Real World Exposure.
During their clinical rotation, residents will be able to focus on particular care fields. Each focus area allows residents to prepare for real world situations through exposure.
Available Focus Areas.
Our primary ED training sites allow exposure to the full spectrum of healthcare, including broad cultural and socioeconomic diversity, as well as tremendous diversity in pathology:
- MedStar Washington Hospital Center
- MedStar Georgetown University Hospital
MedStar Washington Hospital Center (MWHC) is primarily an adult ED. Children’s National Medical Center sits immediately adjacent to MWHC on a shared medical campus (see Pediatric EM below). MedStar Georgetown University Hospital (MGUH) treats both adult and pediatric patients in a single department. The ED experiences at MWHC and MGUH are complementary to one another in many ways.
Our affiliate ED training sites for focused pediatric ED exposure include:
- Children’s National Medical Center Pediatric ED
- Shady Grove Adventist Hospital Pediatric ED
- INOVA Fairfax Hospital Pediatric ED
Residents work a proportion of shifts in the peds ED at CNMC during all MWHC ED months during the PGY-1 and PGY-2 training years, allowing for seasonal variation and continuity of pediatric exposure throughout training.
Additional focused pediatric ED rotations occur at Shady Grove Adventist Hospital and INOVA Fairfax Hospital. Shady Grove is a busy community ED in suburban Maryland, and INOVA Fairfax is a high volume community-tertiary referral center just across the Potomac River in northern Virginia. Both sites provide broad-based pediatric exposure by fellowship trained and pediatric emergency medicine (PEM) subspecialty boarded faculty.
The Georgetown Hospital ED treats both pediatric and adult patients in a single department, allowing for exposure to pediatric care in the fabric of each and every shift. Level 1 pediatric trauma experience occurs at both CNMC and INOVA Fairfax. The PGY-2 pediatric ICU (PICU) rotation at INOVA Fairfax rounds out the pediatric experience by providing experience in managing the sickest kids, whether resulting from medical illness or traumatic injury.
Comprehensive experience in critical care medicine is both a primary focus and strength of our curriculum. We have several EM-critical care faculty members, and MWHC hosts an IM-based critical care fellowship open to EM graduates.
The focus of the intern year is in core critical care procedures, such as central venous access and thoracotomy tube (chest tube) placement, among others. Interns gain exposure to critical care through the following rotations:
- Medical Intensive Care (MICU) at MWHC
- MedSTAR Trauma Service at MWHC
During the second year, residents assume an expanded role in critical care decision-making. This includes working as the primary provider in managing critically ill patients in the units, serving as the code team in the hospital, and evaluating critical care consultations from the ED or the floors. Critical care rotations in the PGY-2 year include:
- Medical Intensive Care (MICU) at MGUH
- Surgical Intensive Care (SICU) at MWHC
- Pediatric Intensive Care (PICU) at INOVA Fairfax
- Trauma Service at the R Adams Cowley Shock Trauma Center in Baltimore
In addition, the proportion of critically ill patients presenting to the ED provides an outstanding ED-based exposure to critical illness. This is particularly true at MWHC, where every day a significant portion of ED patients require critical interventions, including advanced airway management, invasive procedures, and major resuscitations.
We also offer a popular “Resuscitation” elective, where EM residents assist the primary ED teams with resuscitation. This includes assisting with invasive procedures, ventilation management, antibiotic selection, vasoactive selection and titration, and transfer of critically ill patients from the ED to the ICU. Residents begin each day by rounding along with the ICU teams to follow-up on patients who presented through the ED the day prior.
Experience in managing significant traumatic injuries occurs throughout the curriculum. New interns are certified in Advanced Trauma Life Support (ATLS) during the intern orientation program (July of intern year). Progressive responsibilities in directing major resuscitations and invasive procedures occurs throughout the course of training:
- MedSTAR Trauma Service – PGY-1
- Trauma at the R Adams Cowley Shock Trauma Center in Baltimore – PGY-2
- Senior Resuscitation Leader at MedSTAR – PGY-3
Junior residents work as an integral member of the trauma teams at MedSTAR and Shock Trauma during the PGY-1 and PGY-2 years, respectively. Senior residents work solely in the resuscitation bays during the highest volume periods of the week in the roles of resuscitation leader or procedure leader, alternating with the senior surgical resident with each successive trauma activation. The trauma curriculum allows for a well-diversified and broad-based trauma experience, including exposure to blunt and penetrating injury patterns resulting from a wide variety of mechanisms. In addition, pediatric ED rotations at CNMC and INOVA Fairfax, both Level 1 pediatric trauma centers, rounds-out the trauma experience.