Program Overview

St. Barnabas Emergency Medicine Residency Program

Affiliated with the New York College of Osteopathic Medicine and Albert Einstein College of Medicine

4422 Third Avenue

Bronx, New York 10457

718-960-6103

Daniel Lombardi, D.O., Program Director

Michael Gindi, M.D., FACEP, Associate Program Director

Daniel Cerbone, D.O., Assistant Program Director

Dean Olsen, D.O., Research Director

Maria Ferraro, Administrative Assistant/Residency Coordinator

Juana Carmona, Administrative Assistant

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. Accredited in 1990, and beginning with one resident, the emergency medicine residency program now trains over 65 residents in its various programs. The residency program, based at St. Barnabas Hospital, is now a 97,000 visit full service emergency department, accounting for some 70% of the admissions to the 460 hospital beds. Several expansions since 1990 have more than tripled the size of the emergency department, added faculty and resident office space and a resident classroom. A pediatric emergency department opened in 1999, and a level one trauma designation was acquired in July of 2000, with another expansion in 2004, which included a trauma bay, and expanded radiological services. St. Barnabas Hospital is also now a stroke center, the first in the Bronx, a therapeutic hypothermia center, and a STEMI center as of 2011. 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 internship (OGME-1) at St. Barnabas Hospital in fact begins residency training. During this year, residents spend 4 months in “E.D.-2,” caring for the “bread and butter” patients of emergency medicine. Additionally, they spend one month in “ED-1” caring for more acutely ill patients, an additional month is spent in the pediatric emergency medicine department at St. Barnabas Hospital. In the OGME-II year, residents move to “the back side” of “ED-I”; where they care for the moderately ill and injured patients. By the OGME-III year, residents progress to the “front side” of “ED-1”; caring for the most acutely ill and injured patients. In the OGME-IV year, residents act as “critical specialists,” participating in all resuscitations, 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, cannot 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 OGME-2 and 3 years, Tintinalli in the OGME-4 year) with concomitant required quizzes, as well as required 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

Residents will be evaluated after each rotation by individual departments they rotate with, and quarterly by the family practice department. The program stresses the concept of measurable outcomes to document competency over the three-year training period. What is meant by competent? While there are many definitions of competent, the executive director of the ACGME, Dr. David Leach, subscribes to the Dreyfus model, which defines "competent" as a stage along the path to “mastery".

Using measurable outcomes to document competency is referred to by many as "competency based education". This logical strategy is predicated on the concept that faculty will tell residents which competencies they need to master; then instruct the residents; then provide formative assessment/feedback ("educational Dx & Rx") to the resident as to how they are doing. And with a boost of encouragement, the resident should be able to demonstrate mastery (well at least competence) of the particular skill.

The Seven General Competencies

It has been mandated that all residency training programs, teach and assess the following seven General Competencies:

Medical Knowledge (MK)
Patient Care (PC)
Interpersonal and Communication Skills (ICS)
Professionalism (P)
Practice-based Learning and Improvement (PBLI)
Systems-based Practice (SBP)
Osteopathic Philosophy and Osteopathic Manipulative Medicine (OMM)

Out of Department Rotations

All residents rotating throughout the house rotations are evaluated by the rotation chief via a written evaluation form. These evaluations are reviewed by the residency director, and a copy is placed in the file of the resident.

Evaluations which are less than satisfactory or particularly complimentary are brought to the direct attention of the Resident by the Program Director. Out of department evaluations are also discussed during monthly faculty meetings.

Emergency Department Rotations

Faculty meets monthly to discuss each individual resident rotating through the emergency department. Faculty members also evaluate each resident daily using an online survey service. This is reviewed periodically by the Program Director. The consensus evaluation is then reproduced, and distributed to that resident’s faculty advisor. Faculty advisors then meet with their advisees to discuss the evaluation, corrective action plan, suggestions, and goals to achieve. The Program Director is kept apprised of these meetings and their outcome.

Rotation and Evaluation Process

All residents fill out monthly evaluation forms for each rotation, assessing the strengths and weaknesses of the particular rotation. These evaluations are reviewed by the associate residency director. Any significant issues are brought to the immediate attention of the Program Director.

Faculty Evaluation Process

Emergency Medicine Faculty is evaluated bi-annually by the residents. According to a pre-determined schedule, the emergency medicine chief residents lead a discussion assessing faculty members’ performance based upon the following criteria:

The residents evaluate the faculty based on: Fund of Knowledge, Clinical Supervising Ability, Bedside Teaching Quality, Bedside Teaching Quantity, Conference Lecturing Quality, Ethical Behavior, Interpersonal Skills, Participation in Research, Participation in Conference, Role Model, OMT teaching.

The consensus evaluation is then recorded, a copy sent to the Program Director, who then meets one on one with the faculty member to review the evaluation. Brief follow-up evaluations are made by the resident regarding areas of improvement and shared with the faculty and Program Director. Any behavior deemed inappropriate or detrimental to the resident’s training is brought to the immediate attention of the Program Director, either by an individual resident or the chief resident(s), and is appropriately investigated and acted upon.

Faculty Responsibilities / Scholarly Activities

Core Faculty Members must meet all the basic standards delineated by the AOA/ACOEP.

Each full time faculty member is responsible for specific educational, and/or administrative functions within the residency program. These functions include the following:

Academic curriculum development

Research coordination

Resident selection and advising

Outside rotation coordination

Rosen quizzes

Senior topics

Tintinalli quizzes – Seniors

Radiology/EKG quizzes

Written/Oral Board Review

Moonlighting Policy

Moonlighting is permitted only with the express written consent of the Program Director. In order to moonlight, the resident must:

be in good academic standing in the residency program

submit a request in writing to the Program Director

the request must contain the following:

the name of the facility where the resident intends to moonlight

the type of work the resident plans to do

a statement expressing the understanding that moonlighting cannot interfere in any way with the responsibilities of the residency program and that moonlighting hours are included in NY State’s Bell Commission Rules (see attached) which must be followed.

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.

Responsibilities of Resident

By accepting a position in the St. Barnabas Emergency Medicine Department, the resident agrees to the following responsibilities:

To demonstrate academic honestly, professional demeanor and ethical behavior with colleagues, staff, patients and the public.

To strive for the highest ideals of professional conduct

To achieve the objectives of the residency training.

To render patients the best possible care.

To educate patients about health problems.

To refrain from independent outside practice and consulting during the term of residency.

To maintain satisfactory work records, including logs, evaluations and other required forms.

To complete study and reading assignments.

To assist in the clinical instruction of medical students.

To attend all scheduled activities fully prepared and on time.

To attend all Emergency Medicine didactic sessions and other meetings recommended by the Supervisor of Training.

To abide by the rules and regulations of the College, Hospitals, and Clinics.

Ethical Considerations

Emergency Medicine residents of St. Barnabas Hospital are expected to conduct themselves in an ethical and professional manner at all times, especially when representing St. Barnabas in clinical and academic settings. In observing medical ethics, the physician will:

Give primary concern to the patient's best interest.

Be available to one's patients at all times or delegate that responsibility to another capable individual.

Practice within the limits of one's capabilities.

Maintain strict confidence about patients' situations and respect all confidentiality issues.

Not indulge in rumored information.

The residents shall respect their patients' rights to privacy. Residents shall refrain from discussing any confidential information outside of the clinical settings or in any public areas. Any inquiries from the press, radio or television, regarding patient care, medical issues or related activities, shall be referred to the Supervisor of Training.

The AOA Code of Ethics is the primary guide for the osteopathic profession. Residents should seek growth in all aspects of medical ethics: Sensitivity to issues, conceptual analysis, evaluation of completing claims, and development of a personal philosophy. Resources for such growth include departmental faculty, trainers, hospital chaplains, books and journals, special grand rounds, and seminars.

No resident shall be coerced, held liable, or discriminated against in any manner, because of a refusal to perform, accommodate, or assist in a procedure, on any sincerely held religious or ethical grounds. This provision shall not be construed to permit abandoning the patient or withholding treatment urgently required for the preservation of the quality of life in any emergency situation

Legal Considerations

Like any other professional, the resident should be aware of legal issues that may affect his/her practice. Any potential or actual legal difficulty related directly to residency activities should be discussed, as soon as possible, with either the attending preceptor or the Residency Director.

Special Points to note:

Residents have liability coverage through the hospital for activities assigned as part of the residency. This coverage does not extend to independent outside practice and consulting. If questions, or malpractice problems ever arise, the resident will immediately notify the Attending Preceptor and/or Residency Director. Immediate knowledge and appropriate action has proven to be a very successful deterrent and problem-solving mechanism in early malpractice problems.

