Resident Handbook - UC Davis Health System

The goal of this rotation is to develop the skill in the assessment and management of acutemedical and surgical disease entities in the emergency department setting. This rotation willallow the resident to better see things from the perspective of an ED physician, which is differentfrom continuity of care outpatient medicine. In the ED, all patients are evaluated rapidly yetthoroughly and in some cases may be seen as having the worst possible diagnosis until thatdiagnosis is “ruled-out”. In many cases, patients who do not have a clear diagnosis must beadmitted for further evaluation.By the end of the rotation, residents will be able to triage many patients within a few minutesregarding the need for admission. Residents will be encouraged to evaluate and manage anincreasing number of acute medical and surgical patients simultaneously. The goal for a firstyear resident is 1 to 2 patients at a time, then 2 to 3 as a second year, and 3 to 4 as a third year.(See also Residency Goals and Competencies)B. Service DescriptionAs required by the ACGME, residents receive over 200 hours emergency medicine training. Therotation is broken up into two separate two-week rotations in the intern year and for up to 4weeks in the third year. The ED physicians are all partners with California EmergencyPhysicians America (CEP) and work at both Mercy Medical Center Redding and St. Elizabeth’sin Red Bluff. The hospitals are considerably different and provide varied opportunities forlearning. St. Elizabeth is a small community hospital that has a significant migrant workerpopulation and limited subspecialty resources, while Mercy is a Level II trauma center withmany subspecialties that draw people from the entire north state.1. The amount of time residents will be scheduled in the ED will vary by resident year, due todifferences in call and continuity clinic time. R1s will be scheduled for a minimum of 36 hrs/wk(72 hrs over the two week rotation). R2s will work a minimum of 34 hrs/wk (68 hrs over the twoweek rotation) and R3s will be scheduled a minimum of 30 hrs/wk (120 hrs over the four weekrotation). Residents will work a minimum of 24 hours at St. Elizabeth’s Hospital in RedBluff during a 4-week rotation and no less than 12 hours for a 2-week rotation.Residents will have off all post-call days. Residents will be scheduled, as much as possible inmorning clinic at MFHC and then in the afternoon shifts in the ED at Mercy since afternoon andevening times provide the best training opportunities, and this will avoid having EM traininginterrupted by noon conference or clinic. Usual shifts at Mercy for doctors are 6a-2p, 10a-6p,2p-10p, 6p-1a, and 10p-6a (the schedule has been in flux more recently, and ED attending shiftson tues, wed, thurs are 6a-4p, 12p-10p, 4p-12a, and 10p-6a). At St. Elizabeth shift times are 7a-3p, 2:30p-11p, and 10:30p-7a. There will be flexibility for scheduling shifts but for the mostpart, they should coincide with an oncoming doctors shift with a minimum of 8 consecutivehours (except 6p-1a which is 7) to maximize patient care continuity and work flow. Residentsschedules will be made by Dr. Rawlings to accommodate their clinic and call schedules, and thebest attempts will be made to schedule them on the higher acuity shifts and variety spanningearly morning until late evenings. Shifts will generally be 12 hours in length which is mostlydue to the rules on residency work hours to protect the required number of days off and time offbetween shifts. If you see any violation of these rules, please bring that to the attention of Dr.Page 40 of 153C:\Documents and Settings\dhutak\Desktop\rshb13.doc