Formal Education

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Our conference curriculum is designed to cover the Core Curriculum of Emergency Medicine (as developed by the American College of Emergency Physicians and the American Board of Emergency Medicine). Each month covers a specific topic and an 18-month curriculum has been developed to assure coverage of the core curriculum topics. Four hours (8am to noon every Thursday) are devoted to covering the monthly topic and is done so with a variety of formats, including lectures, case discussion, critical review of the literature, combined specialty conferences, interactive question-and-answer sessions, small group sessions, and grand rounds.  While the majority of conference is conducted by faculty, EM residents, under the supervision of a faculty member, are expected to give lectures during each year of their residency. To assure that residents receive preparation for the yearly American Board of Emergency Medicine (ABEM) In-Training examination as well as ABEM's Board Certification examination, residents are required to complete monthly tests. We use an audience-response system that allows the resident to take the exam during conference time and allows the faculty to provide immediate feedback on individual test questions

Click here to view conference schedules and related information.

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To augment the weekly conferences, residents are assigned to complete one topic-based module per month.  Each module consists of up to 4 hours of online lectures and questions that are related to the assigned topic of the month.  Residents complete these assignments at their convenience.  All of the online resources are available at any computer with internet access and many of the lectures can be downloaded to personal devices such as iPods. The modules are constructed to augment the weekly conferences.

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We are one of the few Emergency Medicine residencies in the United States with direct access to a simulation center located on campus. Thomas Jefferson University Hospital and Jefferson Medical College is home to the Dorrance H. Hamilton Medical Education Building (top of this page).  Opened in October 2007, the Hamilton Building is home to a state-of-the-art simulation center that uses high and low fidelity simulators and standardized patients.  Additionally, faculty both within the Department of Emergency Medicine as well as faculty in Jefferson’s Clinical Skills Center participate in our resident’s education.  Our institution is also home to the Center for Bioterrorism and Disaster Preparedness, a federally funded entity with a mission to provide continuing education to the nation’s healthcare workforce and to teach the public about emergency procedures. These two resources together provide the resident with access to multiple adult, pediatric and obstetrical simulator mannequins to teach and evaluate EM residents on a variety of emergency conditions.  In addition, there are simulators for central line placement, lumbar puncture, umbilical vein and artery cannulation, pericardiocentesis, vaginal delivery, and endotracheal intubation.  The simulation curriculum helps to assure enough experiences to prepare them for a variety of emergent conditions and procedures that they may encounter during and beyond their residency training.  It also allows the faculty to assess the skills of the resident so that deficiencies can be addressed in a timely fashion.

Every Thursday afternoon, four residents participate in a simulation session.  Each resident serves as the team leader for a case while the other residents play a variety of roles. This allows a resident to be exposed to a total of four different critical care cases in a session. All sessions are videotaped and are reviewed with the resident by one of three faculty members to assure an in-depth learning experience. Residents participate in four simulation sessions per year.

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The most important skill for the emergency physician is airway management. Rich Levitan, MD, a senior faculty member in our department, is considered to be one of the world's experts in airway management. As part of the first year airway manangement rotation in the PGY 1 year, residents will take Dr. Levitan's two-day workshop that combines multimedia didactic sessions with a hands-on cadaver lab in which the resident will perform over 75 intubations using traditional laryngoscopy, device-assisted intubation, and surgical airway. Resident are required to attend this course one more time during their second or third year. Details on this unique course can be found at http://jeffline.jefferson.edu/jeffcme/Airway/

Essential to the practice of emergency medicine is the acquisition of procedural skills.  Procedural skills laboratories are held twice a year in the Jefferson Medical College’s Department of Anatomy cadaver lab.  In the fall of the academic year, residents teach surface anatomy to the first year Jefferson medical students and demonstrate invasive procedures.  In the spring, a dedicated procedural skills laboratory is done to teach and assess procedural skills.  Procedures include lateral canthotomy, needle and open cricothyroidotomy, pericardiocentesis, needle and open chest tube thoracostomy, and venous cutdown. These sessions afford our EM residents the opportunity to practice and perform needed skills.

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Two ultrasound fellowship-trained faculty members (Bon Ku, MD, MPP and J. Matthew Fields, MD) provide a dedicated ultrasound training experience to the EM residents. Beginning with the 2011-2012 academic year, an ultrasound fellow from the just-established Ultrasound Fellowship in the Department of EM will serve as an additional dedicated ultrasound instructor for the resident.

Currently, our EM residents have 4 weeks of formal ultrasound training during their residency.  Residents have a two week rotation in their first and third years where they have at least 8 eight-hour scanning shifts and are paired with an RDMS ultrasonographer.  During the two week period, a number of ultrasound textbooks are made available for assigned readings. Each resident performs ultrasound scans on ED patients who require an ultrasound based upon their clinical presentation.  The ultrasonographer teaches the practical aspects of ultrasound performance.  All scans are recorded and saved for later review by our ultrasound-trained faculty. At least 6 hours outside of the scanning shifts are dedicated to in-person review of the resident-performed ultrasounds.  

