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Emergency Medicine Residency Naval Medical Center
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Thank you for your interest in our program.
This web site was designed to answer the most common questions about our
Emergency Medicine Residency Program.
If you find you have questions that are not covered, please let us know,
and we will answer them for you.
We look forward to hearing from you.
The Emergency Medicine Residency Program
General Information: The Emergency Medicine Residency Program at the Naval Medical Center, Portsmouth, Virginia, is a three year (PGY 2-4) program with eight residents per year group. It was first accredited in 1992 by the Accreditation Council for Graduate Medical Education (ACGME), and the first class began the program in 1992, graduating in 1995. In 1995, the program was reviewed by the Emergency Medicine Residency Review Committee of the ACGME, and was awarded full accreditation for a 5 year period, becoming the first Emergency Medicine residency program ever to receive 5 year accreditation on the first review. The program was reviewed again in 2004 and given full continued accreditation. Our program scored in the top 10% of EM residencies Nationally in the 2005 in-training examination.Pre-requisites: Successful completion of an ACGME approved PGY-1 program (internship) in any field and documentation of acceptable moral, ethical, and professional behavior as demonstrated in the residency application and reference letters.
The following rotations during internship are strongly desired:
Ward Medicine
ICU
CCU
Emergency Medicine
Ward Surgery (general)
Outpatient Pediatrics
Outpatient OB/GYN with L+D experience
The following rotations during internship are desired but not required:
Anesthesia
Trauma
Ophthalmology
Dermatology
Otolaryngology
Applications: The application is now available online at http://www-nshs.med.navy.mil/gmeapplication/default.asp.
The point of contact for questions concerning the application process may be reached at (301) 319-4514 or DSN 285-5818 (e-mail: jhpelot@nmetc.med.navy.mil) The Navy GME fax number is (301) 295-6113 or DSN 295-6113.
The application must be forwarded through the applicant’s chain of command.
Interviews: Emergency Medicine is becoming one of the most competitive residencies both in the civilian community and in the military. Interviewing with the Program Director is a crucial step in the selection process, and allows both you and the Program Director to determine whether you and the program will be compatible. A face-to-face interview is best, but we understand that operational contingencies sometimes do not allow applicants to leave their operational position for an interview. In these cases, telephone contact is acceptable. On the day of the interview, the applicant will be given a tour of the facility, as well as an opportunity to speak with some of the residents. The applicant will also be interviewed by the Program Director as well as 2-3 other faculty members.To arrange an interview, call the residency secretary, at (757) 953-1407, or write or E-mail the Program Director at the address on the last page.
Selection Criteria: At the selection board, preferences are mandated for certain applicants such as General Medical Officers or applicants with prior active duty service. Our program also views diversity, both in our residents and faculty, with an array of backgrounds, interests, and experience to be a strength. Recognizing the need for an especially strong resident group in a young and evolving specialty, the following attributes will be sought:
Maturity - Residency applicants who have had real-life experience such as prior service, a GMO tour, etc, have had tempering experiences that contribute to a more focused, well-adjusted resident.
Prior experience in Emergency Medicine related activities - Normally, those applicants with prior experience in EMS, ED’s as a GMO or volunteer, etc, usually have realistic expectations of the specialty in the areas of schedules, life-style, and work habits, and are better prepared for the program due to the inherent stress of the Emergency Department.
Professional activities: Involvement in research or publications, or activity in organized medical associations demonstrate a pro-active attitude that indicates a high level of interest in the specialty.
Selection Process: Each year, normally in late November/early December, the Graduate Medical Education Selection Board (GMESB) meets in Washington, D.C. to select post-graduate trainees in all specialties. The Program Directors of Portsmouth and San Diego, as well as the Specialty Leader for Emergency Medicine comprise the Navy members of the committee that selects the residents for military programs. Each resident is scored independently by the three services, according to guidance from the GMESB. Composite scores are then used in the selection process. The scoring is based on medical school performance, internship performance, performance in an operational billet, board scores, letters of reference, and capacity for success both as a Naval Medical Officer and as an Emergency Medicine resident. The selections are presented to and approved by the GMESB, and the results transmitted by message approximately mid-December.
Goals of the Residency: Our goal is to produce well-rounded, community Emergency Physicians who will be able to leave the program and immediately function in the military milieu. Graduates will have a broad-based education in:
Clinical management of ED patients
Pediatric emergencies
Trauma
Toxicology
Prehospital care/EMS systems
Disaster medicine
Environmental medicine
Sound principles of research
- Emergency Ultrasound
- Administrative aspects of Emergency Medicine
- Combat Emergency Medicine
Experiential Curriculum: This aspect of the curriculum consists of 36 one-month clinical rotations designed to give the resident a well-rounded clinical base, with the bulk of emphasis upon management of emergencies and emergency patients.
