Rotations

Clinical rotations outside the Emergency Department account for 25 percent of the residency. Required rotations are: anesthesiology, obstetrics and gynecology, orthopedics/hand surgery, medical intensive care unit, neonatal intensive care unit, and cardiac care unit. There are three required off-site rotations: the New York City Poison Center, Pediatric EM at The Mount Sinai Hospital, and Trauma. During the anesthesia rotation, residents spend the afternoons in the ENT or ophthalmology clinics.

In addition to the required rotations, the residency offers two electives, one that is designated to be for trauma surgery. Residents typically spend a month at either the Rider Trauma Center in Miami or in the R. Adams Cowley Shock Trauma Center in Baltimore. Many residents use the latter rotation as an opportunity to pursue their interests in international medicine by going abroad to places as varied as Nepal, Iran, Puerto Rico, India, and Africa.

We have developed and enhanced our critical care experience with an ED Critical Care rotation during the PGY-2 and PGY-3 years. On this rotation, ED residents act as the ICU consult resident for ED patients evaluating the patient and presenting the case directly to the ICU attending and fellow. As patients wait for transition to the ICU, the ED Critical Care resident guides the management of these patients providing relevant critical care experience in the first hours of the patient's course of treatment.

Resident Teams

Another great part of our EDs is our unique team-based structure, which allows us to see patients quickly and effectively. The resident teams change as you progress through your training:

Interns either work on the Red Team, which is run by the R3, or on the Blue Team, which is a 1-on-1 team with an attending.
Second Years work only on the Green Team, which is a 1-on-1 team with an attending.
Third Years work almost exclusively on the Red Team, running an entire team and supervising and teaching the intern.
In the coming academic year, patients will begin rotating through our Evaluation Unit (a combination of Fast Track and lower acuity patients).

Nurses are also assigned to a team, so that the physician and nurse always know who they are working with throughout a shift and there's no difficulty finding "which nurse is caring for patient X." Team workstations are also all physically located near each other, so it's easy to relay information about a patient to the nurse or other physician on the team.

First Year Rotation

Here is the rotation for PGY-1:

Rotation	Blocks (4 weeks)	Description
Orientation	1/2	The first two weeks of internship are designed to help the new residents integrate into the program and get acquainted with their colleagues. A series of lectures are given on core EM topics, as well as small-group teaching and training sessions. This is also when the ATLS course takes place. A part of this block is spent discovering the New York City night life.
Adult ED	5	Residents work ED shifts at both hospitals and therefore benefit from exposure to two very different populations. While the majority of first year shifts are spent at Mount Sinai St. Luke's, residents spend an equal amount of time at both sites during their second and third year.
Pediatric ED	2	The dedicated pediatric ED averages 40,000 visits a year and is located at Mount Sinai St. Luke's. It is staffed by pediatric emergency medicine board certified attendings. Residents will spend two blocks in the Pediatric ED during their first year and one block in their second year. During the third year of residency residents are assigned to at least one Pediatric ED shift per block throughout the year.
EMS	Throughout Adult and Peds Blocks	One shift of every Adult and Pediatric ED block during the first year is dedicated to EMS ride-alongs. The residents are assigned to an ambulance crew that responds to the 911 system, and spend the day observing and assisting with patient management in the field. This is a great opportunity to become acquainted with the EMS personnel as well as to get a better understanding of how the NYC prehospital system functions.
MICU	1	The Medical Intensive Care Unit is located at Mount Sinai St. Luke's. Residents spend one block of their first year on this busy service and have ample opportunity to perform invasive procedures such as central lines, thoracentesis, paracentesis, and more. They also benefit from bedside teaching on ventilator and pressor management, as well as the general care of critically ill patients.
CCU	1	The Coronary Care Unit is again located at Mount Sinai St. Luke's. This service receives all STEMI patients presenting at both sites. Residents spend one block on this service and learn about the management of acute coronary syndromes dysrhythmias, and heart failure. The cardiology fellows dedicate two hours of every week day to teaching residents about ECG interpretation.
Ob/Gyn	1/2	The labor and delivery service at Mount Sinai West is the busiest in the city and allows residents to become comfortable in assessing women presenting in labor and performing vaginal deliveries. Residents are also welcome to scrub in for cesarean sections and to assist the GYN residents in their ED consults.
Anesthesia/ENT/Ophtho	1/2	The two weeks on anesthesia are spent entirely in the operating room. Residents learn and practice the essential principles of airway management, such as proper bag-valve-mask ventilation technique, endotracheal intubation, and the use of alternative airways such as the LMA. Residents spend the afternoon in the ENT and ophtho clinics learning important skills such as fiberoptic nasopharyngoscopy and slit lamp examination.
Orthopedics	1/2	This rotation is split between the first and second year, two weeks during each year. Residents are paired up with a senior orthopedic resident and respond to all orthopedic consults from the Mount Sinai West ED. The ED residents have no responsibility for floor patients or the OR. This is a great opportunity to learn and practice reduction maneuvers.
Toxicology	1/2	This is another rotation that is split between the first and second year. Residents spend this block at the New York City Poison Control Center. Mornings are spent following up on cases the NYCPCC was consulted on. Daily lectures are given by our faculty. The residents are also on Tox call and respond to all hospital consults under the supervision of our very Toxicologists. During these two weeks, residents complete an online tox curriculum as part of the formal education process.
Ultrasound	1/4	One week of the first and second years of residency are dedicated to Emergency Ultrasonography. Daily scanning shifts are scheduled with the Ultrasound Division directors and fellows. Emphasis is put on core ultrasound applications during the first year and more advanced applications during the second year or residency.
Vacation	1	Split into two 2-week blocks.

