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4422 Third Avenue Bronx, New York 10457 718-960-6103 Juan F. Acosta, D.O., FACOEP, FACEP - Program Director & Research Director Michael Gindi, M.D., FACEP, Associate Program Director Daniel Cerbone, D.O., Assistant Program Director Daniel Lombardi, D.O., Assistant Program Director Maria Ferraro, Administrative Assistant/Residency Coordinator Revised September 10, 2007 General Program Description: The St. Barnabas Hospital Emergency Medicine Residency Program is designed to provide the emergency medicine resident with the skills, knowledge, and experience required to become an outstanding and complete emergency physician. The residency program is based at St. Barnabas Hospital, now a 97,000 visit full service emergency department, accounting for some 70% of the admissions to the 460 hospital beds. [Accredited in 1990, and beginning with one resident, the emergency medicine residency program now trains over 50 residents in its various programs]. Several expansions since 1990 have more than tripled the size of the emergency department, as well as adding faculty and resident office space and a resident classroom. A pediatric emergency department opened in 1999, and a level one trauma application was submitted in July of 2000, with another expansion program slated to handle the additional trauma patients. In 1990, the faculty was composed of two residency trained, board prepared/certified emergency physicians; today, the faculty consists of 22 residency trained, board prepared/certified emergency physicians, all of whom are provided at least 20% “protected time” in order to better train the emergency medicine residents. Clinical Curriculum The clinical curriculum is designed to allow a progressive increase in case load and case complexities, as well as administrative and managerial aspects of emergency medicine. Other clinical, administrative, and research rotations are integrated into the emergency medicine experience as well. The emergency medicine track internship at St. Barnabas Hospital in fact begins residency training. During the track year, interns spend 3 months in “E.D.-2,” caring for the “bread and butter” patients of emergency medicine. Additionally, they spend one month in the pediatric emergency medicine department at St. Barnabas Hospital, as well as a 2 weeks in anesthesia, honing their airway skills. In the PGY-II year, residents move to “the back side” of E.D. I, where they care for the moderately ill and injured patients. By the PGY-III year, residents progress to the “front side” of “E.D.-1,” caring for the most acutely ill and injured patients. In the PGY-IV year, residents act as “critical specialists,” participating in every resuscitation, as well as assisting in the management of the overall department, and the teaching of the junior residents. At all times, an attending faculty member directly supervises emergency medicine residents caring for emergency department patients. While rotating in the ICU, the emergency medicine residents are, at all times, supervised by an attending level intensivist. While rotating on the medical or surgical floors, the residents are supervised by either an attending level physician or a senior resident on service. Academic Curriculum Recognizing that a clinical experience, no matter how broad and varied, can not supply all the knowledge necessary to become complete emergency physicians, a strong complimenting academic curriculum has been developed. The academic curriculum is instructive and at the same time interactive, composed of daily teaching rounds, daily didactic sessions – including a full morning of didactics every Wednesday, required weekly readings (Rosen in the PGY-2 and 3 years, Tintinalli in the PGY-4 year) with concomitant required quizzes, as well as required bi-monthly graded exercises in EKG and radiographic interpretation. In order to assure accountability, all residents are required to maintain a 70 average in all quizzes and exercises. Wednesday conference is required of all residents except those on specific rotations (including trauma, ICU, and out of town rotations), or when in conflict with Bell Commission rules. Plaques and prizes are awarded to those residents scoring the highest in Rosen, Radiology, and EKG quizzes. Resident Evaluation Process 1) Out of Department Rotations
Faculty Responsibilities / Scholarly Activities
Moonlighting is permitted only with the express written consent of the Program Director. In order to moonlight, the resident must:
It is the responsibility of the Program Director to determine the appropriateness of the moonlighting request. If the request is approved, a letter so stating will be provided to the resident and a copy placed in the resident’s file. Research Activities All residents are required to participate in research activities/projects throughout their training years. A written report must be submitted annually, with approval by the research director. Residents are strongly encouraged to submit completed research projects to the ACOEP research competition, as well as to other research formats and publications. All residents whose research is presented at a national venue will be reimbursed for travel and hotel expenses directly related to the presentation. In this context, the definition of “research” is extended to presentation of papers, posters, research abstracts, as well as participation in CPC competition.