EM-1 year
Emergency Medicine: 5.5 months - NMC Portsmouth 1 month - DePaul Medical Center Trauma: 1 month - Sentara Norfolk Trauma Center Pediatric Emergency Medicine: 1 month - Childrens Hospital of the King’s Daughters
Anesthesia: 1 month - NMCP Cardiac Care Unit: 1 month - NMCP Orthopedics: 1 month - NMCP OB/GYN: 1/2 month - NMCP
EM-2 year
Emergency Medicine: 4 months - NMC Portsmouth 2 months - DePaul Medical Center Trauma: 1 month - Sentara Norfolk Trauma Center Adult ICU: 1 month - NMCP Pediatric ICU: 1 month - NMCP EMS: 1 month - NMCP (local EMS agencies) Administration: 1 month - NMCP Ultrasound: 1 month - NMCP
Each resident is provided an individual desk
and networked computer.
Digital radiology.
EM-3 year:
Emergency Medicine: 5 months - NMCP 1 month - DePaul Medical Center Teaching: 1 month - NMCP Toxicology: 1 month - NYC Poison Control Center, NY, NY Electives: 2 months Trauma/EM: 2 months - Riverside Regional Medical Center Notes:
The EM-2 rotation in EMS/prehospital care will require the resident to participate in the prehospital arena, ride with EMS units, and provide prehospital care. Involvement in helicopter transports is allowed but not required.
Any clinical specialty may be used for elective time, which is selected by the resident in conjunction with their academic advisor to enhance areas of interest. All electives are approved by the Program Director.
Didactic Curriculum: This aspect of the curriculum consists of conferences, readings, labs, and courses that cover all aspects of the core curriculum. The core curriculum is covered in a recurring 18 month cycle. Specific elements of the didactic curriculum include:
Weekly Conferences: Held each Wednesday from 0800-1300. Residents are excused from clinical duties for conferences. Attendance to conferences is mandatory. Four hours of formal lectures include visiting lecturers or joint conferences with other departments, Morbidity and Mortality Conference, Follow-up conference, faculty lectures, and resident lectures. One hour of conference is spent in discussing the week's assigned readings, and in a quiz. Journal Club: Journal Club is held monthly, on the 4th Tuesday of each month, usually at a faculty member’s home. Residents are excused from clinical duties for this meeting, and attendance is mandatory. At Journal Club, residents and staff present and discuss a variety of articles pertinent to that month’s curriculum topic, as selected by the Research Coordinator. Articles are discussed in a stylized format, critiquing the study methodologies, statistical use, and conclusions. Articles pertinent to the clinical practice of Emergency Medicine are normally chosen.
Life Support Lab: Basic and advanced procedures are practiced in a monthly procedural skills lab. A staff member as well as an EM-3 resident proctor the lab, which includes Emergency Medicine residents as well as rotating interns. A laboratory manual, distributed to all residents, describes the procedures for this lab.
- Cadaver Lab: Advanced airway and other procedures are practiced in a bimonthly cadaver lab. A faculty member proctors this lab.
Advanced Life Support Courses: Residents all become trained in ACLS, ATLS, and PALS, with many becoming instructors in these courses.
Research Course: All EM-2 residents attend the four day research course sponsored by the Society for Academic Emergency Medicine, held at the annual SAEM meeting.
Morning Report: Held immediately after change of shift rounds in the Emergency Department. An interesting case from the prior 24 hours is usually discussed by a faculty member or senior resident, with evaluation and management skills stressed.
Required Readings: Emergency Medicine texts, including the Rosen text, and the Roberts and Hedges (Procedures) text are studied throughout the three years of the residency, with weekly reading assignments based on the monthly curriculum topic.
Academic Project: Each resident is required to complete a significant scholoarly activity academic/research project during the residency. The purpose of this is to allow the resident to develop in-depth knowledge about a specific topic germane to Emergency Medicine, to investigate the current knowledge base about the area, and improve upon that base. A variety of activities, from case reports to formal research, may contribute toward this requirement.
Evaluations: Residents receive feedback on their performance through a variety of mechanisms that include:
Rotational Evaluations: Completed at the end of each rotation, these evaluations offer information about the clinical performance while on the particular service. On Emergency Medicine rotations, extensive feedback is given, including a separate feedback form from each faculty member.