In addition to the 4 formal weeks of ultrasound training, residents have access to three SonoSite MicroMaxx ultrasound machines (two are located at TJUH and the third is located at Methodist Hospital) and are .  The machines include curved array, linear array, phased array and endovaginal transducers.  Residents are encouraged to use ultrasounds when clinically applicable.  All scans done in the EDs of Thomas Jefferson University Hospital and Methodist Hospital are reviewed by the EM ultrasound faculty. 

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Third year residents spend one month on the EM Administration and Teaching (EMAT) block.  During this time, the resident has a number of formal teaching responsibilities. The EMAT resident will prepare and present two lectures for the weekly conferences, prepare and present a critical review of the literature session, conduct a daily teaching session for the residents working in the ED, and will teach fourth year medical students in their required EM rotation. Jefferson Medical College fourth year students participate in a required four-week clerkship in Emergency Medicine. At the end of each of the first three weeks, medical students spend 3 hours in the class and 4 hours in the simulation lab learning EM. The EMAT resident teaches one lecture and one skill session per week in this course.  EM procedural skills such as lumbar puncture, central line placement, and suturing are covered by the resident during the skill sessions.   Additional EMAT duties during the rotation include participation in an ongoing continuous quality improvement (CQI) project, bedside teaching and procedures supervision of junior residents and medical students, and laboratory/radiology patient follow-up.

Second year residents spend two weeks on an Education block.  During this time, the resident completes a module in Evidence Based Medicine (EBM). This module involves the completion of assigned readings on the process of EBM, the development of a question relevant to the practice of emergency medicine, a literature review, and a presentation, during our weekly conference, of an interactive session where the resident leads a discussion on the topic.  Other duties during this block include teaching in the ED and teaching in the fourth year medical student course.

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A formal scholarly project is a residency requirement. Residents may accomplish in a number of different ways such as collaboration with a faculty member in clinical or laboratory research, epidemiologic surveys, written case reports, or book chapters. The Department of Emergency Medicine is home to two laboratories devoted to basic science research in neurologic and cardiac injury research and provides a unique opportunity to the resident interested in a laboratory experience. Residents have a one-week block in their second year dedicated to either starting or completing their scholarly project and can use up to four weeks of elective time in their third year as well.

With regards to elective time, there are four weeks in the third year that can be used for a variety of activities. A resident may use that time to complete their scholarly project, receive clinical experiences to enhance their education, or travel for a medical experience. For those interested in travel to a foriegn country, their education will be augmented by the Global Health faculty as well as fellow from our newly-established Global Health Fellowship.

Examples of scholarly activity by TJUH EM residents (click here for a complete listing of current resident and recent graduate scholarly activities):

Roman Bish, MD (Class of 2011): The EM Intern Guide to Thomas Jefferson University Hospital and Methodist Hospital.

Joe Portale, MD (Class of 2011): The TJUH Department of EM Annual Ultrasound Instruction Course for Faculty and Residents

Arthur Au, MD (Class of 2011) and Bon Ku, MD: Resident Ultrasound View Guide

Tom Gilmore, MD (Class of 2012) and Wayne Lau, MD: Exosomal RNA as a Marker of Acute Kidney Injury in Trauma Patients

Jennifer Jachowski, DO (Class of 2012) and Al Saccchetti, MD: Remifentanyl Use for Analgesia and Sedation in Pediatric Emergency Patients

Samantha Furia, MD (Class of 2010) and Ralph Riviello, MD: Liver Emergencies. In Aghababian RV, editor - Essentials of Emergency Medicine, 2nd Edition (in press).

Alex Kleinmann , MD (Class of 2010) and Ralph Riviello, MD: Do not miss the occult hip fracture in elderly patients.  In Mattu A, Chanmugam AS, Tibbles CD, Woolridge DP (eds).  Avoiding Common Errors in the Emergency Department.  Wolters Kluwer/Lippincott, Williams & Wilkins, Philadelphia, PA, 2010, p 263-264.

Timberly Booker, MD (Class of 2009) and Harsh Sule, MD: Nontraumatic Spinal cord Injury. Critical Decisions in Emergency Medicine September 2010.

Arleen Allen, MD (Class of 2010) and Bernard L. Lopez, MD, MS: Nontraumatic Increased Intracranial Pressure. Critical Decisions in Emergency Medicine November 2009

Serge Hougeir, MD (Class of 2009) and Nara Shin, MD: Feeding Tube Complications. Critical Decisions in Emergency Medicine April 2009

Emily Chen, MD (Class of 2009) and Ron Hall, MD: Abdominal Aortic Aneurysm.Critical Decisions in Emergency Medicine December 2008

Janelle Martin, MD (Class of 2008). Interpersonal Violence. In Riviello RJ (Ed.) Manual of Clinical Forensic Emergency Medicine – A Guide for Clinicians, 1st ed.  Boston: Bartlett and Jones Publishers, 2010, pp 122-127.

Tao L, Jiao XY, Gao ER, Lau W (Class of 2007), Lopez BL, Christopher TA, Rao S, William W, Southan G, Sharma K, Koch WJ, Ma XL. Nitrative Inactivation of Thioredoxin-1 and Its Role in Post-Ischemic Myocardial Apoptosis. Circulation, 114:1395-1402, 2006.

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