Curriculum

The HAEMR educational mission

• Our goal is to provide outstanding clinical and academic training in EM.
• We support a diversity of academic pursuits, the development of leadership skills, and the commitment and ability to care for a diverse array of patients in a skilled and compassionate manner.
• This will be accomplished through a unique educational methods, mentorship, and devotion to professionalism and community.

The HAEMR Curriculum

Our curriculum follows a one-year modular format, starting with the Cardiovascular Module every July and running through to EMS/Administration in June the following year. The modules are centered around 3 hour sessions the combine a variety of teaching methods to cover a content area, combining patient and procedural simulation training, ultrasound training, small group workshops, evidence-based medicine exercises, content lectures, mock oral board cases, and others to create a rich and in-depth learning environment. Using this method, we are able to cover the core content of Emergency Medicine (EM) each year, ensuring that every incoming class covers the critical topics of EM (e.g. dysrhythmia recognition and management, acute coronary syndromes, airway management, and trauma resuscitation) early in the year. The didactic schedule also contains many other features such as The Children's Hospital lecture series, Grand Rounds given by national leaders in EM, New England Journal of Medicine Clinicopathologic Conferences, the HAEMR research curriculum, and visiting local expert lectures.

All residents learn and apply the entire body of knowledge they will be responsible for as an EM attending at least twice during their residency. We have drawn the core content covered in these modules from various resources including the American Board of Emergency Medicine EM Model (Ann Emerg Med. June 2008;52(2):e1-e17), the current editions of Rosen's, Tintinalli's, and Adams' essential references for the practice of Emergency Medicine, and several well-known review texts for the ABEM written certification examination.

For more information on our educational curriculum, see HAEMR Core Content and Takayesu et al. Incorporating Simulation into a Residency Curriculum. CJEM. 2010 Jul;12(4):349-53.

In addition to providing residents with an outstanding education in EM, we are also committed to providing ample time and guidance in the establishment of an academic focus to prepare residents for a future career in academic EM. We provide 5.5 months of uncommitted academic elective time during which residents may explore areas of potential academic interest at home or abroad starting in the PGY 2 year.

We also provide $1000 to each resident to attend either SAEM or ACEP during their residency training as well as coverage for residents to present their research at national EM conferences (SAEM, ACEP, AAEM) and to attend Dr. Wall's Airway Course (www.theairwaysite.com) once during their residency.

STRATUS Center for Medical Simulation

Over the past year, HAEMR has re-designed the academic curriculum to incorporate active learning methods that include seminar-based teaching, small group learning, mock oral board testing, and, most importantly, simulation-based education. Click here for more information about STRATUS.

Professional Development

Residency may seem long at first glance, but four years to become a competitive applicant in the academic and community job markets is not. There are many things to keep track of to ensure one is developing clinically and academically, while also achieving life-balance and wellness. We use a portfolio system that houses evaluations from faculty, peers, and nursing as well as resident procedure logs, academic projects, mentorship contacts, and self-reflections that support individual resident development. Every six months, we meet individually with residents for at least one hour to review their clinical and academic development. Separate meetings with the program director, Dr. Eric Nadel, are designed to focus on career development and facilitate clinical and academic mentorship throughout the institution. While our central goal is to develop outstanding clinicians, the professional development process is structured to ensure residents are achieving the clinical and academic milestones that will make them extremely competitive in the academic and community job market. During their final year of training, residents are provided with one-on-one mentorship to guide them through the job application and contract negotiation process.

Rotations

Rotations are broken down into four-week blocks. During off-service rotations, emergency medicine residents join the teams of some of the leading medical and surgical services in the United States. These rotations have been selected from among the best educational experiences available throughout the Harvard medical system. Our administrative rotation provides in-depth exposure to quality & safety, ED operations, and continuous quality improvement programs. The teaching rotation emphasizes bedside teaching in the emergency department and classroom to junior EM residents and on the development of a teaching portfolio for graduating residents.

The pre-hospital experience involves administrative training and rotations with Boston Medflight (www.bostonmedflight.org), as well as rides with the Boston Health and Hospitals' ambulances and providing medical control for paramedics. Focus is directed toward acquiring the skills needed to direct paramedics, to create pre-hospital protocols and to interact with other public services, including police departments, city councils, and accrediting agencies.

The First Year

The goals of the first year (EM-I) are to provide the resident with basic skills and a fund of knowledge to practice emergency medicine. This is achieved by combining 5 blocks of adult emergency medicine and one block of pediatric emergency medicine with rotations in obstetrics, internal medicine, medical intensive care, general surgery, otolaryngology, ophthalmology, anesthesiology, and pediatric intensive care.

The Second Year

In the second year (EM-2), the resident spends 5 blocks in the adult emergency departments of the affiliated hospitals as well as 1 block at Children's Hospital. The remainder of the year is spent on important off-service rotations, such as pre-hospital care, advanced orthopedics, trauma surgery, surgical intensive care, the cardiac step down unit and an elective block.

The Third Year

During the third year (EM-3), the resident begins to assume a supervisory role in each of the emergency departments, advising junior house-staff and senior medical students, and directing paramedics. The primary goal of the third year is to acquire the skills necessary to manage multiple critical emergencies. Pediatrics is a focus third year as well. Off-service rotations include 2 months of research elective.

The Fourth Year

The EM-4 resident functions as the supervisory emergency physician for the base institutions. Under the guidance of the emergency medicine attendings, the senior resident will direct major resuscitations and direct patient care and flow in each ED. Senior residents also will learn the skills needed to administer emergency departments, teach medical students and paramedics, and direct a research project. There are 2 one-month blocks of elective time in the senior year. The time may be used for research or added clinical activities related to emergency medicine. The fourth year also contains rotations in ED administration/risk management, teaching, ophthalmology/otolaryngology (at Massachusetts Eye & Ear Infirmary), and toxicology. Fourth year residents gain experience with systems-based practice and quality & safety by giving a Morbidity & Mortality Conference and Trauma Conference. Throughout the fourth year curriculum our graduates develop the clinical and administrative skills necessary to assume leadership roles in emergency medicine.