The curriculum of the Emergency Medicine Residency at the University of Maryland Medical Center (UMMC) contains a number of rotations that facilitate in-depth learning of the practice of Emergency Medicine and other related specialties. Some of the core rotations are briefly reviewed here. For combined residents (EM/IM, EM/Peds), some of the rotations occur during different years.
Most of your EM months throughout all years of residency will be spent at the University of Maryland Medical Center adult ED. The adult acute care side serves a local urban population where the acuity and utilization is high, but is also a referral center with complex cardiology, transplant, cancer, neurology, surgical, critical care and other tertiary/quaternary-level services. There is a graduated level of responsibility with PGY-2 and PGY-3 residents serving as senior residents on a team that also includes an attending, intern and medical student. A “swing” team made up of a resident and attending also is present during the busiest hours of the day that floats through the department to help manage flow, run resuscitations, perform procedures and care for their own patients as well. Because of the complexity of emergency medicine at this academic medical center, the rotations are rigorous, but graduates laud the program for preparing them for any academic or community job regardless of patient population or volume.
Our residents rotate through the University of Maryland Medical Center pediatric emergency department both on dedicated rotations in the PGY-1 and PGY-2 years and as longitudinal shifts mixed in their PGY-3 year as the senior resident in the department. The pediatric ED sees a good variety of bread-and-butter pediatric complaints with a mix of complex tertiary complaints and referrals. The pediatric ED is staffed with pediatrics and fellowship-trained attendings, dedicated pediatric nurses and has unique resources like Child Life specialists.
A dedicated UMMC Adult ED night shift block in the PGY-2 and PGY-3 year is a traditional favorite for multiple reasons including the predictable set schedule that includes every weekend off, as well as learning the unique aspects of being a “nocturnist” and practicing EM while the rest of the world (and most of the hospital) is sleeping. Because of this rotation, as a senior resident, you will work very few overnight shifts during your other UMMC Adult ED rotations.
A real highlight of the residency is our longstanding close relationship with the world-famous R Adams Cowley Shock Trauma Center (STC), the nation’s first and only integrated trauma hospital. Physically connected to UMMC, STC is functionally a freestanding center with its own Trauma Resuscitation Unit (TRU), which receives a high volume of trauma activations, dedicated ORs, ICUs and admitting floors. STC is the Primary Adult Resource Center for trauma (above Level 1) and receives trauma patients from throughout the state and regional area through local EMS and the network of Maryland State Police helicopter medevac system. This leads to caring for an incredible breadth and variety of types of traumatic injuries. The trauma team is a multidisciplinary service of emergency medicine and surgery residents and our EM residents rotate on the trauma team in all years of residency and are an integral part of the team, managing trauma resuscitations in the TRU. We do more rotations on the trauma team than any other residency in the hospital, and at any given time, we have at least one resident on all three of the trauma teams. As a PGY-3, residents have a special role of being responsible for overseeing all activities in the TRU. Other rotations in STC including Trauma anesthesia and Trauma ICU are described below.
The University of Maryland Prince George’s Hospital Center (aka “PG”) is a Level 2 trauma center located just outside Washington D.C. Rotations occur during all three years. Residents particularly enjoy this rotation because of the “county” type of feel with very high acuity and volumes.
Located in the heart of downtown Baltimore, this highly regarded academically-affiliated community hospital hosts our PGY-2 and PGY-3 residents over three blocks where they work directly one-on-one with a faculty attending.
One month during your PGY-1 and again during your PGY-2 year is spent rotating here in the Pediatric ED with our neighbors across town. In the Maryland EMS system, the JHH Peds ED is the designated pediatric trauma center for the Baltimore region. The volume and acuity is high and the attendings and fellows are eager to teach.
Residents get exposure to and utilize ultrasound daily during all aspects of their residency, however dedicated ultrasound rotations and didactics are also included in all three years. During the PGY-1 and PGY-2 years, a week is spent rotating with our ultrasound faculty and fellows, and during the PGY-3 year, an entire block is spent on the “ultrasound team”, where they also help lead and teach the junior residents and medical students. By the end of residency, our trainees frequently amass hundreds of collected and reviewed ultrasound studies that far exceed ABEM requirements.
specifically dedicated to them.