Semi-annual Program Director Meeting: Each resident meets formally with the Program Director on a semi-annual basis to review progress, goals, and future plans.
Testing: Residents receive additional feedback on didactic learning from the weekly quizzes on the required reading, quarterly oral board examinations, and the annual in-service examination.
Chart-review: All resident charts are reviewed by staff, with immediate feedback.
Goals and Objectives for Residents: Resident responsibilities will be graduated and will be based not only on year level but also by recommendation of the promotions committee. Individual resident responsibilities are conferred when they have reached the proper clinical maturity for advancement along the following guidelines:
EM-1 residents have responsibility for initial workup and individual patient management; no supervisory responsibilities; have procedural assignments in major resuscitations, and will take ACLS, ATLS, and PALS courses.
EM-2 residents will have multiple patient management responsibilities either as the primary physician or as supervisor of interns; will act as team leader in resuscitation in absence of an EM-3; will take ACLS, ATLS, and PALS instructor courses and actively teach.
EM-3 residents will assume control of ED patient flow by supervising, teaching and coordinating the activities of subordinate physicians, medical students, and departmental staff. The EM-3 will serve as the more junior resident's first consultant within the ED, demonstrate leadership and administrative skills by performing as team leader in resuscitations, and will continue to teach ACLS, ATLS and PALS courses.
Goals and Objectives EM-1 Year
To learn to recognize the acutely ill patient.
To develop a systematic approach to the stabilization of the acutely ill patient.
To routinely develop a differential diagnosis while addressing the most serious possible diagnosis, based upon pertinent history, physical exam, and laboratory studies.
To refine individual patient evaluation and management skills.
To develop a rational approach in the use of laboratory and X-Ray studies.
To learn and recognize the indications for admission and prompt consultation.
To be able to manage multiple patients simultaneously.
To develop technical skills in all Emergency Medicine invasive procedures.
To recognize indications, contraindications, and complications of all types of emergency department procedures including venous cutdown, central venous line placement, pacemaker insertion, tube thoracostomy, intraosseous placement, pericardiocentesis, thoracotomy, peritoneal lavage, and cricothyroidotomy.
To develop technical speed and skills in the repair of all types of wounds while recognizing the indications for specialty consultation and repair under general anesthesia.
To develop the habit of thorough record-keeping and documentation on the Emergency Treatment Record.
To learn the proper technique of wound evaluation, preparation, and dressing of wounds.
To become expert at airway management and protection for all types of emergency patients.
To develop a rational approach to the management of poisoned patient.
- To become proficient in bedside ultrasound.
To become involved with the activities of the EMS system and learn to function via communication with pre-hospital personnel.
To correctly interpret each radiology study, including special studies such as CT scans, lung scans, etc. To prepare a limited number of lectures and presentations for the weekly conferences.
To increase fund of knowledge in the field of Emergency Medicine by attending lectures, in private readings, and from bedside teaching by staff and senior residents.
To become involved with reading and evaluating the literature, to gain an understanding of statistics, and to learn how to develop research protocols.
To become acquainted with the administrative problems of an Emergency Medicine Department and Residency Program.
- To begin a scholarly activity project.
To gain exposure to the oral board format.
To identify interesting cases for interesting case/follow-up conference and for possible case report publication.
To diligently maintain a follow-up log on admitted patients and interesting outpatients and a procedure log.
To academically recognize elements of resident physician impairment.
To gain academic awareness of leadership and management skills.
To have successfully completed the ATLS, ACLS, and PALS provider courses.
Goals and Objectives EM-2 Year
To be able to manage many patients simultaneously while supervising all personnel to ensure overall quality of care and adequate patient flow.
To help manage all major medical emergency conditions and resuscitations.
To be able to supervise interns and IDC students, focusing on quality of care, patient flow, and Emergency Treatment Record documentation.
To have increased administrative responsibilities-serving on departmental committees, performing quality assurance review, handling patient transfers, and serving as liaison with members of other residency programs.
To continue work on scholarly activity.
To develop communication skills and professional qualities to improve interpersonal interaction with staff, patients and their families.
To develop a thorough understanding of all components of pre-hospital services and communication.
To develop confidence in managing major trauma.
To develop a thorough understanding of all components of emergency medicine departmental organization and administration.
To refine major resuscitative technical skills.
To actively teach ATLS, ACLS, and PALS courses.
To gain increased facility with the oral board format.
- To polish bedside ultrasound skills.
To submit case reports for peer review journal publication.
To diligently maintain a follow-up log on admitted patients and interesting outpatients and procedure log.