Specific Rotation Descriptions, Goals and Objectives First Year (PGY-II)
This training will include exposure to and explanation of the general protocol for emergency treatment of various medical and surgical emergencies as they present initially to the emergency department. The resident will also be trained in the indications for and use of consultations for emergency department patients. In addition, the resident will be taught the following:
In conjunction with emergency department training, the resident will be taught the fundamentals of reading chest and abdominal x-ray films. Residents on rotation in the emergency department will participate in radiology conferences, as appropriate for their training. The emergency department rotation training will be provided mainly in the emergency department of St. Barnabas Hospital, and in the emergency department of one or more of our affiliated hospitals.
The resident will be responsible to care for the acute burn patients. The resident will learn resuscitation and stabilization of the major burn victim; outpatient decision-making; This training will take place at New York Cornell. The supervision will be done by the Attending physician and the Fellow. There will be an on-call schedule provided during the first day of the rotation.
This time will include rotation on the intensive care unit service. The resident will be supervised on physical examination and evaluation of patients in the intensive care unit by intensive care unit affiliates. Emphasis will be placed on the acute and long-range treatment of patients with medical and surgical critical care illnesses. The resident will be involved in TPA and nitroglycerin protocols for emergency department patients. Additionally, the resident will receive instruction in technical skills such as central line placement and the use of cardiac pacemakers and other appropriate technical skills as necessary for emergency intervention in critically ill patients. On a daily basis, the resident will also receive instruction in the interpretation of electrocardiograms, analysis of arterial blood gases, and management of ventilated patients.
The resident will be instructed in the proper evaluation and initial stabilization of acute and chronic orthopedic injuries as they pertain to the emergency patient. In addition, the resident will be taught the basics of splinting and casting techniques and the indications for specialty intervention in these types of cases. The resident will participate in the orthopedic clinic as well as have the opportunity for follow-up orthopedic patients initially treated by the resident in the emergency department.
The resident will rotate in the pediatric emergency department for intensive training in evaluation, diagnosis, and therapeutic intervention of acute and chronic pediatric patients as they present to the emergency department. This rotation will provide exposure to all types of pediatric emergencies as well as proper instruction in emergency intervention techniques.
The resident will be taught the fundamentals of endotracheal intubation as well as fiber optic laryngoscopy techniques. In addition, the resident will be instructed in regional block anesthesia and spinal tap procedures. This rotation will provide the resident the opportunity for involvement in endotracheal intubation, nasotracheal intubation, fiber optic laryngoscopy and regional anesthetic techniques as appropriate for patients presenting to the emergency department.
The resident will be taught the essentials of the neurologic examination and how these apply to the emergency department. Emphasis will be placed on appropriate diagnostic work-up and treatment of acute and chronic neurologic cases including headache, seizure, coma, altered mental status, concussion and head trauma.
The resident will ride with the FDNY-EMS paramedics and EMT’s for exposure to medical care and prehospital emergency medical care. During this rotation, the resident will be introduced to the use of Medical Command for city-wide Emergency Medical Services paramedic intervention, as well as quality assurance issues in pre-hospital care, the role of the Physician Director in EMS, medical legal aspects of EMS, and the practice and principles of disaster medicine.
The resident will receive instruction in the diagnosis, stabilization and treatment of patients with an acute infectious process. Specific emphasis will be placed on immunocompromised patients.
The resident will rotate on the Trauma Service at St. Barnabas Hospital under the direction of Fausto Vinces, D.O. The resident will participate in all trauma resuscitations in the emergency department, perform trauma consultations, as well as participate in surgical procedures, trauma critical care, and recovery phase of the patient’s care. The resident will also be encouraged to participate in research activities while on the trauma service.
Second Year (PGY-III)
This rotation to include time in the emergency department of St. Barnabas Hospital as well as our affiliated hospitals. These different emergency department settings will expose the residents to different types of patient situations and thus broaden the scope of the training. During the PGY-III year the resident will be given more responsibilities for patient care during each emergency department rotation and become involved with medical command communication and responsibility for pre-hospital advanced life support treatment.
