University of Maryland Emergency Medicine: EMIM Critical Care Option

RESIDENCY : EMIM CRITICAL CARE OPTION

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EMIM Critical Care Option

Introduction
Recent literature highlights the unfortunate reality that the supply of critical care physicians is woefully inadequate. In fact, only 10% to 20% of intensive care units across the United States are staffed by dedicated critical care physicians. It is estimated that, by increasing staffing of intensive care units with physicians trained in critical care medicine, over 50,000 lives and $5 billion dollars could be saved annually. As a result, there is growing interest in training physicians in critical care medicine.

In September of 1999, both the American Board of Emergency Medicine and the American Board of Internal Medicine approved a 6-year integrated curriculum in emergency medicine, internal medicine, and critical care medicine (EM/IM/CC). The primary goal of this integrated curriculum is to prepare physicians for practice and academic careers addressing the spectrum of illness from entry into the hospital until discharge. At the completion of training, residents are eligible for board certification in all three specialties. Currently, there are 2 approved EM/IM/CC programs in the United States, the first at Henry Ford Hospital in Detroit, Michigan and the other at Long Island Jewish Medical Center in New Hyde Park, New York.

Recently, The University of Maryland petitioned both the American Board of Emergency Medicine and the American Board of Internal Medicine for approval of an EM/IM/CC residency program. In August 2006, we were granted approval for a 6-year program in EM/IM/CC and are currently accepting residents.

The Program
The Department of Emergency Medicine, Department of Medicine, and the Division of Pulmonary/Critical Care Medicine are all academically outstanding components of The University of Maryland School of Medicine. All faculty members within each specialty hold appointments within the School of Medicine. Many are nationally recognized for their efforts in teaching and/or primary investigational research. In addition, the categorical programs in emergency medicine and internal medicine, as well as the pulmonary/critical care fellowship program, are fully accredited by their respective Residency Review Committee (RRC).

The EM/IM/CC program at our institution is a logical extension of our already popular and successful 5-year EM/IM program. Residents in both programs have nearly identical rotations, schedules, and responsibilities for the first four years of their respective programs. Please see the EM/IM section for information regarding these rotations. Beginning in PGY-5, residents in the EM/IM/CC track assume a supervisory role equivalent to that of a critical care fellow. During PGY-5 and PGY-6 years, EM/IM/CC residents perform 11 months of dedicated critical care patient responsibilities. These 11 months primarily consist of training in the Medical Intensive Care Unit (MICU), Coronary Care Unit (CCU), and Cardiothoracic Intensive Care Unit (CTICU) at The University of Maryland Medical Center. In addition, EM/IM/CC residents also rotate through the Trauma Intensive Care Units at the world-renowned Shock Trauma Center. Aside from dedicated patient care months, 4 contiguous months are provided for the initiation of critical care research. The remaining months in the latter two years are spent in rotations of Internal Medicine and Emergency Medicine. Please see the block schedule below for a sample grid of rotations.

The Facilities
Founded in 1823, The University of Maryland Medical Center is one of the nation’s oldest teaching hospitals. The Medical Center is a major tertiary and primary care center with many world-renowned specialized programs. Currently, The Medical Center treats approximately 30,000 inpatients and over 200,000 outpatients per year. The Medical Center is primarily comprised of University Hospital and its affiliated outpatient clinics. University Hospital has outstanding new state-of-the-art facilities in Emergency Medicine and Critical Care.

In November 2002, The Medical Center opened a 54 bed Emergency Department. Our Emergency Department has an annual census of approximately 47,000 patient visits per year; 20% of these patients are admitted with 5% of these admissions to intensive care units. Thirty-eight percent of all hospital admissions are through our Emergency Department.In May 2006, the Medical Center unveiled a new 29-bed Medical Intensive Care Unit (MICU). The MICU is now the largest unit in The Medical Center. It supports nearly every other specialty area of the hospital. The MICU is staffed with 24-hour attending supervision. At present, staffing of the MICU is divided into two provider teams, both of which have dedicated critical care attending and fellow supervision.

In addition to the new Emergency Department and MICU, The Medical Center has also opened a new 30 bed Cardiac Surgery Intensive Care Unit and Telemetry Unit, as well as a new 32 bed Surgical Acute Care Unit. With over 240 critical care beds, The University of Maryland Medical Center is one of the largest providers of intensive care in the Mid-Atlantic region.

The R Adams Cowley Shock Trauma Center is the nation’s only dedicated Trauma Hospital. Each year, the Trauma Center treats over 7,500 critically injured patients. It is regarded as one of the international standard-setters for the care of injury. Here, EM/IM/CC residents will rotate through the Neuro-critical Care Unit and the Multi-trauma Critical Care Unit.

Here is a sample block schedule for residents in the combined emergency medicine and internal medicine program. These blocks are subject to change.

BLOCK	PGY1	PGY2	PGY3	PGY4	PGY5	PGY6
1	MICU	Inpatient General Med	Cardiology Consult Service	Adult ED	MICU	Research
2	Inpatient General Med	Ambulatory Block Rotation	Inpatient General Med (Infectious Dis)	Adult ED	STC	Research
3	Dermatology	Neurology	CCU	Peds ED (CNMC)	STC Intensive Care	MICU
4	Adult ED	Adult ED	STC	Ambulatory Block Rotation	Ambulatory Block Rotation	STC Intesive Care
5	Peds ED	STC Anesthesia	Adult ED	MICU	Inpatient General Med	Cardiology Consult Service
6	STC	Adult ED	Peds ED	Inpatient General Med (Cardiology)	MICU	Adult ED
7	CCU	MICU	Ambulatory Block Rotation	Adult ED	Adult ED	MICU
8	Inpatient General Med (Infectious Dis)	Night Float & Day Float	Inpatient General Med (MAO)	EMS Toxicology Ultrasound	CCU	MICU
9	Inpatient General Med	Inpatient General Med (Cardiology)	Inpatient General Med	Adult ED	Rheumatology	Elective
10	Adult ED	Adult ED	Adult ED	Inpatient General Med (Geriatric/GIM)	MICU	Cardiothoracic ICU
11	Anesthesia	Adult ED	MICU	Endocrinology	Research	Adult ED
12	Obstetrics	Peds ED	Adult ED	Inpatient General Med	Research	MICU

Three weeks of vacation per year are incorporated into each resident's block schedule.

Legend:
CCU = Coronary Care Unit, University of Maryland Medical Center
CNMC = Childrens National Medical Center Washington, D.C.
MAO = Medical Admitting Officer
MICU = Medical Intensive Care Unit, University of Maryland Medical Center
STC = R. Adams Cowley Shock Trauma Center

Applying

It is important to understand that the creation of our EM/IM/CC program does not increase the overall number of combined resident positions. This 6-year program is offered as an extension of our current 5-year EM/IM program. If EM/IM residents are interested and dedicated to critical care training and certification, they have until the start of their PGY-4 year to transition into the 6-year track. Therefore, prospective applicants interested in the EM/IM/CC track should apply and interview for our 5-year EM/IM residency program.