Curriculum Overview

The post-graduate program will focus on a specific clinical module topic each month, in addition to focusing on a specific procedure each month. Each day the residents will present a clinical case presentation with a case-based education seminar that will last approximately one hour, and during clinical shifts the residents will round on patients in the emergency department with faculty. Each week there will be at least 9 hours of educational seminars, focusing on the month’s modular topic and core literature in Emergency Medicine. This will include didactic presentations, journal club article reviews, simulation exercises, guest speakers from senior consultants and online educational materials. In addition to the overall curriculum structure, each resident will receive a monthly set of clinical and educational assignments and responsibilities.

The primary textbook will be Emergency Medicine: A Comprehensive Study Guide 8th edition edited by Judith E. Tintinalli. In addition, Rosen’s Emergency Medicine: Concepts and Clinical Practice will serve as a supporting textbook, and Clinical Procedures in Emergency Medicine by James R. Roberts and Jerris Hedges will be used to teach necessary procedures in the emergency department. Each module will end with a post-test to measure the residents’ level of comprehension and mastery of the materials during the module session. The Society for Academic Emergency Medicine (SAEM) and the Council of Emergency Medicine Residency Directors (CORD) have developed a “Model Curriculum for Emergency Medicine” which serves as a basis for the post-graduate program’s curricular structure. The curriculum will be implemented on a rolling 36 month basis in coordination with other MEM programs in India to allow for streamlining and coordination.

The following table describes the curriculum details for the 36-month post-graduate program:

Table 1. Curriculum for Post Graduate Program in Emergency Medicine
3 year Didactic Schedule

Educational Program

The residents will receive instruction from a combination of faculty from RRIEM or their designees (academic faculty from other US or UK institutions, senior faculty from long established MEM programs in India) and the host medical institution. These educational experiences will include one-hour morning seminars with an emphasis on case-based teachings that will focus clinical management issues. The residents will be given or themselves present a clinical scenario, and then the instructor will lead the residents through a discussion that includes: developing a differential diagnosis, ordering appropriate laboratory and radiology diagnostic tests, finding the diagnosis, and managing and treating the clinical problem.  It is suggested that this occurs in ‘oral board style’ exam format. Instructors will then provide clinical teaching through bedside clinical rounds with specific patients.

Each week, the program will dedicate a total of at least 9 hours for educational conference. At least two weekly synchronous virtual sessions will be provided by RRIEM faculty, developed as case-based, evidence based, high yield learning sessions. These sessions will augment educational sessions provided by local faculty which will include additional didactic lectures, case conferences, journal article discussions, and guest lecturers. During these conferences, whether in person or virtual, the residents will be excused from clinical responsibilities, and will have protected time for their educational development. Fundamental components of the education program include:

• Lectures on the modular topic of the month
• Evidence-based medicine
• Journal article discussions
• Grand rounds and guest speakers
• Morbidity and mortality (M&M) conferences
• Follow up case discussions on patients admitted through the emergency department
• Procedures and skills seminars
• Presentations by the residents
• Multidisciplinary case discussions

The content of the weekly seminars will also focus on the modular topic for the particular month.  Residents will be expected to prepare presentations for their colleagues on both the modular topics and related journal clubs. These presentations will improve the residents speaking and presentation skills. The Emergency Medicine faculty will also invite experts from other fields such as cardiology, surgery, critical care, OB-GYN and pediatrics to give guest lectures on important topics that are related to emergency medicine. Residents will be expected to read assigned chapters in their textbooks and to read relevant journal articles.

RREIM will provide a faculty member onsite at host medical center each quarter during the three-year program for intensive academic instruction and for project oversight.  RRIEM faculty will also provide synchronous educational sessions as described above, in addition to eight to nine hours of remote educational web-based resources monthly such as evidence based medicine articles, lecture presentations including video grand rounds, specific online resources and journal clubs.

Thesis Requirement

In addition to clinical and class room responsibilities, residents will be required to initiate and conduct a research project or comprehensive topic review pertinent to emergency medicine, and they will be encouraged to write a scholarly article that is worthy of publication. The residents will be expected to work on a research project with the faculty, and they will be encouraged to submit one abstract or oral presentation at a medical conference. The residents should also each submit one paper to a journal for potential publication. Finally, successful graduation for each resident will require the completion of a thesis paper that may be based on the resident’s research presentations or published articles.

George Washington University Observership

During the third year of training, residents selected by host medical center and RRIEM will have the option of spending 4 weeks at George Washington University Hospital doing an observership with the faculty in Washington, D.C. as an elective.  These residents will be responsible for their airfare, housing, and meals during the elective.

Clinical Rotations

The residents will rotate through both the emergency department and other important clinical services. The residents will spend 7/12 months each year in the Emergency Department and of the remainders of the time rotating through other services. The rotations in the other departments will provide the residents with opportunities to develop important knowledge and skills in core subjects. Expected rotations will be as follows:

PGPEM Year I:

• Emergency Department (7 months)
• Research/Ortho procedures & wound care(2wk/2wk)
• Pediatric Ward (1 month)
• ICU (1 month)
• CCU (1 month)
• Anesthesia (1 month)

PGPEM Year II:

• Emergency Department (7 months)
• Research/elective (2wks/2wks)
• ICU (1 month)
• OB/Gyn (1 month)
• Trauma (1 month)
• Peds ED (if available)/PICU(1 month)

PGPEM Year III:

• Emergency Department (7 months)
• Research/elective (2wk/2wk)
• ICU (1 month)
• PICU/NICU (2 wk/2wk month)
• Trauma (1 month)
• USA (1 month)/ or elective

Evaluation and Assessment

Residents will be evaluated according to expectations of graduated experience, knowledge, and responsibilities as they progress in the 36-month curriculum.  All residents are expected to abide by the highest standards of professionalism and abide by hospital rules. Residents will be evaluated regularly by faculty members, and also expected to participate in regular self-evaluations. While completing ED based rotations, residents will be expected to complete self-evaluations at least weekly which will then be sent to an attending supervisor for evaluation focused on competency based milestones.  Faculty members will be expected to meet to review all program residents bi-annually, after which residents will be scheduled to review their evaluations, procedure logs, tests, and overall progress with the program director. Residents will be given feedback on performance in the program, pointers on how to improve their performance, and an opportunity to discuss program-related issues with the program director. This will also be an opportunity to review procedure logs and research projects.

Examinations

The residents will be routinely evaluated to assess their continuous learning and incorporation of the emergency medicine knowledge and skills. The residents will take monthly post-tests using a formative assessment tool of online questions to gauge learning and identify areas needed for increased levels of study. Quarterly exams will be given as summative assessment and preparation for end of year testing, and a minimum level of performance will be required in order to sit for the end of year exam and ultimately complete the program. In addition the faculty will conduct yearly written and oral exam that covers the core topics of Emergency Medicine.

Final Exams

A comprehensive final exam including both a written and an oral component will be given at the end of the residency program, with minimum requirements for certificate distribution. The final exam will include both a comprehensive written (on-line) exam and a two-day oral/practical exam. The written exam may be taken at the home institution. The oral/practical exams will be conducted virtually online in a proctored setting at the home institution. The exam will be administered by international faculty from GW as well as senior academic EM faculty from India. The oral practical exam will include various testing modalities such as simulation, case scenarios, and OSCE stations. Practical exams will be designed to test knowledge, teamwork, communication skills, and clinical decision making.