apply for one of two positions in the longitudinal Mercy Air track. Selected residents complete two 24-hour flight shifts each month throughout the PGY-3 and PGY-4 years, with two weeks of elective time each year dedicated to advanced aeromedical training.

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 is 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 has 48,000 – 50,000 ED visits annually, Palomar between 42,000 and 46,000 per year, and Children’s Hospital approximately 96,600 ED visits per year. 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.

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
  • Quarterly “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 drive for donation to UCSD’s Street Team that reaches out to those experiencing homelessness in San Diego.
  • Tijuana clinic and street medicine opportunities are available.
  • Additionally there is ongoing EDI research at the department and institutional level, given we serve the 4th largest unhoused population in the country.
  • 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).

We have 4 weeks of elective time every year, in two 2-week blocks. Benefits, malpractice, and paycheck continue even if your elective is off-site.

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
• Research
• Risk Management
• Simulation Training
• Sports Medicine
• Teaching Elective
• U/S Guided Procedures
• Ventilator Management
• Wilderness Medicine (including assisting with the Spring SOM course)

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

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 take these skills and apply them to their future careers in either academic and community settings.

As an intern, you are assigned a faculty advisor who you meet with every 6 months for your semi-annual review (milestones, procedures, check in on research and quality improvement projects, review evaluations, etc.). Additionally, our faculty is always available for informal mentorship including career mentorship, research, etc. Interns are additionally assigned a resident “big sibling” who is a PGY-3 to help with the transition to intern year.

Areas of distinction 

• Aeromedicine - flight medicine
• rural/border/global health
• Geri EM/Palliative/Pain
• MedEd/Sim
• Telemed/Tech/Robots

The relationship between residents is very cohesive and supportive! We have a month-long intern orientation during which the new intern class gets up to speed on procedures, refreshes their EM knowledge base, practices ultrasounds, completes their ATLS/ART/PALS credentialing, and gets to start shifts in the ED. Orientation ends with intern retreat!

Each class gets “Class Night” once per quarter where the whole class gets the night off to do something fun! Residents and attendings are also divided into “families” - and each family organizes several family nights per year. In the past we have done beach bonfires, murder mystery parties, and the Hot Ones challenge. 

Every year after the in-training exam, we have a residency retreat, where the entire residency is given the night off! In recent years, we have rented a house in Oceanside.

Our residents say that our attendings are incredibly supportive, great teachers, and give good feedback. Our attendings are also invested in helping foster this ongoing community culture, including family events (as above), leading Women in EM, etc.

We have great relationships with our additional ED staff, including nurses, techs, RTs, and more! They help to organize bar nights throughout the year so that residents can spend time with them outside of the department as well.