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Emergency Medicine Residency Program

Educational curriculum

The educational curriculum for Loma Linda University Medical Center (LLUMC) emergency medicine residents has been developed to provide an environment where learners have optimal exposure to the core content of emergency medicine training. Under the direction of experienced emergency medicine attendings, residents will develop their skills in a graded fashion over the three year period with progressively greater responsibility and autonomy. By the close of their training residents are equipped to work in either academic or community settings. The monthly block rotations and didactic sessions have been designed to optimize the educational experience in all aspects of emergency medicine including trauma, pediatrics, EMS, and ultrasound.

Trauma

ThoracotomyTrauma training is essential for mastering the specialty of emergency medicine. Both LLUMC and Riverside County Regional Medical Center (RCRMC) are high-volume trauma centers with significant numbers of both blunt and penetrating trauma. LLUMC is the only Level 1 trauma center in San Bernardino and Riverside county.  At both institutions trauma teams are activated for the most critical trauma patients. Emergency medicine residents play essential roles on these teams. In all trauma activations emergency medicine residents are responsible for securing the airway. The department of anesthesia is not a member of the trauma activation team and they do not respond to trauma activations. The trauma captain role alternates between the surgery senior resident and emergency medicine senior resident in a prearranged schedule. Emergency medicine senior residents are trauma captains every other day. Due to the high volume and acuity of trauma at both institutions, residents have ample opportunities to perform a variety of procedures such as thoracostomy tubes, cutdowns, and central lines. Most residents perform a number of cricothyrotomies and emergency department thoracotomies prior to completing the program.

Photo: An EM resident performs cardiac massage on an emergency department thoracotomy patient.

Pediatric emergency medicineEM resident

Recognizing and caring for the critically ill child is an important part of the practice of emergency medicine and therefore is a principle part of the training at Loma Linda. More than 30 percent of patients seen in the program's two emergency departments are children. Riverside County Regional Medical Center is the local county hospital and has become the entrance point to the health-care system for many children without financial resources. Loma Linda University Children's Hospital is a large referral center for the surrounding community and is also the region's only pediatric trauma center. Residents thus receive exceptional training in both trauma and the resuscitation of critically ill children.

During the PGY 1 and PGY 2 year resident physicians have a dedicated pediatric emergency medicine month in which all of their shifts are in the Pediatric Emergency Department.  In addition, every month residents spend a minimum of 20 percent of their total Loma Linda emergency department shifts in the pediatric ED. This format ensures residents are consistently learning pediatric emergency medicine throughout the year instead of just during their dedicated pediatric emergency department month rotations. Residents are taught only by board certified pediatric emergency medicine attendings or board certified emergency medicine attendings. The pediatric emergency department is a state-of-the-art newly renovated facility that was completed in July 2002. Loma Linda also offers a fellowship of pediatric emergency medicine that has consistently attracted bright and energetic residents interested in subspecializing in the emergency care of children.

Pediatric Emergency Medicine Residency

Photo: An emergency medicine resident physician successfully intubates a child.

Emergency medical services (EMS)

Resident participation in pre-hospital care and education takes several different forms. Residents participate in "ride-out" experiences on paramedic ground ambulances during their PGY-2 EMS rotation. Ride-out experiences on helicopters are also available, but not required. Residents play an active role in the training of local paramedics and emergency medical technicians, as well as disaster planning and drills. Residents with additional interest in this area of emergency medicine have ample additional opportunities to get involved. You can learn more about these opportunities on our EMS/tactical EM/event medicine page.

Ultrasound (US)

Ultrasound teaching is incorporated into all aspects of residency education, from didactic sessions to bedside instruction. Both RCRMC and LLUMC have their own dedicated ultrasound machines that are used extensively in patient care. With the high volume and acuity of patients seen residents rapidly become adept in using ultrasound for evaluating trauma patients, central vascular access, pregnancy evaluation, and the many other emergency medicine applications.  Credentialing is not only provided, it is expected over the course of the three-year residency. Residents graduate with superior ultrasound knowledge and expertise--skills that are increasingly sought in both community practice and academia.

Photo: An EM resident quickly performs the FAST exam on a trauma patient while surgery stands by.

Block schedules

Postgraduate year (PGY)-1

Rotation

Number of months

Location

Riverside emergency department

2

RCRMC

LLU emergency department

1-1.5

LLU

LLU MICU

1

LLU

Cardiac care unit

1

LLU

General surgery

1

LLU

Trauma surgery

1

LLU

Anesthesia

1

VA

Orthopedic surgery

0.5

RCRMC

Orthopedic procedures

1

LLU

OB/GYN

0.5-1

LLU

LLUMC pediatric emergency department

1

LLU

LLU Ultrasound

 0.5

 LLU

PGY-2

During the PGY-2 year emergency medicine residents rotate through the busy MICU/CCU and PICU. Our residents rotate senior call with internal medicine and pediatric residents, respectively, and while on call are the most senior in-house physicians for these ICUs. This experience provides extensive opportunities for leading resuscitations and performing critical care procedures. The Medical Center's pediatric ICU is among the busiest in the nation. On average, emergency medicine residents take call on inpatient rotations every fourth night during both the PGY-1 and PGY-2 years.

Rotation

Number of Months

Location

LLU emergency department

4.5

LLU

RCRMC emergency department

3

RCRMC

LLU pediatric intensive care unit

1

LLU

LLU surgical intensive care unit

0.5

LLU

VA intensive care unit

1

VA

LLU pediatric emergency department

1

LLU

Elective

1

LLU/RCRMC

PGY-3

RotationNumber of monthsInstitution
LLU emergency department

5.5-6.5

LLU

RCRMC emergency department

3-4.5

RCRMC

Elective

1.5

LLU/RCRMC

Didactics

Five hours of formal emergency medicine conferences take place each week and are designed to complement the residency's strong clinical ED experience. Over 75 percent of the lectures are given by faculty. The simulation center run by our EM faculty is frequently utilized during these didactic sessions.  Core curriculum didactic sessions are supplemented with dedicated conferences towards research, morbidity and mortality reviews, oral board practice cases, US lectures and labs, dedicated ECG and radiology topics as well as grand rounds. Additionally, regularly scheduled journal clubs held at attendings' houses allow for reviews of hallmark literature in a relaxed environment.