What sections/pods are in your Emergency Department?
We have many different areas of our Emergency Department that allow us to see about 100 patients at once without feeling the chaos. At the busiest time of the day, there are 11 ED attendings working, 5-6 residents working (sometimes more), and 3-4 nurse practitioners. We see over 160,000 patients per year and continue to grow! Some of our pods include acute care sides 1, 2, and 3, which is where the residents spend the majority of the time and see the most critical patients. We have a pediatric ED, a few fast track areas, an observation unit, and 2 sections that make up our geriatric emergency department.
What does being “1:1” with an attending mean?
Each section has one attending and one resident and usually a medical student. Any patient in that section will be seen by either your attending alone or by you alongside an attending. Any procedures or critically ill patients in your pod belong to you and only you. This allows for a fast paced learning environment with an attending near you at all times as well as a setting in which you may become proficient in procedures very early into residency.
Are there any issues getting enough procedures?
Not at all. All of our residents are comfortable with performing various procedures very early into their residency. Intubations come somewhat frequently at St. Joseph’s. Some residents have performed intubations or central lines beginning on their first day in July. Further, many sections of our ED are only staffed by attending so frequently you will be offered intubations or other procedures in those other sections as well and then return to your dedicated side.
What kind of help is available if I am not clear on what to do?
Our ED model will always have you alongside an emergency medicine attending. Also, the first few months, senior residents will be on “teaching shifts,” which essentially places them in the department with the sole purpose of teaching procedures, diagnostic workups, and being your mentor as you grow as a resident.
How does a trauma work?
Most traumas are identified by the paramedics. The resident/attending who answers the call from the medics in the field responds to the trauma. The rest of the trauma team is then overhead paged which consists of the trauma surgeon, trauma residents, trauma nurses, radiology dept. and other sources etc. The ED resident always manages the airway. The rest of the procedures that may need to be done are divided between the ER resident and trauma resident. For a traumatic arrest, both the ER resident and trauma resident will do chest tubes and another resident will put in a cordis catheter. Typically, residents from other ED pods respond to traumas because there’s usually a procedure to perform. We have a very large trauma bay with a helicopter pad on the roof for air transport to our hospital. This helipad is the largest in the Northeast.
What time are your shifts?
Our shifts vary between 8, 9 and 12 hour shifts. Weekend shifts in the Adult ED and all shifts in the Pediatric ED are 12 hours. Weekday shifts in the Adult ED are either 8 or 9 hours. There is a detailed morning report from 700-730 am followed by breakfast. Some morning reports may last longer or we may do a simulation lab from 7-8 am in which case you would eat breakfast before the simulation lab. Shifts start promptly at 800 am. You are not expected to go to morning report after a night shift.
How are conferences?
Conferences are typically run by attending and grand round speakers. Resident lectures are included and residents are expected to present at least once a year. We have had very well-known national speakers come to our conferences and residents learn a great deal of evidence based practice here. You are always off Tuesday night so that you may benefit the most from conference. In addition, Journal Club is held once per month at an outside venue which allows for socializing along with discussion of evidence based medicine. We do attend various regional conferences including EMCrit, NJACEP, and ANSER (all NJ EM residency conference).
How is the interview day?
Typically, there is a morning and an afternoon group. The morning group will have a lecture, followed by a tour and interviews. The afternoon group will have a similar agenda but have allotted time for lunch as well. The morning group may stay for lunch with the residents as well or may leave after there last interview. Interviews are generally brief about 15-20 minutes, and sometimes consist of three separate interviews: directors, faculty, and residents.
Do the residents hang out outside of residency?
Yes. All classes are generally very happy and socialize outside of work. Please speak to the students that have rotated through or ask the residents for more details.
What rotations are NOT available ?
Fortunately, almost all of your rotations will take place at St. Joseph’s. We have a great deal of pathology at our hospital and do not need to rotate out for many services. We go to the NYC Poison Center for toxicology (one month), and we work at St. Joseph’s Wayne (2 months). Wayne is our local community hospital that provides us with a community emergency department experience during our third and fourth year.
Do you have separate months of Pediatric ED?
Yes. We have separate months of pediatric ER. In addition, during our adult ER blocks we also rotate through the pediatric ER at least once.
What sources do residents use to learn from?
We have a wide range of sources. Aside from learning from our experienced attendings, many of the residents are up to date with evidence based medicine. We listen to podcasts, read websites, read journals, and send emails to each other with interesting cases or concepts so that we may all learn together. In addition, about once a month, we have a journal club where attendings and residents meet to discuss a new article related to emergency medicine.
What is the patient population like?
We have one of the busiest emergency departments you will rotate at (3rd busiest ED in the country), and with that comes a very diverse and underserved patient population. Our patients have very unique pathology and each day residents are presented with diagnostic challenges and critical patients.