CLINICAL CURRICULUM
Emergency Department (ED) Shift Structure
Shifts in the Emergency Department are structured as 9-hour blocks, incorporating a 1-hour overlap to ensure comprehensive hand-offs and seamless shift transitions. During each shift, residents work directly with a single attending physician, fostering continuous supervision, mentorship, and cohesive patient management throughout the duration of the shift.
The distribution of shifts per block is tiered according to postgraduate year (PGY) to balance educational progression with workload expectations:
- PGY-1 residents: Up to 20 shifts per block
- PGY-2 residents: Up to 19 shifts per block
- PGY-3 residents: Up to 18 shifts per block
EM1 Overview
Your experience during the first year serves as the foundation for your emergency medicine career and emphasizes training in the emergency department, experience resuscitating and stabilizing critically ill or injured patients, as well as developing a deeper understanding of the care they experience after admission into the hospital. Rotations focus on building a knowledge and procedural base that will be vital to success in the EM2 and EM3 years, and beyond.
Orientation
Your entire first-year class will begin residency with one month of interactive discussions, focused chief complaint-based educational sessions, and hands-on procedural skills labs during the highly regarded orientation block. Throughout the month there will be shifts in the DRH ED, where you can apply your skills and knowledge while getting to know the staff, flow, logistics, and routine of our ED. Weekly social events ensure that you get a chance to know your co-residents and faculty outside the hospital and familiarize yourself with the city!
Emergency Medicine
Eight additional weeks in the DRH ED are built into the first year, and for most shifts, you will work with a dedicated attending and third-year resident. First year residents aren’t “shielded” from seeing high-acuity patients or patients with specific chief complaints. You will take care of the regular mix of ED patients and will begin to run resuscitations with one-on-one coaching from a faculty member toward the end of the year.
Pediatric Emergency Medicine
To develop a strong foundation in pediatric emergency medicine, you will spend eight weeks in the ED at the Children’s Hospital of Michigan (CHM) your EM1 year. For the remainder of residency, CHM shifts will be spread throughout each EM block during the year with a dedicated two week block in your third year, so you can also appreciate the seasonal trends in pediatric emergency medicine and bookend your residency with some solid pediatric exposure.
Critical Care
Two well-received critical care months anchor the off-service experience in the first year. In the Neurocritical Intensive Care Unit (NICU), you will manage patients with complex neurologic and neurosurgical emergencies, such as strokes, intracranial hemorrhage, and traumatic brain injuries. In the Medical Intensive Care Unit (MICU), you will care for a population of patients with diverse critical care needs and gain experience with ventilator management, vascular access, invasive hemodynamic monitoring, and bedside ultrasound. Both critical care rotations are structured to maximize your return on investment with transportable knowledge and skills that you can apply in the emergency department setting.
Ultrasound
Four weeks of full-time emergency department ultrasound training will lay the foundation for integration of bedside imaging into your everyday practice as an emergency physician. The rotation is entirely in the ED and is team-taught by fellowship-trained EM ultrasound faculty and US fellows.
Trauma Surgery
While on the surgical service, you will manage patients with both traumatic and non-traumatic perioperative surgical concerns. You will also develop further experience participating in trauma resuscitations in the emergency department and will have the advantage of exposure to these situations from both an emergency medicine and surgical perspective.
Anesthesia
The anesthesia block at Huron Valley Sinai Hospital is structured to provide you with intensive experience in airway management, rapid sequence intubation, difficult airways, and procedures such as fiberoptic intubation and use of intubating LMAs. In addition, you will learn more about regional anesthesia, nerve blocks, and anesthesia pharmacology from faculty anesthesiologists and will apply your knowledge to intubation, procedural sedation, and pain management in the ED.
Orthopedics
In addition to integrated hand surgery and spine surgery experience, you will rotate on the Orthopedic Trauma service at DRH and hone your skills in x-ray interpretation, wound management, fracture and dislocation reduction, immobilization, and splinting. This rotation is a night-based rotation, allowing you to avoid daily morning rounds and focus mainly on ED orthopedic consults and their subsequent management.
Obstetrics and Gynecology
During your two weeks at Hutzel Women’s Hospital, you will have plenty of opportunity to perform routine and high-risk deliveries and to manage the complications that occur during the peripartum period. You will also become facile with obstetrical ultrasound while evaluating patients who present with pregnancy-related concerns.
EMS
Interns will spend a dedicated two weeks riding along with Detroit EMS, both on advanced life support (ALS) and basic life support (BLS) units. This valuable experience highlights where your patients are coming from, the prehospital challenges encountered in caring for them, and is a chance to see the city from an entirely different perspective. Additional time is spent performing online medical control answering radio calls and on ride time in the physician response vehicle with the EMS fellow.
Elective
Everybody has unique interests in medicine, and this is your opportunity to pursue additional training in an area of your choice. Popular electives include EKGs, pharmacology, medical student teaching, advanced EMS, additional critical care time, international medicine, and clinical or basic science research. You are also free to design your own in an area of your choice!
