Academic Department, IU Department of Emergency Medicine

ur residency is based in two high volume, high acuity Emergency Departments that manage patients with every type of medical condition. The combined ED census of over 200,000 patients has a wide socioeconomic variety, with opportunities to care for celebrities and homeless patients alike. All patients are under the administrative control of EM physicians. Almost all patients are directly staffed with our faculty rather than with an upper level EM resident. We believe that you maximize learning opportunities by interacting with an experienced faculty member rather than a more senior level EM resident who may only have experienced 6 more EM rotations. During a "typical" shift at the Methodist ED you will manage a pediatric patient with a fever, repair a laceration or relocate a dislocated joint, evaluate a pregnant patient with vaginal bleeding, care for a victim of domestic violence, evaluate a middle age homeless man with chest pain and care for an elderly nursing home patient presenting after a fall. At the Wishard facility you will care for a victim with multiple gunshot wounds, a young man with a respiratory arrest associated with IV drug abuse, an elderly woman with pneumonia, a child with a burn and an incarcerated patient with blunt trauma from a baseball bat. Thus you are challenged with the entire breadth of our specialty on EVERY shift rather than having exposure in isolated blocks of time (e.g. a Pediatric ED experience once or twice a year, after which you do not care for children any other time). Your clinical skills are less likely to atrophy in such a setting.

Another unique aspect of our residency is the wide exposure to a variety of "provider / consultants". At the Wishard site the more traditional housestaff hierarchy serves as the initial resources for admissions and consultations. At the Methodist facility, one third of the admissions are handled by the traditional housestaff teams, while two-thirds of consultations and admissions occur directly with the patient's attending physician. Because the residents must communicate with a variety of providers (HMO, PPO, hospitalists, private solo practice, group practice, public clinics and housestaff teams), they develop a critical skill set required to interact with "real world" attending physicians. This interaction promotes an understanding of the "nuances" of community practice as well as providing an educational opportunity at the subspeciality attending level.

Both facilities use advanced computer technology, including a completely computerized triage and tracking system, immediate access to discharge, operative and consultation reports, laboratory data and ED records (directly entered through our dictations), and digitized radiology. At both facilities we staff our "Fast Track" area with faculty and Nurse Practitioners as we believe resident involvement in such areas provides limited educational dividends. We also operate a 13 bed Intensive Diagnostic and Treatment Unit under the operative control of the Methodist ED. Here we manage adult and pediatric patients for up to 23 hours. Examples of conditions that may be managed here include chest pain (dobutamine stress echocardiograms), poisonings and intoxications, asthma/COPD, minor head trauma, dehydration, and selected abdominal pain. Both facilities offer comprehensive care for victims of sexual assault through our "Center of Hope" network.

Our LifeLine program is staffed 24 hours a day with our R2 and R3 residents acting as medical control officers (not as a one month guest joining an established flight crew). This allows our R2 and R3 residents to experience conditions similar to a single coverage community ED in that they must resuscitate and provide care for the most critically ill and injured patients with only a flight nurse to assist them. In such a role they must learn to simultaneously manage and direct care without the immediate assistance of other physicians. Supervised flight opportunities are incorporated into the R1 year.

Our Toxicology experience is truly exceptional. We house the Indiana Poison Center, the only one in the entire state and one of the overall busiest in the nation. Our 4 board certified medical Toxicologists supervise the Medical Toxicology Fellowship as well as both an inpatient and outpatient service with primary (not simply consulting) patient care responsibilities. Inpatient adult and pediatric cases are managed primarily by the Toxicology service.

In the area of Mass Gathering Medicine, we have a wide variety of opportunities including planning and providing care at the Indianapolis Motor Speedway (Indianapolis 500 , Brickyard 400 and North America Formula One races), the Indianapolis Mini-Marathon, the RCA Tennis Championships, events in the RCA Dome and Murat Theater, several PGA/WPGA tournaments, the National Rowing championships, and numerous NCAA events. Clarian was the medical sponsor for the World Police and Fire Games (9,000 athletes from over 40 nations) as well.

Outside of the ED, many of our off-service rotations are directly under the supervision of a faculty member rather than a traditional tiered housestaff team. In such a system, increased levels of responsibility and access to procedures is possible, even at R1 levels of responsibility. Ongoing pediatric experience occurs in a number of these rotations such as Orthopedics, Neurosurgery, and trauma surgery. Pediatrics is a major focus of our residency. Since 1991 we have sponsored the oldest combined EM-Pediatrics combined residency in the nation. Five of our faculty are double boarded in EM and Pediatrics. Our didactic schedule focuses almost one third of our time on Pediatric emergency care issues.

Our track record for graduates is excellent, with a 99% pass rate on both parts of the ABEM certification examination for all classes since 1984. Our graduates have had uniform success accessing the career pathway of their choice, be it academic, fellowship, or community practice. Because our residency has been in existence since 1976, we also have a nation-wide "network" that assists our graduates in the job market. Many of the best jobs in EM are available only through word of mouth.

We believe that the most challenging job an EM physician will face is that of the busy single coverage community ED. In such a setting, the EM physician is the only physician in the hospital, and must manage all problems without the assistance of second opinions, extra hands or other physicians for at least 30-45 minutes. We prepare all of our graduates to meet this standard so that they can comfortably step into any ED in the nation and have a rewarding practice.
Finally, although the 3 years of post-graduate study in EM is challenging and busy, we have not lost sight of the need for your personal as well as professional development during this time. We believe that optimal learning occurs not in a stiff, hierarchical system, but instead in one that values collegiality and camaraderie. We view our residents as our future peers, and place emphasis on maintaining non-abusive work environments and maximizing resident input into their education process. Our resident class each year is comprised of graduates from schools in an average of nine different states. Their selection of our Midwest program was obviously not for Indiana's oceanfront or ski resorts. We believe their decision rests with the truly unsurpassed training opportunities available here.