Three Great Years of Emergency Medicine Training

Ultrasound

Clinical rotations outside the Emergency Department account for 25% of the residency. Required rotations are: anesthesiology, obstetrics/gynecology, orthopedics/hand surgery, MICU, CCU and neonatal intensive care unit. Residents spend some time off site at other rotations including Emergency Medicine at Mount Sinai Beth Israel, Pediatric Emergency Medicine at Mount Sinai Hospital, Toxicology at the New York City Poison Center and a trauma elective at a tertiary referral adult and pediatric trauma center.

Our critical care experience is augmented with a critical care consult rotation in the second year. On this rotation, ED residents act as the ICU consult resident for ED patients and present the case directly to the ICU attending and fellow. As patients wait for transition up to the ICU, the ED Critical Care resident guides the management of these patients providing relevant critical care experience in the first hours of the patient's course. In the MICU, our residents have a fully functional team in the unit of our EM-3 and EM-1 giving our residents valuable critical care training and decision-making experience as a senior.

Another great part of our EDs is our unique team-based structure, which allows us to see patients quickly and effectively. The resident teams change as you progress through your training:

Disaster Day
  • Interns either work on Red Team, which is run by the R3, or on Blue Team, which is a 1-on-1 team with an attending.
  • Second Years work only on Green Team, which is a 1-on-1 team with an attending.
  • Third Years work almost exclusively on Red Team, running an entire team and supervising and teaching the intern.
  • Residents also rotate through our Evaluation Unit, which serves lower-acuity patients.

Nurses are also assigned to a team, so that the physician and nurse always know who they're working with throughout a shift and there's no difficulty finding "which nurse is caring for patient X." Teams' workstations are also all physically located near each other, so it's easy to relay information about a patient to the nurse or other physician on the team.

First Year

RotationBlocks
(4 wks)
Description
Orientation ½The first 2 weeks of internship are designed to help the new residents integrate into the program and get acquainted with their colleagues. A series of lectures are given on core EM topics, as well as small-group teaching and training sessions. This is also when the ATLS course takes place. A significant part of this block is spent discovering the New York City night life.
Adult ED MSSL/MSW 3 ½Residents work ED shifts at both Mount Sinai St. Luke's and Mount Sinai West Hospitals and therefore benefit from exposure to two very different populations. While the majority of first year shifts are spent at St. Luke's, residents spend an equal amount of time at both sites during their second and third year.
Adult ED MSBI 1 ½Mount Sinai Beth Israel is the downtown campus of the Mount Sinai Health System. Residents in the ED for six weeks under the supervision of faculty from the MSBI residency program. This provides exposure to a different patient population from our primary sites as well as continued high acuity in this stroke and STEMI center.
Pediatric ED MSSL 1 ½The dedicated pediatric ED averages 20,000 visits a year and is located at St. Luke's hospital. It is staffed by pediatric emergency medicine board certified attendings. Residents will spend two blocks in the Pediatric ED during their first year and one block in their second year. During the third year of residency residents are assigned to at least one Pediatric ED shift per block throughout the year.
Pediatric ED MSH 1Residents spend two weeks in the Mount Sinai Pediatric ED. This institution provides a significant amount of complicated, tertiary care to sick pediatric patients. As a result, residents see a large complexity of patients with more exposure to sick children.
EMSThroughout Adult and Peds BlocksOne shift of every Adult and Pediatric ED block during the first year is dedicated to EMS ride-alongs. The residents are assigned to an ambulance crew that responds to the 911 system, and spend the day observing and assisting with patient management in the field. This is a great opportunity to become acquainted with the EMS personnel as well as to get a better understanding of how the NYC prehospital system functions.
MICU1The Medical Intensive Care Unit is located at St. Luke's hospital. Residents spend one block of their first year on this busy service and have ample opportunity to perform invasive procedures such as central lines, thoracentesis, paracentesis, and more. They also benefit from bedside teaching on ventilator and pressor management, as well as the general care of critically ill patients.
CCU1The Coronary Care Unit is again located at St. Luke's hospital. This service receives all STEMI patients presenting at both sites. Residents spend one block on this service and learn about the management of acute coronary syndromes dysrhythmias, and heart failure. The cardiology fellows dedicate two hours of every week day to teaching residents about ECG interpretation.
Ob/Gyn¾The labor and delivery service at Mount Sinai West Hospital is the busiest in the city and allows residents to become comfortable in assessing women presenting in labor and performing vaginal deliveries. Residents are also welcome to scrub in for cesarean sections and to assist the Gynecology residents in their ED consults.
Anesthesia ½The two weeks on anesthesia are spent entirely in the operating room. Residents learn and practice the essential principles of airway management, such as proper bag-valve-mask ventilation technique, endotracheal intubation, and the use of alternative airways such as the LMA.
Orthopedics ½Residents do two weeks on the orthopedic ED consult service in their intern and second years. On the rotation, residents are paired up with a senior orthopedic resident and respond to all orthopedic consults in the Mount Sinai West ED. The ED residents have no responsibility for floor patients or the OR. This is a great opportunity to evaluate orthopedic and hand injuries while practicing valuable skills like splinting, reductions, and complicated wound repair. Residents spend one day a week in the outpatient private practice of our Sports Medicine attending as well.
Ultrasound¼One week of the first and second years of residency are dedicated to Emergency Ultrasonography. Daily scanning shifts are scheduled with the Ultrasound Division directors and fellows. Emphasis is put on core ultrasound applications during the first year and more advanced applications during the second year or residency.
Toxicology ½On this rotation, residents rotate through the New York City Poison Control Center. Residents take part in follow-up calls made to the center as well as the didactics associated with the toxicology fellowship program and rotating resident curriculum. While on this rotation, residents take call with the toxicology faculty in our department responding to any consults in the MSSL and MSW EDs.
Vacation1Split into two 2-week blocks.

