Year-Directed Didactic Curricula

R1 Orientation

The R1 orientation program is conducted from mid-June through the end of July. In addition to administrative requirements necessary for inprocessing and payroll; R1s experience a wide variety of didactic and experiential sessions to enable them to prepare for clinical duties and get the most out of the remainder of their residency.

• Orientation in June is largely conducted in groups with other residents in other programs affiliated with Wright State University. This half-month includes short courses in basic life support (BLS), advanced cardiac life support (ACLS), advanced trauma life support (ATLS), and pediatric advanced life support (PALS).
• Orientation in July begins with an overview of the three-year curriculum by the Program and Education Directors, followed later in the month by an introduction to evidence-based medicine (EBM) and guidance on writing and presenting Critically Appraised Topic (CAT) discussions.
• July also initiates the R1 year-directed curriculum (YDC) focusing on the approach to undifferentiated presentations grouped by chief complaint. Most of these are conducted before new residents begin clinical shifts, so they have a foundation to approach some of the most common and potentially most serious patient complaints. A session on the rational use of ancillary studies is also presented. ED directors discuss documentation, risk management, cultural barriers to care, and patient satisfaction.
• R1s receive introductions to the subdisciplines of emergency medical services (EMS), pediatric emergency medicine, sports medicine, and toxicology. An additional discussion on how physicians interface with EMS providers is also conducted. Additionally, an introduction to disaster medicine is provided. R1s are fully introduced to their integral roles in disaster-response plans for the eight-county Ohio Emergency Management Agency Region II. R1s subsequently complete the short course in basic disaster life support (BDLS). This is complemented by a day of hands-on instruction in personal protective equipment (PPE) and decontamination techniques for healthcare providers managing patients exposed to chemical, biological, or radiological (CBR) materials.
• Managing personal & professional stress is another session targeted at resident wellness. Additionally, a series on workplace violence, physical safety in the ED, and personal defensive tactics is presented during the orientation month. This prepares R1s for three hands-on defensive-tactics classes taught over the next few months by key faculty and other local combatives experts.

Topics and supporting experiential activities include the following:

ACLS = Advanced Cardiac Life Support; ATLS = Advanced Trauma Life Support; BDLS = Basic Disaster Life Support; BLS = Basic Life Support; ECG = Electrocardiography; DVT = Deep Venous Thrombosis; FAST = Focused Assessment using Sonography for Trauma; PALS = Pediatric Advanced Life Support; US = Ultrasonography

R1s work six 10-hour shifts in one of the emergency departments during the latter half of July, so all will experience clinical emergency medicine in their first month before starting the remainder of their onservice and offservice rotations.

R1 Year

The R1 year-directed curriculum (YDC) concentrates on the approach to the undifferentiated patient complaint [i.e., complaints for which the diagnosis is not already known]. The ability to conduct simultaneous resuscitation and treatment while evaluating life-threatening and other serious problems is an essential skill for all emergency physicians. The YDC begins in orientation and continues throughout the R1 year. Small-group sessions enable case-based discussions where R1s can ask questions and draw on the real-world experiences. The "approach to ___" topics are based on chapters in Mahadevan & Garmel [eds]: An Introduction to Clinical Emergency Medicine (Cambridge: Cambridge, UK; 2005). Supplemental information is drawn from section II of Marx et al. [eds]: Rosen's Emergency Medicine: Concepts and Clinical Practice [6th ed] (Mosby: Philadelphia; 2006).

The small-group discussions, experiential activities, and short courses specific to the R1 year include the following:

ABEM = American Board of Emergency Medicine; ACLS = Advanced Cardiac Life Support; BLS = Basic Life Support

In addition to scheduled simulation sessions, R1s are provided an extra day on unknown case simulations every month they are on an EM clinical rotation.

As part of the Emergency Medical Services (EMS) curriculum, R1s will schedule several ride-along shifts with the Dayton Fire Department and Kettering Fire Department.

R2 Year

The focus areas of the R2 year-directed curriculum (YDC) are critical care and procedural skills. Actual equipment and supplies are available for familiarization or demonstration when necessary. R2s may choose which of the two major procedure textbooks to read ahead of discussions: Reichman & Simon [eds]: Emergency Medicine Procedures (McGraw-Hill: New York; 2004); or Roberts & Hedges [eds]: Clinical Procedures in Emergency Medicine [4th ed] (Saunders: Philadelphia; 2004).

The small-group discussions, experiential activities, and short courses specific to the R2 year include the following:

ABEM = American Board of Emergency Medicine; ADLS = Advanced Disaster Life Support; ECG = Electrocardiography; KCMA = Kettering College of Medical Arts; NDLS = National Disaster Life Support; PALS = Pediatric Advanced Life Support; TeamSTEPPS = Team Strategies and Tools to Enhance Performance and Patient Safety

In addition to scheduled simulation sessions, R2s are provided an extra day on adult resuscitation simulations every month they are on an EM clinical rotation.

An introduction to quality management provides a framework for a required quality assurance (QA) or quality improvement (QI) project in the R3 year.

In addition to their continued experiences in Emergency Medical Services (EMS), R2s will participate in a hands-on laboratory learning how extrication is performed while providing medical care to trauma victims trapped inside vehicles.

PALS recertification is provided the month before its two-year expiration date. ACLS provider and instructor recertifications are usually not a problem, if residents have taught four classes in the preceding two-year period.

R3 Year

Success in personal and professional lives is one key characteristic for a fulfilling long-term career in emergency medicine. The R3 year-directed curriculum (YDC) focuses on some related knowledge, skills, and abilities necessary to achieve this. The small-group discussions are led by local experts in the respective topics.

The small-group discussions, experiential activities, and short courses specific to the R3 year include the following:

ABEM = American Board of Emergency Medicine; AHRQ = Agency for Healthcare Research and Quality; ECG = Electrocardiography; ED = Emergency Department; EM = Emergency Medicine; EMS = Emergency Medical Services; KCMA = Kettering College of Medical Arts; TJC = The Joint Commission

For those with an interest, some R3s become Assistant Medical Directors for local emergency medical services (EMS) systems. Others will continue the ride-a-long program with increased responsibility.