Integral to the educational philosophy of the Harbor-UCLA Medical Center's residency in Emergency Medicine is a graduated responsibility given to residents as they advance through the program . As residents gain experience and knowledge they expand their role in the emergency department. In addition to providing patient care, supervising medical students, interns, and other junior residents is essential to the training of emergency medicine residents. An important role of the senior resident is to run "rounds" held twice daily in the emergency department facilitating both continuity of care and resident education.

Ultrasound Program

The Department of Emergency Medicine is committed to training Emergency Medicine residents in the most up-to-date technology available for the care of emergency patients. An example of this commitment is the institution in 1999 of a comprehensive program in Emergency Ultrasound, which includes instruction in trauma ultrasound, abdominal ultrasound, cardiac ultrasound and pelvic ultrasound. There is also an optional elective in Emergency Ultrasound. A one year fellowship in Emergency Ultrasound is available to program graduates.

We have two state-of-the-art ultrasound machines which are dedicated solely to the Emergency Department and have both doppler and endovaginal capability. The Department of Emergency Medicine looks to establish a leadership role in training and development of this important and exciting new emergency tool. Mike Peterson, MD, an emergency physician with 12 years experience in performing emergency ultrasounds and the developer of the Emergency Ultrasound Training Program at Texas Tech University in El Paso, Texas, is the Director of the Emergency Ultrasound program at Harbor-UCLA Medical Center.

Residents start their exposure to emergency ultrasound on their first rotation in the Emergency Department in the PGY1 year by doing ultrasounds with faculty and more senior residents. Cases can be submitted from day one of residency toward eventual certification under the American College of Emergency Physician's Ultrasound Training Guidelines. In the beginning of the PGY2 year a whole day is dedicated to learning emergency ultrasound and includes a scanning laboratory. Emergency Medicine residents and General Surgery residents together learn theory and practice of ultrasound from Dr. Peterson, the Ultrasound Fellow, and ultrasound technicians during this day long course.

In the PGY3 year there is an optional Emergency Ultrasound elective lasting from 1 to 4 weeks. The elective is taken by the majority of the senior class. This elective focuses on concentrated ultrasound scanning of the high acuity population in the Harbor ED in order to complete ACEP training criteria. In addition, elective participants have the option to acquire advanced skills in emergency ultrasound including evaluation for soft tissue fluid collections, deep venous thrombosis, and procedural applications such as line placement, lumbar puncture assistance, and thoracentesis/paracentesis/abscess drainage. New equipment recently acquired will allow the program to expand in the near future into foreign body localization, deeper venous access, joint effusion and musculoskeletal diagnosis, as well as ocular ultrasound.

The Department of Emergency Medicine at Harbor-UCLA Medical Center relies heavily on emergency physician performed ultrasound to provide timely care. Patients are frequently managed on the basis of ED ultrasounds alone. Since its inception, the program has documented a 97% percent accuracy rate, which rivals that of imaging specialists. The department produced 2400 training (practice) examinations and 900 patient care exams during the last academic year alone. Nearly 100% of the resident class of 2006 graduated with multiple certifications in emergency ultrasound.

Conferences

Teaching rounds are held twice daily in the adult and pediatric areas of the emergency department. In addition to these teaching rounds, didactic conferences are held two days a week. The conference schedule is listed below.

Thursday

8:00 am Procedure Conference - Junior and senior residents teach hands-on techniques pertinent to emergency medicine.

8:30 am Core Conference - Core conferences cover a series of basic topics fundamental to practicing emergency medicine. This conference is taught by faculty members (75% of conferences) and senior residents (25% of conferences).

9:30 am Follow-up Conference - Supervised by faculty and taught by junior and senior residents, this conference focuses on the presentation, diagnosis, management and follow-up of interesting and instructive cases seen in the ED.

Friday

8:00 am Grand Rounds - This conference, taught by Harbor-UCLA Emergency Medicine faculty members and visiting professors, emphasizes the current state of the art on topics important to emergency medicine.

9:00 am Morbidity and Mortality Conference - Morbidity and Mortality cases are discussed by faculty members with resident input. Teaching points which can improve future patient care are emphasized. Joint conferences with the departments of surgery and pediatrics are conducted several times yearly to discuss cases pertinent to each specialty.

10:00 am Journal Club / Practice Management Conference / Pre-hospital Tape Review - Journal Club is held monthly. Three or four articles from the current literature are discussed in depth by residents and faculty members. Practice Management conferences are also held monthly. These conferences expose residents to topics such as contract negotiation, malpractice insurance, financial planning, medicolegal issues and extracurricular involvement opportunities in emergency medicine. Once a month, Pre-hospital Tape Review Conference is held to review audio tapes of pre-hospital paramedic runs that are felt to be particularly educational.

Additional Educational Experiences

In addition to the scheduled conferences, residents are given oral patient management case scenarios twice yearly and a written departmental exam three times each year. All residents take the American Board of Emergency Medicine inservice exam each year as well.

Two to three times a month the faculty teach intern conferences. These weekly conferences are case-based and are geared to the needs of the interns in the Department of Emergency Medicine.

A resident-faculty meeting is held three to four times yearly to discuss and evaluate the program. Throughout the year residents evaluate their rotations, and these evaluations are used to improve the program on a continuing basis.

Research

Under the guidance of Research Director Roger Lewis, M.D., Ph.D., many clinical studies are ongoing in the department. Residents who wish to become involved may participate in current research projects in the department. Residents may also work with faculty members on case reports, review articles, literature updates and textbook chapters.

Emergency Medical Services

Residents are involved with paramedics and EMS personnel on a daily basis in the emergency department. The emergency department is a Paramedic Base Station which receives approximately 4700 telemetry calls annually. Residents are trained to receive base station calls and are involved in the clinical teaching of paramedics. Residents do a rotation in EMS during their second year. Many residents also participate in an elective rotation with the County Air Squad Helicopter Rescue or with the Coast Guard. During their rotations, residents ride with paramedics, tour the dispatch center, participate in tape reviews and review EMS guidelines. Residents may obtain more in-depth exposure to pre-hospital care with Marianne Gauche-Hill, M.D., the Pre-hospital Care Director.

Disaster Management

The mission of the South Bay Disaster Resource Center (DRC) at Harbor-UCLA Medical Center is to prepare both Harbor and nine neighboring hospitals to deliver effective and coordinated medical care to victims of terrorism and other multi-casualty incidents and public-health emergencies. The South Bay DRC is an extension of Harbor's Emergency Management Plan, and is funded with federal grant monies from the National Hospital Bioterrorism Preparedness Program. This federal program recognizes that hospitals 1) are on the frontline for terrorist incidents and other multi-casualty disasters, 2) will be the first responders in a bioterrorism incident, and 3) must, therefore, coordinate emergency-management preparation and planning with their neighboring hospitals, and develop their “surge capacity”. The South Bay DRC is one of 11 multi-community DRC catchment areas established in Los Angeles County. Residents obtain in-depth exposure to disaster preparedness and management through lecture and frequent hands-on disaster management drills under the supervision of Amy Kaji, MD, MPH, the Director of the Disaster Resource Center.

ACEP / SAEM Scientific Meetings

The faculty supports the educational and academic endeavors of the residents by sending senior residents to the meeting of their choice, either the ACEP Scientific Assembly or the Society for Academic Emergency Medicine Annual Meeting. In addition, the department will also defray most of the costs of attending a second scientific meeting when a resident has a paper accepted for presentation.