Second Year

Rotation Blocks
(4 wks)
Description
Adult ED MSSL/MSW 6 ¾During the second year at Mount Sinai St. Luke’s and Mount Sinai West, residents work directly with an attending physician one-on-one as a team with nurses and techs. This provides a significant amount of direct learning from attending physicians. Additionally, the second year resident is the airway resident in the ED.
Adult ED MSBI1Mount Sinai Beth Israel is the downtown campus of the Mount Sinai Health System. Residents in the ED for six weeks under the supervision of faculty from the MSBI residency program. This provides exposure to a different patient population from our primary sites as well as continued high acuity in this stroke and STEMI center.
Pediatric ED1See above.
Pediatric ED at Mount Sinai½

Residents spend two weeks in the Mount Sinai Pediatric ED. This institution provides a significant amount of complicated, tertiary care to sick pediatric patients. As a result, residents see a large complexity of patients with more exposure to sick children.

Orthopedics ½This is the second portion of the orthopedics rotation with similar responsibilities as the first year.
Trauma1 We augment our trauma experience with a dedicated month offsite from Mount Sinai St. Luke’s in order to expose residents to trauma in a referral center with different population dynamics. Options currently include Jackson Memorial in Miami and the R Adams Cowley Shock Trauma Center associated with the University of Maryland Medical Center in Baltimore.
Ultrasound¼See above.
Critical Care Consult1 This is a unique rotation where the ED resident functions as the ICU resident consult for patients being considered for ICU admission throughout the hospital. After evaluation, the ED resident presents the case directly to the ICU attendings and fellow with direct one-on-one teaching related to the patients. The consult resident becomes responsible for the patient until they are moved into the ICU. This rotation allows residents to develop skills in the management of patients after their acute management is completed and during the initial course of their critical illness.
Neonatal ICU ½Residents will rotate through the NICU at Roosevelt Hospital for 2 weeks. This will expose residents to the critical care management of neonates as well as pediatric procedures. Residents will be part of the team to respond to deliveries and take part in neonatal resuscitations.
Vacation1Split into two 2-week blocks.

Third Year

Rotation Blocks
(4 wks)
Description
Adult ED MSSL/MSW 8 ½During this year, the resident is responsible for running the Red Team. He or she is supervising an intern, running a team of nurses and techs and ultimately responsible for the flow of the team. The third year resident is also responsible for running every trauma and medical resuscitation in the department.
Adult ED MSBI1Mount Sinai Beth Israel is the downtown campus of the Mount Sinai Health System. Residents in the ED for six weeks under the supervision of faculty from the MSBI residency program. This provides exposure to a different patient population from our primary sites as well as continued high acuity in this stroke and STEMI center.
Pediatric ED1Third year residents are assigned approximately 1 out of every 4 shifts in the pediatric ED. This allows them to see pediatric patients throughout the year.
Research/Admin 1This four week rotation provides residents the opportunity to finalize scholarly activity as well as to take part in departmental administrative activities. This is also an opportunity to become involved with the QI process in a more formal way.
Medical ICU (MICU) 1Our PGY3 resident is the leader of one of the four resident teams in the MICU. The team is made of our EM3 and EM1 residents and is fully integrated into the unit as a team.
Elective1Opportunity for elective at SLR, away institution or internationally.
Vacation1 Split into two 2-week blocks.