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Clinical Curriculum

EM4 Overview

During the senior year, emphasis is placed on supervisory control of the entire Emergency Department at Denver Health Medical Center. Balancing patient flow, student, intern and junior (EM2 and EM3) resident clinical teaching, directing resuscitation of medical and trauma patients and area-wide management are the goals of the senior (EM4) resident. There is additional experience in the emergency department of the Children's Hospital. This year also emphasizes continued academic growth. The resident is expected to become more involved with the administrative aspects of Emergency Medicine. In other emergency departments, the resident continues to be supervised, but functions with greater autonomy. In addition, the resident takes part in an obstetrics rotation, performing deliveries and providing care to patients over 20 weeks gestation, as well as taking part in high risk deliveries and neonatal resuscitations. Finally, the majority of elective rotations are completed during the senior year. The specific schedule for the EM4 year is as follows:

EM4 Schedule

Emergency Medicine (est. 36 wks) 
     -   Denver Health (16 wks)
     -   Privates (12 wks)
     -   Pediatric EM (8wks)
Obstetrics (3 wks)
Toxicology (2 wks)
COPIC (1wk)
Elective (6 wks)
CME / Reading (1 wk) 
Vacation (3 wks)

Rotation Descriptions

Emergency Medicine – Denver Health The resident has overall responsibility for the function of the area, and will direct major resuscitations as well as provide base station control to paramedics in the field via radio. The resident is responsible for keeping the Emergency Department running smoothly, providing a balance between patient evaluation, supervision, and teaching. 

Emergency Medicine – Privates A large, combined emergency department is the setting for both the Exempla Saint Joseph Hospital and Kaiser emergency medicine experiences. The resident will care for HMO and non-HMO patients. The resident will be exposed to a patient population similar to those found in the majority of emergency department private practices. An emphasis is placed on teaching the administrative necessities of managing a private emergency department, the emergency case management (ECM) of HMO patients, outcome-based emergency medicine research, ultrasonography in the emergency department, and the utilization of Physician Assistants as physician extenders.

Pediatric EM - Denver Emergency Center for Children The pediatric emergency department at Denver Health,  this is a high volume department in which the resident directs resuscitations, does pediatric procedures and gains experience in managing acutely ill children and children with exacerbations of chronic illnesses.

Obstetrics The resident evaluates medical and obstetric problems of patients at greater than 20 weeks gestation. The resident performs normal deliveries and is ‘first assist’ in C-sections. Additionally, residents gain experience in the delivery of high-risk patients and neonatal resuscitations.

Toxicology The resident works under the supervision of the toxicology staff and clinical fellows at the Rocky Mountain Regional Poison and Drug Center, one of the best toxicology centers in the country. The goal is to gain experience in diagnosis and treatment of a wide variety of toxic exposures via participation in conferences and consultations.

COPIC Insurance The resident spends one week working at the office of a medical liability insurance company. By examining current cases involving complaints or lawsuits, the resident learns about important factors in risk management. This popular rotation gives residents a heightened appreciation for quality in patient care and charting.

Elective During these weeks the resident may select from various clinical and administrative experiences relevant to Emergency Medicine. Some may be taken outside of Denver. All electives are subject to prior approval of the Program Director.

CME / Reading Residents are provided one week in each of their upper level years for independent reading. The only clinical obligation during this week is covering sick call for their respective EM class.

Chief Resident

Up to four EM4 residents are selected on the basis of their previous performance to become chief residents. They have major administrative and academic responsibilities such as organizing and running Denver Health Medical Center Emergency Medicine Morbidity and Mortality Conferences, overseeing the organization of other resident functions, and creating the annual and monthly resident schedules. The Chief Residents receive a stipend in addition to their EM4 salary.