Clinical Curriculum

As an Advanced Practice Provider (APP) resident, you spend time both in the Emergency Department learning the basics of Emergency Medicine, and additionally spend time on a variety of other services to learn skills essential to the practice of Emergency Medicine.

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Fundamentals Course

The Iowa Fundamentals of Emergency Medicine Course is a week long CME course for APP providers across the state.  Throughout this week, learners will be exposed to both basic and advanced elements of emergency care.  In addition to small group sessions, learners will have the opportunity to participate in simulation sessions and procedure labs.  APP residents participate in this course during their first month of residency.  Enrollment fees are waived for Iowa APP residents.

Advanced Life Saving Course

The Advanced Life Saving (ALS) Course occurs every July and serves as the orientation month for physician residents and fourth year medical students interested in emergency medicine.  APP residents also participate in the course.  The ALS course is a great opportunity for APP residents to learn through “spaced repetition” the concept that learning something once (during the Fundamentals Course at the beginning of your residency) then again at a later date increases retention.  Throughout the ALS course, residents will have the opportunity to participate in faculty led didactic sessions, case-based small group discussions, procedure competency labs, and high-fidelity simulations.  The highlights of the month are the annual Wilderness Medicine race that pits teams of residents (and sometime faculty) against each other in a race at Lake Macbride.  Additionally, residents have the opportunity to provide medical support for RAGBRAI at the end of the month.

Emergency Medicine

APP residents will spend the majority of their time in the main emergency department during the eighteen month curriculum, approximately nine total months. The emergency department is structured into two teams, with each team having an attending physician and a mix of one to three emergency medicine physician and APP residents and off service residents from a variety of specialties. There is also a group of staff APPs working in the emergency department between the hours of 7:00AM and 12:00AM. APP residents will be assigned to a team on the schedule and will be required to staff all patients with that team’s corresponding attending physician. Shifts are scheduled for nine hours, with the expectation of seeing patients for eight hours and using the last hour to disposition patients, transition care to the oncoming team, and finish up notes. There are multiple set shifts which cover the 24 hours that the department sees patients.

APP residents will be allowed to see all patients needing care in the emergency department. As you progress through the curriculum, we expect you to become more comfortable and efficient caring for a larger number of patients as well as seeing more critically ill patients. APP residents will be allowed to perform any procedures required by the patients they are caring for under the supervision of an attending physician, senior emergency medicine resident or credentialed staff APP. As APP residents advance through the curriculum, they will also have an expanded role in assisting with the clinical training of more junior emergency medicine learners.    

Pediatric Emergency Medicine

APP residents spend three dedicated blocks seeing patients in our pediatric emergency department. Between the hours of 12:00PM and 12:00AM, a team of providers is assigned to see all patients up to the age of 18. This team is made of a pediatric emergency medicine staff physician along with one to three physician and APP residents from emergency medicine and a variety of other specialties.  Being a tertiary referral center, APP residents are exposed to a diverse mix of “bread and butter” pediatric patients along with complex and clinically challenging patients. APP residents have the opportunity to perform a number of different pediatric procedures including procedural sedation, foreign body removal, laceration repair, and lumbar punctures. During these blocks, APP residents will also have the opportunity to participate in pediatric traumas. There are also a number of pediatric didactic sessions throughout these blocks facilitated by pediatric emergency medicine staff. The department will also arrange for APP residents to complete Neonatal Resuscitation Program training.

Anesthesia

All APP residents spend two weeks rotating through anesthesia.  During this rotation, residents have the opportunity to practice a variety or airway maneuvers including bag-valve mask ventilation, supraglottic airway placement (laryngeal mask airways) and endotracheal intubation (both direct laryngoscopy and indirect laryngoscopy).  Residents have also had the opportunity to participate in other advanced airway skills including fiberoptic awake intubation and nasotracheal intubation.  This is a great month to augment the airway experience that you gain in the emergency department and in the ICU.

