Residency Clinical Curriculum PGY-1
Emergency Medicine (24 weeks)
Vanderbilt University Medical Center (VUMC), located in the heart of Nashville, serves the people of Tennessee and throughout the region in neighboring states.
VUMC is a leading research organization devoted to patient-centered research and receives research funding from many federal sources. The emergency department is a leader in emergency care research and enrolls thousands of patients every year in multiple high-quality, multicenter studies.
It is a National Cancer Institute-designated Comprehensive Cancer Center, comprehensive stroke center, the only national Level I trauma center, Level I pediatric trauma center, and comprehensive burn center in Middle Tennessee. In addition to our residency program, VUMC is also home to more than 90 other training programs with over 1,000 residents and fellows, which means that residents will learn alongside other superior trainees from across the country.
Anesthesia (3 weeks)
Interns spend three weeks with anesthesia faculty and certified registered nurse anesthetists practicing endotracheal and nasotracheal intubations, bag-valve masking, LMA placement, IV insertion and peripheral nerve blocks.
This is strategically placed within the intern year to give first-year residents practice and build their confidence with the technical skills intubation requires before proceeding with difficult airways in the emergency department. Most residents will log about 30-50 intubations over the course of three weeks.
OBGYN (2 weeks)
Though most residents will deliver a baby (or multiple) in the emergency department or ambulance bay during their training, interns rotate on the labor and delivery service for two weeks to gain experience delivering babies.
The Department of Emergency Medicine works closely with the OBGYN residents and faculty, as well as the nurse midwives, to run the labor and delivery unit. Most residents will assist with about 10 deliveries per week, far surpassing the required 10 deliveries to graduate.
The time spent on the labor and delivery service helps residents feel equipped to handle anything related to active deliveries. Additionally, this rotation helps foster great relationships (and friendships) between the emergency department and the OBGYN residents.
Trauma (4 weeks)
As part of the department’s relationship with the trauma surgery department, each resident spends four weeks during the first year and six weeks during the second year as a member of the trauma team.
As the “trauma junior,” residents are actively involved in all level one and level two trauma resuscitations that present to the hospital, responsible for primary/secondary surveys and emergent procedures when indicated in the trauma bay. Vanderbilt is a busy trauma center, and most residents attend about 30-50 resuscitations during the month. Emergency Medicine residents work alongside surgical residents to see all trauma consults, develop plans, perform procedures, and attend trauma teaching conferences daily.
Residents manage the trauma patients admitted to the Intensive Care Unit (ICU) as well as the stepdown unit. This rotation is one of the highest-yield for procedures, including central lines (5-10), arterial lines (10-20), ultrasound-guided peripheral IVs (too many to count!), and chest tube placement (5-10).
Ultrasound (2 weeks)
This rotation is focused on high-quality, hands-on ultrasound training by the devoted ultrasound faculty and fellow. In addition to scanning patients throughout the department over several weeks, residents are able to scan standardized patients with real-time feedback from faculty.
Residents attend weekly ultrasound conferences where scans from the prior week are reviewed and assessed for quality.
Residents typically log about 150-200 ultrasounds over the course of this rotation, which surpasses ACGME requirements. Residents become very comfortable integrating ultrasound into everyday patient encounters in the emergency department.
Vanderbilt Medical ICU (4 weeks)
Interns spend four weeks in the Medical ICU at VUMC caring for some of the sickest patients in the hospital with a wide range of diagnoses including multisystem organ failure, acute respiratory failure, acute decompensated liver failure, renal failure, sepsis, ingestions, GI bleeds, and end-of-life care.
The day starts with a lecture led by one of the Medical ICU fellows, followed by rounds with a senior resident, fellow, attending, pharmacists and nurses. Residents are then responsible for placing consults, talking to consultants, managing patients, and performing all procedures.
The critical care attendings at Vanderbilt are world leaders in management of respiratory failure, and have pioneered some of the landmark developments in the field. Learning the basics (and beyond) of ventilator management in this environment is a priceless opportunity.
VA Medical and Cardiac ICU (4 weeks)
The Veterans Affairs Hospital in Nashville is located on Vanderbilt’s campus directly next to Vanderbilt University Hospital. