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Clinical Curriculum

As a Physician Assistant 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.

Microsoft Office document iconBlock Curriculum

Fundamentals Course
The Iowa Fundamentals of Emergency Medicine Course is a week-long CME course for APP and primary care providers working in emergency medicine. Learner practice locations range from local to international and practice settings range from rural to urban and community to academic. A small number of participants encourages frequent discussion and plenty of time to ask experts questions. Throughout the course, learners will be exposed to both basic and advanced elements of emergency care with a focus on up-to-date, evidence based medicine. In addition to traditional lectures, learners will have the opportunity to participate in small group discussions, simulation sessions and hands-on skill workshops. PA residents participate in this course during their first month of residency. Enrollment fees are waived for PAs enrolled in the residency training program.

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. PA residents also participate in the course. The ALS course is a great opportunity for PA residents to learn through “spaced repetition”, the concept that learning something once (i.e. 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 sometimes faculty) against each other in a race at Lake Macbride.

UIHC Emergency Medicine
PA residents will spend the majority of their time in the main emergency department during the 18 month curriculum, approximately seven blocks in total. 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 PA 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. PA 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.

PA 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. PA residents will be allowed to perform any procedures required for the patients they are caring for under the supervision of an attending physician, senior emergency medicine resident or credentialed staff
APPs. As PA 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
PA residents spend two and a half dedicated blocks seeing patients in our pediatric emergency department. Specific pediatric resident coverage occurs between the hours of 1:00PM and 1:00AM with pediatric EM faculty coverage beginning at 10:00AM. Pediatric nurses are present in the department 24 hours daily. The pediatric provider team is assigned to see all patients up to the age of 18.99 years old. Being a tertiary referral center, PA residents are exposed to a diverse mix of “bread and butter” pediatric patients along with complex and clinically challenging patients. PA 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, PA residents will also have the opportunity to participate in pediatric traumas after they have completed their trauma and anesthesia blocks. The department will also arrange for PA residents to complete Neonatal Resuscitation Program training.

WCHC Emergency Medicine (Washington County Hospital and Clinics)
PA residents will complete two blocks at the Washington County Emergency Department, one block during their first 12 months and one block during their last 6 months. All shifts during the rotation will occur with direct physician supervision on site. This department is staffed by EM faculty from the University of Iowa. PA residents will have the opportunity to evaluate and treat a variety of critical, emergent and lower acuity patient presentations in a rural emergency
department setting with more limited access to resources compared to the University of Iowa emergency department. A goal of this rotation is to emphasize and highlight that emergency medicine occurs in many different clinical settings. In keeping with the mission of our program, we realize that some of our PA resident graduates will go into practice in resource limited, critical access healthcare settings that will require them to be self reliant and adaptable. This rotation will provide a unique emergency medicine experience to PA residents that is different from the experience at the UIHC main campus which has all specialty services and an abundance of resources available at all times.

Anesthesia
All PA residents spend a half block 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 and endotracheal intubation (both direct laryngoscopy and video laryngoscopy). PA 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
PA residents spend a half block on an orthopedic surgery rotation. Half of the time is spent in the sports medicine clinic. 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, PA residents gain exposure to various orthopedic injuries, hand injuries, sports injuries and infections as well as having the opportunity to practice reduction, splinting, arthrocentesis, interpreting radiographic studies and practicing special exam maneuvers.

Toxicology
PA residents will complete a half block rotation with the Toxicology hospital consult service. This is a division within the Department of Emergency Medicine staffed by physicians who have completed fellowship training in Toxicology. The state of Iowa also relies on the Poison Control Center which works closely with the Toxicology service. A broad array of intentional and accidental poisonings are managed by the toxicology service. PA residents will work with other
learners while on this rotation and will have responsibilities including taking consult calls from UIHC providers, seeing and presenting patients to Toxicology attending physicians, recommending diagnostic and therapeutic care plans in conjunction with the patient’s primary team and rounding on patients being followed by the toxicology service. Daily didactic sessions are scheduled to cover common toxicology topics with presentations being given by attending toxicologists as well as learners participating in the rotation.

Trauma Surgery
The trauma surgery rotation is an exciting opportunity for PA residents to experience trauma from the point of view of the surgeons rather than the EM providers. PA residents along with physician residents from surgery and other services are paged to the emergency department whenever a trauma is set to arrive. The PA residents participate in the trauma resuscitation along with surgery residents and the EM residents working in the emergency department.  Additional requirements for the rotations include rounding on all patients admitted to to trauma surgery service and handling floor calls for the trauma patients. The patient population is typically split about equally between the SNICU and the regular floor, exposing PA residents to a broad range of patient complexity. The hours are typical of a surgical service, running from 5:30am–6:30pm on weekdays with shorter hours rounding on the weekends, but PA residents do get two full weekends off during the full block rotation with no patient care responsibilities.  The weekly trauma conference is an excellent learning experience and the topics presented are frequently highly relevant to emergency medicine practice. PA residents also attend surgery grand rounds and M&Ms, which presents another great opportunity for learning. While this is a particularly challenging month, the experiences gained and relationships formed are crucial to hone skills necessary for trauma patients in the emergency department.

Ultrasound
Ultrasound curriculum for the PA Residency will train residents according to current SEMPA/ACEP standards for bedside clinical ultrasound. This will involve both didactic and bedside education over the entirety of the residency. An initial bootcamp for the PA Residents in their orientation month will give PA Residents a strong working base of knowledge to start incorporating ultrasound into their clinical practice. Moving forward, each resident will have regularly scheduled ultrasound scanning shifts which will be proctored by Ultrasound Faculty or senior residents for further guided practice. During these scanning shifts, PA Residents will have hands on guidance on acquiring, interpreting and documenting clinical ultrasounds performed in the department. In addition, this time will also be used to dive deeper into clinical decision making processes associated with clinical ultrasound. Education will cover core exams of clinical ultrasound including: eFAST, Cardiac, Thoracic, Biliary, Renal, Aorta, Transabdominal and Transvaginal OB, DVT, Soft Tissue as well as adjunct areas including procedural guidance, musculoskeletal and ocular. When PA Residents perform scans on their clinical shifts, they will still be able to store and interpret images, which will all receive regular feedback by email from scheduled Quality Assurance meetings conducted by the US Faculty, to allow for even further asynchronous educational opportunities.

Surgical and Neuroscience Intensive Care Unit (SNICU)
While rotating in the SNICU for one full block, PA residents manage critically ill patients from the Trauma Service, General Surgery, Neurosurgery, Neurology, Transplant Surgery, Obstetrics and Gynecology and other surgical patients.  Common diagnoses include polytrauma, intracranial bleeding, stroke, septic shock, hypovolemic shock, cardiogenic shock, and respiratory failure.  You will interact with other ICU providers and learners from various specialities while developing treatment plans for critically ill patients. There are opportunities to perform critical care skills and procedures relevant to emergency medicine on a regular basis including intubation (direct, video, fiber optic), central lines, arterial lines, ventilator management, tube thoracostomy, vasopressor management, and volume resuscitation.

Medical Intensive Care Unit (MICU)
PA residents spend a half block working in the MICU which provides another opportunity to work closely with intensive care specialists and learners from other medical services. Additional knowledge and skills regarding ventilator management and other noninvasive respiratory support will be a main focus as a number of patients admitted to this unit have respiratory failure from diverse etiologies. You will help care for patients with complex pulmonary and cardiovascular pathology as well as all forms of shock and severe metabolic derangements. As many of these patients are critically ill, you will also have opportunities to be involved with close communication between patients and family and friends and participate in goals of care discussions when appropriate.