To develop didactic teaching skills by preparing and presenting a selected topic several times throughout the year as part of the Intern/Medical Student repetitive EM curriculum.
Goals and Objectives EM-3 Year
To assume overall responsibility for the Emergency Department clinical areas with staff guidance, supervising all personnel to ensure overall quality of care and adequate patient flow.
To actively teach EM-2 residents, EM-1 residents, interns, and medical students in addition to maintaining quality of care and adequate patient flow.
To refine leadership and management skills.
To have greatly increased administrative responsibilities including:
counseling residents, interns, and medical students
teaching a good portion of the intern and medical student core curriculum
scheduling and instructing in the animal laboratory
participating in departmental quality assurance
completing special tasking by the departmental chairman, program director and chief residents.
To focus on patient interactive skills and patient's psychosocial needs.
To complete the comprehensive study of standard specialty textbooks by Tintinalli, Harwood and Nuss
To continue and complete scholarly activity.
To have confidence in approaching the oral board format.
To continue active teaching of ACLS, ATLS, and PALS courses.
To gain full confidence in major resuscitative technical skills.
To be prepared to pass both parts of the ABEM certification examination.
To develop didactic teaching skills by preparing and presenting a selected topic several times throughout the year as part of the Intern/Medical Student repetitive EM curriculum
Shifts and Schedules: Rotational schedules for the academic year are written by the Program Director, after soliciting resident requests. The rotational schedule is normally completed in March. Residents work 10 hour shifts in the Emergency Department, on a staggered schedule. EM-1 residents work an average of 22 shifts per month, EM-2 residents 20, and EM-3 residents 18. The total number of work hours is slightly below national average.
Leave/TAD: EM-1 residents are allowed 14 days of leave per year, and EM-2 and EM-3 residents are allowed 21. Otherwise, normal Navy leave regulations apply. Incoming residents are encouraged to not have too many leave days accumulated before beginning residency so as to avoid accumulating over 60 leave days at the end of a fiscal year, which results in loss of leave days. Required TAD to out of town rotations or courses is fully funded. No-cost TAD is available for additional conferences.
Faculty: The Emergency Medicine residency faculty consists of 16 medical officers, all residency trained (at many different programs) and board certified in Emergency Medicine. The current faculty have a diverse Navy background, with all operational areas represented. A wide variety of staff interests, including research, EMS, medical photography, blast electrocardiography, hemostatics simulation, toxicology, Peds EM, operational medicine, environmental medicine, ultrasound, multi-media education techniques, and ED administration are represented. All of the faculty are credentialed in ultrasound (the first Navy Emergency Medicine physicians to be credentialled in this area). Several of the faculty are nationally-known speakers and authors, and a wide variety of articles, textbook chapters, and books have been published from the program. Several faculty members are also involved in organized medical societies on a national basis. Each faculty member is assigned one or more residents to act as their academic advisor, meeting with them on a monthly basis, and all faculty members are involved in both bedside and didactic teaching. There is faculty coverage 24 hours per day in the Emergency Department, with double coverage 16 hours daily. All the faculty have collateral duties, both within the department, and for the command.
Special Interests: The program prides itself on its experience and expertise in medical photography. Faculty are active in national photographic contests, and a photographic atlas has been published by one of the faculty members. All residents receive instruction on medical photography, and most residents have entered some of their photographs in national contests. A second area of special expertise is the area of multi-media presentation skills. The department has multiple modern scanners, computers, and palettes to allow all faculty and residents to become proficient in a wide variety of software and presentation techniques.
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Resuscitation Room |
Facilities:
Charette Health Care Center (NMCP): The bulk of the residency training is spent at this new facility which opened in 1999. The ED has an annual census exceeding 80,000 patients with an approximately 13% admission rate and a 3% critical care admission rate. Approximately 9% of the patients arrive by ambulance. Fourteen of the beds are centrally monitored. There are eight GYN equipped rooms, an opthalmology/ENT room, a psych room, and a two bed resuscitation/trauma bay with state-of-the art equipment available. Additionally, there is a three bed observation unit and an attached Pediatrics Emergency clinic. A digital radiology suite is present and dedicated for ED use only. The department has private elevators to the OR and critical care areas.CT scanners and a planned hyperbaric chamber are also adjacent. The doctors work area has a 40 volume library, as well as several computers with internet access. The entire clinical area is integrated within the CHCS system. There are dedicated ED educational spaces including a state-of-the-art multimedia conference room seating 40 people, a resident's work space with a private work-station for each resident, numerous personal computers, and a multi-media area available for the residents to prepare professional presentations. Other administrative spaces include private offices for each faculty member, and two 60-person locker rooms. Voice activated dictation will begin this year.DePaul Medical Center: A large urban Emergency Department with 38,000 annual visits and exposure to high census of older, high acuity patients, as well as exposure to civilian managerial techniques. Staffed full-time by board-certified Emergency Physicians.