Residents have two elective blocks, one in each the PGY-2 and PGY-3 year, which they can use to explore any aspect of emergency medicine training they choose. Residents have utilized this to spend time with specialties like ophthalmology, ENT, wilderness medicine, or toxicology, to pursue a rotation in the unique Critical Care Resuscitation Unit, gain additional experience with EMS or our risk management department, perform research, practice government advocacy, and more. Your imagination rules here.
The 29-bed MICU cares for the most critically ill medical patients and one of the most complex patient mixes on the East Coast. One month is spent here during intern year, and is an invaluable introductory education to critical care. Interns are trained with a team of residents, fellows and attendings, all in-house 24/7.
A month on the Primary Cardiology Service allows interns to learn in depth cardiovascular medicine and care for patients both in the Cardiac Intensive Care Unit (CCU) and the stepdown telemetry Primary Cardiac Unit (PCU). Typical patients on this service include those with acute myocardial infarction, have undergone complex coronary interventions or ablations, rhythm disorders, valvular heart disease and congestive heart failure.
A dedicated month is spent on the labor and delivery unit at Mercy Medical Center, which sees a high volume of obstetric patients, to learn how to care for the actively laboring patient and to gain experience delivering babies.
Two months in the first year is spent in the recently renovated 21-bed ED at the Baltimore Veterans Affairs Medical Center, which is directly adjacent to UMMC and staffed by University of Maryland faculty. The Medical Center is the acute medical and surgical care facility for the VA Maryland Health Care System. Here, our interns get to help care for our nation’s veterans in a facility and medical system
Shock Trauma provides residents many exciting opportunities, one of these is our month of trauma anesthesia. Not only do our residents get to perform dozens upon dozens of OR and traumatic intubations, they also gain experience with regional anesthetic blocks and procedural sedation. With direct supervision from an Attending Anesthesiologist you will quickly become comfortable intubating some of the most difficult patients at the most critical times. You also quickly learn to use adjuncts, like bougies and LMA's, to help secure the difficult airway.
During this rotation, our residents work with the orthopedic team that specifically manages the high volume of orthopedic injuries that come through the Shock Trauma TRU. Here, we get to learn from specialists how they manage complicated orthopedic injuries and practice skills like fracture and dislocation reduction, splinting, blocks, pinning and traction.
The University of Maryland Children’s Hospital Pediatric Intensive Care Unit (PICU) provides state-of-the-art multidisciplinary critical care for young patients with life-threatening medical and surgical conditions. One month is spent here during the PGY-2 year.
The University of Maryland Medical System includes several hospitals on Maryland’s Eastern Shore, which is largely rural. During this block, residents rotate both at University of Maryland Shore Medical Center at Easton, which is a regional acute care medical center as well as University of Maryland Emergency Center at Queenstown, a freestanding emergency center. This exciting opportunity allows the experience to learn how emergency medicine is practiced in an environment with limited consultative services as well as a freestanding ED.
Our senior residents help care for the most critically ill trauma patients in the Trauma ICU, working closely with the trauma/critical care fellows and attendings, and essentially functioning in a similar role to a fellow. This rotation, which is full of procedures and critical care interventions, consistently receives excellent ratings from the residents.
A month is spent in the Pediatric ED of the UM Upper Chesapeake Medical Center, a high volume, high acuity suburban hospital to allow exposure to community based pediatric emergency medicine. This rotation often provides lots of bread-and-butter pediatric complaints like fractures and lacerations, while also being the primary landing zone for sick children in Harford County, about 30 minutes outside Baltimore City.
This “selective” rotation allows residents to arrange and rotate at a community emergency department of their choosing in order to continue learning the practice of “real-world” emergency medicine outside of an academic tertiary care medical center. Some residents also utilize this rotation to “try out” a hospital they are considering working at after graduation. Popular selections are Baltimore Washington Medical Center, Upper Chesapeake Medical Center Adult ED, and St. Joseph’s Medical Center, all within 15-30 minutes of Downtown Baltimore.