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 supervised clinical, didactic, and experiential sessions to enable them to get the most out of the remainder of their residency.

• Orientation in June 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 by an introduction to evidence-based medicine (EBM) and guidance on writing and presenting Critically Appraised Topic (CAT) discussions.
• Several of the R1 YDCs [see below] 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. Another session discusses the rational use of ancillary studies.
• Additional small-group discussions cover risk management, patient satisfaction, multiculturalism, and managing personal & professional stress.
• Laboratory experiences include airway interventions, central and peripheral intravenous access, trauma resuscitation, suturing, and personal protective equipment for healthcare providers managing patients exposed to biological, chemical, or radiological (CBR) materials.
• Six hours of small-group discussion and six hours of hands-on laboratory training initiate R1s to the use of bedside ultrasonography in emergency medicine.
• 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.
• An introduction to the subdiscipline of disaster medicine is provided to R1s. They 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).
• A series on workplace violence, physical safety in the ED, and personal defensive tactics is presented. This prepares R1s for four hands-on defensive-tactics classes taught by 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 excluding 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 with a senior teaching resident enable a case-based discussion where R1s can ask questions and draw on the real-world experiences.

Experiential activities include a continuation of high-fidelity case simulations and hands-on defensive-tactics classes. Teaching simulations combine unknown cases for R1s. The R1s present their cases to R3s, who discuss them and teach the R1s as they would do in the emergency department. The last two months focus on skills necessary to function effectively in an adult ICU during the R2 year.

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; EM = Emergency Medicine

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).

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

As residents become more and more responsible for managing critical patients, the early R2 year-directed curriculum (YDC) focuses on procedural skills. Actual equipment and supplies are available for familiarization or demonstration when necessary.

Based on resident feedback from their curriculum evaluations in 2006, administrative topics are now included in the last four months of the R2 YDC, whereas they had previously been exclusively within the R3 YDC. The topics chosen for the end of the R2 year specifically relate to finding a great job to enjoy after graduation. These are blocked by general topic and discussed in a two-hour small-group session with a faculty member.

Experiential activities include more high-fidelity case simulations, along with a combined session with R3s managing multiple patients simultaneously.

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; NDLS = Basic Disaster Life Support; PALS = Pediatric Advanced Life Support; US = Ultrasound

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).

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.

Experiential activities include more high-fidelity case simulations. Three sessions focus on teaching and multitasking skills in conjunction with R1s and R2s, respectively.

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

ABEM = American Board of Emergency Medicine; ECG = Electrocardiography; ED = Emergency Department; EM = Emergency Medicine; EMS = Emergency Medical Services

The R3 YDC is designed to help residents transition to the roles of attending clinicians and academic faculty, depending on their individual career interests.

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