Sentara Norfolk Trauma Center: Located in Norfolk, Virginia, this is a busy level I trauma center.
Riverside Medical Center: Located in Newport News, Virginia, this level II trauma center sees 38,000 patients per year with a 25% admission rate. EM residents are the first physician responder and team leader for all trauma patients, while also managing other emergency department patients.
New York City Poison Control Center: Located in Manhattan, NY and affiliated with New York University Medical Center. Didactic teaching is by nationally known toxicologists. This program also has several toxicology fellows.
The Emergency Medicine Department
General Information: The Emergency Medicine Department is an independent department which is in the Medical Directorate. At the current time, the Emergency Medicine Department is responsible for the operations of the emergency treatment area, and the Fast Track treatment area. Forty officers, over 50 corpsmen, and over 15 civilian workers are members of the department.Department Activities: The Medical Officers of the department (including residents) have several social activities throughout the year. These include the welcome party in August, the Christmas Dinner in December, the residency graduation dinner in June, and the monthly Journal Club which a majority of the faculty attend.
Naval Medical Center, Portsmouth, Virginia
The Navy’s "First and Finest" medical center is located on Hospital Point in the City of Portsmouth, on the Elizabeth River. Established in 1824, it is a 300 bed, tertiary care facility and is the lead agent for Mid Atlantic Region. The local catchment area contains over 400,000 beneficiaries. This large patient population provides a wide variety of acute and chronic medical problems for the facility to manage. Residency programs in anesthesia, emergency medicine, general surgery, internal medicine, obstetrics and gynecology, oral surgery, orthopedics, otorhinolaryngology, pathology, pediatrics and psychiatry are present as well as a transitional internship program. A state of the art research facility supports these training programs.The hospital also contains a small exchange and barber shop, post office, several dining facilities, and a comprehensive medical library which currently subscribes to several hundred periodicals including 6 Emergency Medicine journals.
The compound has a new gymnasium, swimming pool, and jogging tracks.
The medical center has a large parking garage, which is rarely full.
The new Acute Treatment Facility is a one-million square foot building. It is the most modern Navy Medical Facility, and was designed with teaching in mind. All clinics are on the first two floors, with inpatient care areas on the third and fourth floors.
The Hampton Roads Area
The Hampton Roads area consists of the cities of Norfolk, Virginia Beach, Portsmouth, Chesapeake, Suffolk, Hampton, and Newport News. There are over one million people living in Hampton Roads. The weather varies with the seasons, with long, mild springs and falls. The winters are typically short, but snow is seen once or twice each year. The area is renowned for its resort status, and Virginia Beach is one of the top tourist destinations on the East Coast. All the localities have excellent school systems and the cost of living is the lowest of any of the three main Navy teaching hospitals. A wide variety of outdoor activities are available in the area such as hiking, boating, diving, and fishing, and several ski resorts are within a 4 hour drive. Cultural activities include theater, music, a newly renovated opera house, and college and professional sports. The area is renowned for its many fine restaurants. The historic areas of Yorktown and Williamsburg are about a one-hour drive away.Eastern Virginia Medical School and Norfolk General Hospital, with a level-one trauma center, are in Norfolk. NGH is also the home of an Emergency Medicine Residency program, with which our program cooperates in areas such as conferences.
The Hampton Roads area is home to the world’s largest naval base in Norfolk, as well as two Naval Air Stations, the Naval Amphibious Base, and the home base for two Navy Seal Teams.
Clinical Clerkships
Medical students from USUHS or who are in the HPSP program may rotate on a clinical clerkship in the department. This is an excellent opportunity to learn Emergency Medicine and to interview for acceptance to various internship programs. The rotation is designed for fourth year students, although third year students will be accepted on a case-by-case basis. Students work 8 hour shifts, and have a designed curriculum and readings, and also attend all conferences. To obtain further information or arrange a clinical clerkship, contact:
Graduate Medical Education Coordinator
Naval Medical Center
Portsmouth, VA 23708-2197
(757) 953-5109
Further Information:
For any further information about our program, please call at 953-1407, or E-mail the Program Director .We look forward to receiving your application and meeting you personally.
Last updated: 03-Oct-2007