Second Year Rotation

Here is the rotation for PGY-2:

Rotation	Blocks (4 weeks)	Description
Adult ED	7 3/4	During the second year, residents work directly with an attending physician one-on-one as a team with nurses and techs. This provides a significant amount of direct learning from attending physicians.
Pediatric ED	1	See above.
Pediatric ED at Mount Sinai Hospital	1/2	Residents spend two weeks in the Mount Sinai Hospital Pediatric ED. This institution provides a significant amount of complicated, tertiary care to sick pediatric patients. As a result, residents see a large complexity of patients with more exposure to sick children.
Orthopedics	1/2	This is the second portion of the orthopedics rotation with similar responsibilities as the first year.
Trauma	1	We augment our trauma experience with a dedicated month on the trauma service at the R Adams Cowley Shock Trauma Center associated with the University of Maryland Medical Center in Baltimore. This is a large referral center with a helipad, high trauma acuity, and high procedure volume.
Toxicology	1/2	This is the second portion of the toxicology rotation. The daily structure is similar to the first year with on call tox responsibilities again. At the completion of this rotation during the second year, residents will prepare a morning report on a topic assigned by the toxicology faculty.
Ultrasound	1/4	See above.
ED-Critical Care	1	This is a unique rotation where the ED resident functions as the ICU resident consult for patients being considered for ICU admission. After evaluation, the ED resident presents the case directly to the ICU attendings. He or she is then involved with the management of the patient in their time before moving upstairs to the ICU. This allows additional skills in acute critical care management and skills as well as one-on-one learning with ICU attending physicians. This is a high yield, high procedure month focusing on the early critical care management of ED patients.
Neonatal ICU	1/2	Residents will rotate through the NICU at Mount Sinai West for two weeks. This will expose residents to the critical care management of neonates as well as pediatric procedures. Residents will be part of the team to respond to deliveries and take part in neonatal resuscitations.
Vacation		Split into two 2-week blocks.

Third Year Rotation

Here is the rotation for PGY-3:

Rotation	Blocks (4 weeks)	Description
Adult ED	9 1/2	During this year, the resident is responsible for running the Red Team. He or she is supervising an intern, running a team of nurses and techs and ultimately responsible for the flow of the team. The third year resident is also responsible for running every trauma and medical resuscitation in the department.
Pediatric ED	1	Third year residents are assigned approximately 1 out of every 4 shifts in the pediatric ED. This allows them to see pediatric patients throughout the year.
Research/Admin	1/2	Two weeks of a rotation to have time to finalize scholarly activity as well as to take part in departmental administrative activities. This is also an opportunity to become involved with the QI process in a more formal way.
ED-Critical Care	1	See above for complete details of this rotation. This is an additional two week experience in the third year allowing for more decision-making and responsibility in the management of critical care patients in the ED.
Elective	1	Opportunity for elective at Mount Sinai St. Luke’s, Mount Sinai West, away institution, or internationally.
Vacation	1	Split into two 2-week blocks.