Doctors are accustomed to doing
assessments and tests to diagnose patients, but in UC's emergency
medicine residency training program, it's the physicians who are being
The program, the oldest in the United
States, celebrates its 35th anniversary this year--plus a lot of
progress in the way emergency residents treat patients.
"In the past, residents weren't
necessarily actively taught how to do procedures," says Andra
Blomkalns, MD, program director and assistant professor of emergency
medicine. "They learned by simply doing them on real patients. At UC we
really focus on orientation, formal instruction and competency.
"During my residency," says Dr.
Blomkalns, "I wasn't formally trained how to put a line in someone's
chest. I learned by watching one done, and then just did it.
"Today, as part of our overall training
and patient-care quality initiative, our attending physicians watch and
grade residents the first several times they perform a procedure before
they're permitted to do it by themselves. The reason for this is
simple--we're committed to patient safety."
This initiative, called the Committee on
Procedural Quality and Evidence-Based Medicine, is headed by emergency
medicine faculty members Alexander Trott, MD, and Stewart Wright, MD.
To increase the quality of patient care
and residents' ability to learn, most programs now restrict duty hours.
Residents are not allowed to work more than 80 hours a week or more
than 30 hours in a row, and are off one in every seven days. At one
time there were no restrictions on hours.
An aspect of UC's program that's
different from most is the orientation that participants undergo a
month prior to officially beginning their residency.
Orientation includes dealing with patient
emergencies, interviewing and handling displeased or violent patients,
as well as an overview of commonly prescribed medications and common
"People are concerned about medical
errors, so we also ensure that recent medical school graduates are not
plopped into an environment where they make life-or-death decisions on
their first day, without having been taught any practical skills for
doing that," explains Dr. Blomkalns.
"The patients we're treating have greatly
changed as well," she says. "We're seeing more patients and sicker
patients, because they're coming to the emergency department for
treatment instead of going to their primary-care physician's office."
In response to the changing patient mix,
UC's emergency medicine physicians are developing new skill sets, such
as the use of ultrasound. Previously patients were sent to radiology
for imaging, which can take longer and isn't generally available in the
middle of the night.
"Emergency medicine physicians are like
chameleons--we change to adapt to the needs of the patient, and that's
not always easy," says Dr. Blomkalns. "We're being more selective in
"People who used to be admitted to the
hospital for days, such as those with pneumonia or other infections,
are now being taken care of in our department in 23 hours. We're
rapidly moving them through their workup and treatment, which takes
some of the inpatient burden away from providers and saves inpatient