Year-Directed Didactic Curricula

Year-directed conferences (YDCs) are monthly small-group discussions designed for the specific needs of each residency class. They are interspersed with quarterly sessions in one of our two high-fidelity simulation laboratories. The scenarios used in these labs reinforce concepts and principles discussed in preceding YDCs.

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, advanced cardiac life support, pediatric advanced life support, and advanced trauma life support.
  
• Orientation in July begins with an overview of the three-year curriculum by the Program and Education Directors.
  
• Several of the R1 YDCs 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.
  
• Additional small-group discussions cover evidence-based medicine, risk management, patient satisfaction, multiculturalism, and managing personal stress.
  
• Six hours of lecture and three hours of hands-on laboratory training initiate R1s to the use of bedside ultrasonography in emergency medicine.
  
• Laboratory experiences include airway interventions, central and peripheral intravenous access, trauma resuscitation, suturing, and personal protective equipment for patients exposed to biological, chemical, or radiological materials.
  
• R1s complete the short course in basic disaster life support, and are introduced to their roles in regional disaster response.

R1s will 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 focus of R1 YDCs is 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. Small-group sessions with a faculty member and senior resident enable a case-based discussion where R1s can ask questions and draw on the real-world experiences of more senior practitioners. The "approach to ___" topics are based on chapters in Hamilton et al. [eds]: Emergency Medicine: An Approach to Clinical Problem-Solving [2nd ed] (Saunders: Philadelphia; 2003), and its accompanying workbook. Supplemental information is drawn from section II of Marx et al. [eds]: Rosens Emergency Medicine: Concepts and Clinical Practice [6th ed] (Mosby: Philadelphia; 2006). Both of these are required R1 textbooks.

Based on resident feedback from their curriculum evaluations in 2006, procedural skills are now interwoven into the last four months of the R1 YDC curriculum, whereas they had previously been exclusively within the R2 YDCs.

R2 Year

As residents become more and more responsible for managing critical patients, R2 YDCs focus on procedural skills. These are blocked by general topic and discussed in a two-hour small-group session with a faculty member. R2s may choose which of the two major procedure textbooks to read ahead of these 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). 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 curriculum, whereas they had previously been exclusively within the R3 YDCs. The topics chosen for the end of the R2 year specifically relate to finding a great job to enjoy after graduation.

R3 Year

Success in personal and professional lives is one key characteristic for a fulfilling long-term career in emergency medicine. R3 YDCs focus on some related knowledge, skills, and abilities necessary to achieve this. The small-group discussions are led by local experts in the respective topics. They include reimbursement for services, malpractice issues, personal financial considerations, and individual and group dynamics. All of these are designed to prepare graduates for their futures as
attending emergency physicians.

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