EM2 Overview
The second year emphasizes the development of clinical skills necessary to evaluate and treat patients in the emergency department setting. You will work closely with EM faculty to effectively investigate the chief complaint, consider “can’t miss” diagnoses, and discern which diagnostic tests or studies are necessary to either identify and exclude emergency conditions. You will be the team leader in resuscitations and learn to approach patients with life, limb, or reproductive threats in an organized manner. You will learn to multitask effectively and maintain patient flow as you gain confidence in your clinical decisions and ability to disposition patients effectively and safely. All EM blocks will have shifts at DRH, CHM, and Harper University Hospital (HUH). There will be one full EM block (4 weeks) based at Huron Valley-Sinai Hospital (HVSH) in order to obtain community medicine experience, with longitudinal shifts there monthly onwards.
ED Critical Care
Quite unique to DRH is the ED Critical Care block, during which you will spend a month in the DRH ED garnering concentrated bedside experience managing critically ill ED patients. This is not an ICU-based rotation, with 100% of time spent in the ED. With built-in faculty support, you will be responsible for participating in all medical and trauma codes and function as an adjunct “floating” resident for critical patients throughout the ED focusing on their minute-to-minute management. During downtime, you will receive focused didactic training in areas such as sepsis, oxygen delivery, shock, therapeutic hypothermia, mechanical ventilation, difficult airway management, pharmacology, and pre-hospital critical care. You will also assist the intern ultrasound resident with procedural education by overseeing their procedures as well as ultrasound scans until they are competent to perform these procedures on their own.
Pediatric Intensive Care Unit
Experience caring for critically ill children is highlighted in the Pediatric Intensive Care Unit at Children’s Hospital of Michigan in their newly-renovated unit. This is one of the few and one of the busiest PICUs in the state and you will care for patients who are transferred in from across the region. Teams are composed of EM and pediatric residents, PICU fellows, Pediatric Intensivists, as well as Pediatric Cardiothoracic Surgeons. You will help manage rare pediatric conditions, congenital cardiac conditions, as well as post-cardiac or transplant surgical patients. You will receive thorough didactic education during this rotation, especially during your time spent on the cardiac team. You will learn the essentials of pediatric resuscitation and pediatric critical care, treating pediatric patients of all ages, and rarely some adults admitted for known congenital issues.
Harper Medical Intensive Care Unit
A challenging but extremely rewarding rotation, the Harper MICU has been a well-received and integral part of EM2. You will function as a senior resident, managing critically-ill patients with a variety of pathologies, including patients in the cardiovascular ICU as well as Karmanos Cancer Institute ICU. This rotation highlights a slightly different patient population than the DRH MICU experience in EM1, with added responsibility as a senior EM resident and a broader breadth of pathologies seen in a quaternary care center.
Huron Valley Sinai Hospital (HVSH) EM
Starting as a EM2, residents will complete a 4 week block at HVSH in Commerce Township, just a short drive from Detroit. A busy community hospital, HVSH provides valuable experience seeing both adult and pediatric patients, and is representative of what bread and butter emergency medicine is like. This experience will develop your communication skills in discussing cases with primary care physicians and consultants and you will gain perspective in assessing when and what types of patients need to be transferred to a higher level of care. After completing a dedicated month at HVSH, residents will be scheduled there for monthly shifts spanning the remainder of residency ensuring longitudinal community EM experience.
EM3 Overview
This year is dedicated to the complete practice of emergency medicine. During each EM block, you work shifts at DRH, CHM, Harper University Hospital, and Huron Valley-Sinai Hospital, covering the entire spectrum of emergency care. At each site, you will be exposed to a unique clinical experience, the sum of which will prepare you for virtually any academic or clinical practice for your emergency medicine career. Residents take a leadership role in the department, owning the workflow and working closely as resident teachers with rotating medical students from Wayne State University School of Medicine, Michigan State University College of Osteopathic Medicine, Central Michigan University School of Medicine, and Meharry Medical College among others.
Toxicology
As part of the Toxicology rotation, you will rotate at the Michigan Poison and Drug Information Center (MiPDC) operated by the Wayne State University School of Medicine, which is the ninth largest poison control center in the US serving 18 counties of southeastern Michigan. The PCC provides 24/7 service to the public and health care professionals with an annual call volume of approximately 70,000 calls. You will work alongside Medical Toxicologists and Toxicology Fellows answering emergent consults and reviewing cases from the area. Additionally, you will spend time seeing routine toxicology inpatient consults and medication assisted therapy addiction medicine consults in our Detroit hospitals.
Pediatric Anesthesia
During the pediatric anesthesia block, you will spend two weeks with pediatric anesthesiologists learning pediatric airway management in a controlled environment. The skills learned during this block are invaluable and easily transferable to the rest of your career as an emergency physician. By the end of the block you will have significant exposure to a variety of pediatric airways and have the skills necessary to transfer to the ED environment when needed