Grievances

On occasions, residents may have questions or problems regarding performance of work administration or policies and practices, which are not specifically covered in the Resident Manual, One or more of the following steps, in sequence, may be taken:

Confidential discussion with:

Immediate clinical preceptor

Faculty Advisor

Residency Director

If the problem is unresolved at the above three steps, there may be a hearing of the entire Emergency Medicine administrative committee

Resignation

Residents shall give a minimum of 30 days notice of resignation from a training program. All resignations must be submitted to the Residency Director, in writing, and include the reason for leaving the residency.

Leave Policy

Leave of Absence Policy. Although leaves of absence are permitted as detailed below, the House Officer recognizes that he/she is pursuing an educational course of study and any time away from the Residency Program may affect the House Officer’s ability to complete the year in question and/or the Residency Program as a whole. The House Officer must discuss with the Program Director the time required to fulfill the educational requirements of the Residency Program as a result of any leave of absence approved. The decision of the Program Director.

Paid Leave of Absence. The Hospital provides the following paid leaves to House Officers after a thirty (30) day waiting period from the commencement of the Residency Program:

Bereavement Leave. Three (3) days for death of spouse, parent, child, brother, sister or grandparent. The Program Director may require written proof before paying the leave.

Jury Duty. House Officers are required to notify their supervisor when a subpoena for jury duty is received. If the absence would create a hardship on the Hospital, the Program Director should contact Human Resources to obtain a letter requesting that the employee be excused. House Officers who serve on jury duty will receive their regular pay for each day served. After the completion of jury duty service an employee must provide to his/her Program Director a copy of a court clerk’s certificate or jury pay stub noting the actual time served and the pay received for jury service. Checks should be given to the Prorgam Director who, in turn, forwards them to the cashier’s office. It is the responsibility of the Program Director to insure that House Officer returns these funds to the Hospital to be credited toward the stipend already paid. This excludes funds paid for transportation.

Marriage Leave. Three (3) days. A copy of the marriage license may be requested by the Program Director.

Birth of a Child. One (1) day off for the birth of his/her child.

Maternity Leave. It is the policy of the Hospital to provide paid maternity leaves to House Officers. House Officers will be provided with a maximum of two (2) months paid leave. If the House Officer requires more than two (2) months of leave and becomes eligible for short-term disability, the House Officer will be paid the Hospital’s short-disability rate for the duration of the disability to a maximum of six (6) months.

Unpaid Leave of Absence. The Hospital permits the following unpaid leaves of absence to House Officers:

Family & Medical Leave. The Hospital provides House Officers with up to thirteen (13) weeks of unpaid leave in any twelve (12) month period for family and medical leave as defined in the Family and Medical Leave Act of 1993 (“FMLA”). Eligibility for such leave is set forth in the Hospital’s FMLA Policy

Personal Leave. Personal leaves of absence shall be granted solely in the discretion of the Program Director and may be determined on a case-by-case basis

Military Leave. The Hospital permits leaves of absence for active duty military service and applies the regulations set forth in the Uniformed Services Employment and Reemployment Rights Act of 1994, 38 U.S.C. 4301-4333

Dismissal for Cause

The Residency Committee has the right to dismiss, without warning, in cases of unacceptable conduct. Anyone who is dismissed for cause may use the grievance procedure in this manual, for review and final dispensation. Grounds for immediate dismissal include, but are not limited to, the following infractions:

· appropriate professional conduct or unethical behavior

· Conduct endangering the life, health or safety of other

· Verbal or physical abuse of patients, patients' family members, or fellow workers

· Reporting to work under the influence of intoxicants or drugs.

· Illegal possession or use of intoxicants or drug

· Inefficient performance of duties or neglect of duty

· Falsification, misrepresentation, or omission of any information on employment or other official records

· Improper or unauthorized use of medical facilities or equipment

· Failure to respect patient confidentiality or discussion of patient's condition with unauthorized personnel.

· Malicious gossip about an employee, patient, physician or departmental representative.

· Leaving assignment during working hours without prior knowledge or permission of trainer.

· Insubordination

· Lack of cooperation in actual emergencies or in fire/disaster drills.

· Theft, regardless of value.

· Accepting monetary tips from patients or families.

· Intentional violation of other departmental policies.

Resident Hours

Each rotation will establish resident hours and on call schedules. They must comply with a schedule that allows time for educational conferences, study periods and meals.

All programs must comply with the New York State maximum residency workweek schedule. (See appendix A)

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.

St. Barnabas Emergency Medicine