The resident will function as a senior level resident continuing to broaden his/her scope of critical care medicine.
The resident will broaden his base knowledge of the acute pediatric patient by functioning as a middle level resident in the Pediatric Emergency Department.
The resident will rotate at the New York City Poison Control Center at Bellevue Hospital. During this time the resident will be taught the protocols for the management of toxic ingestion as well as drug interaction and untoward reactions. In addition, the resident will participate in conference at the center and receive instruction in the handling of on-line toxic emergencies referred to the New York City Poison Center at Bellevue Hospital.
The resident will become familiar with the daily and long range management of the emergency department, as well as become involved with quality assurance in the emergency department.
This time is to be utilized by the resident to coordinate and complete at least one research project pertaining to the specialty of emergency medicine. During the first two years of training, each resident will be given direction and assistance in the initiation of an appropriate research project. Additionally, the resident will be encouraged to apply to the Dean of the New York College of Osteopathic Medicine for consideration of the completed research project as fulfillment of the requirement for granting a Masters degree in Emergency Medicine.
This is a time for the resident to familiarize themselves with ultrasound. This rotation is done in the radiology department under the guidance of the Radiology Residency Director Dr. Marie Gade.
The resident will rotate on the Trauma Service for in-depth training in the initial evaluation and treatment of the acutely traumatized patient. This will provide the resident with exposure to the traumatized patient from the initial presentation in the emergency department through the operative and post-operative care in the trauma intensive care unit. Additionally, the resident will receive instruction in invasive procedures as appropriate for the management of the acutely traumatized patient.
Third Year (PGY-IV)
This rotation to include time in the emergency department of St. Barnabas Hospital as well as our affiliated hospitals. During the PGY-IV year, the resident will have attending physician responsibility for patient care and for supervising junior residents in the emergency department. While continuing medical command responsibilities, senior residents will be more involved in the review and critique of pre-hospital ALS cases. In addition, this training period will include: lecture and practical experience in planning, organizing and operating an efficient emergency department including instruction in quality assurance, business management, scheduling, recruiting, insurance and billing procedures.
The resident will rotate through the OB/GYN service at St. Barnabas Hospital where he/she will be trained in performing simple, complicated, and precipitous vaginal deliveries, as well as be exposed tot he indications for forceps and Cesarean deliveries. The resident will also be taught management principles of patients presenting with third trimester bleeding, as well as post-partum complications. Techniques of neonatal resuscitation will also be stressed. The goals of the rotation is to train the resident in proper management of patients presenting to the emergency department in labor, along with the management of complications of delivery and 3rd trimester bleeding.
The resident will undergo extensive training in the management of the pediatric airway – from neonate to adolescent. Airway management skills will be learned in the delivery room as well as the operating room, and these skills will then be put to use in the pediatric intensive care unit. The resident’s resuscitation skills and procedural skills will further be enhanced through the pediatric intensive portion of the rotation. This training will take place at NY Medical Center - Queens.
This rotation will be spent in ophthalmology clinic. The resident will be taught the proper evaluation and treatment of acute eye problems including lacerations of the eyelid or globe, foreign bodies in the eye, blunt and penetrating eye injury management, chemical injuries to the eye and acute glaucoma. In addition, the resident will be taught the proper use of the slit lamp for acute and chronic problems.
The resident will receive instruction in the interpretation of radiologic studies – particularly advanced studies of CT, MRI, and ultrasound. Particular attention will be paid to the technique of performing, as well as interpretation of ultrasound.
The resident will receive instruction in the evaluation of the emergency psychiatric patient. Residents will primarily examine all psychiatric patients presenting to the emergency department and manage these patients in conjunction with the psychiatric and emergency attending physician.
Emergency Medicine Residency Program Benefits & Salary Scale for Emergency Medicine Residents 4 weeks vacation/year Additional Benefits Include Free meals Medical, Dental, Prescription Plan (Resident/Family plan) Malpractice Insurance
2006 – 2007 Salary Scale PGY-II……………………..$43,500.00 PGY-III…………………….$46,500.00 PGY-IV……………………..$49,000.00 PGY-V………………………$51,850.00
St. Barnabas Hospital Faculty Faculty Member Emergency Medicine Board Status
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