Orthopedic Surgery

APP residents spend two weeks on an orthopedic surgery rotation. Half of the time is spent in orthopedic clinic, predominately hand surgery and sports medicine.  The remainder of the rotation is working with the orthopedic surgery residents responding to consults in the emergency department as well as inpatient consults.  Throughout this rotation, APP residents gain exposure to various orthopedic injuries, hand injuries, sports injuries and infections as well as having the opportunity to practice reduction, splinting and casting techniques.

Trauma Surgery

The trauma surgery rotation is an exciting opportunity for APP residents to experience trauma from the point of view of the surgeons rather than the EM practitioners. APP residents along with other interns are responsible for handling floor calls for the trauma patients, ranging from medication checks to wound care to acute decompensation of patients on the team. The patient population is typically split about equally between the SNICU and the floor, exposing APP residents to a broad range of patient morbidity. They are also paged to the ED whenever a trauma is set to arrive. The APP residents participate in the trauma resuscitation along with surgery residents and the EM residents working in the emergency department. There is a small component of clinic work seeing follow-up patients, but this is typically quite straight-forward and there is a dedicated trauma nurse-practitioner who sees many of the patients in clinic. The hours are typical of a surgical service, running from 5:30am–6:30pm on weekdays with shorter hours rounding on the weekends, but APP residents do get 2 full weekends off during the month-long rotation with no patient care responsibilities. The weekly trauma conference is an excellent learning experience, and the topics presented frequently overlap with EM issues and practice. APP residents also attend surgery grand rounds and M&Ms, which are also great for learning. All in all, the month is filled with remarkable educational experiences which help to hone skills necessary for working with traumas in the Emergency Department.

Ultrasound

All APP residents will be required to complete a two week block of ultrasound training. This block will cover core ultrasound studies for emergency medicine providers. APP residents will be required to view a number of instructional videos prior to performing ultrasound exams in the emergency department. APP residents will be assigned hands-on scanning times to work directly with emergency medicine staff experienced in ultrasound training for a number of shifts during the two week block. APP residents will also be expected to scan on their own or with peers in the emergency department on their own to complete additional practice exams. You will have the ability to record images and video clips on our modern, high quality ultrasound machines that will be stored in a virtual workflow station, and can later be reviewed with faculty.  This rotation may also serve to gain credentialing for any clinical setting that you may work in the future.

You may consider using elective block time for advanced ultrasound training to pick up extended level of skills such as for advanced cardiac imaging, bowel imaging, testicular and ovarian imaging, ultrasound guided peripheral vascular access, ultrasound guided nerve blocks, advanced musculoskeletal imaging, ocular imaging, or simply to enhance skills obtained during the required block. Opportunities are available within our emergency department as well as with specialty clinics outside of our department.  

EKG Course

APP residents will complete this course during their first month of the residency. You will work with other APP residents and emergency medicine faculty to improve core skills with EKG interpretation and identifying can’t miss diagnoses aimed at junior emergency medicine learners.  Core topics will include Basics of EKG reading, Approach to Ischemia, Approach to Syncope, Approach to Bradydysrhythmias, Approach to Tachydysrhythmias. During the 18 month curriculum, additional dedicated EKG training will be available and aimed at more advanced learners. Finally, there is never a shortage of interesting real life EKGs to interpret while working clinically.   

Surgical Intensive Care Unit

While rotating in the SNICU, residents manage critically ill patients from the Trauma Service, General Surgery, Neurosurgery, Cardiothoracic Surgery, Transplant Surgery, and other surgical patients. Common diagnoses include poly-trauma, intracranial bleeding, stroke, septic shock, hypovolemic shock, cardiogenic shock, respiratory distress, and hypertensive emergency. The opportunities to perform an abundance of procedures/critical skills relevant to Emergency Medicine are performed on a regular basis including: intubation (direct, glidescope, fiberoptic), central lines, arterial lines, ventilator management, tube thoracostomy, vasopressor management, and volume resuscitation.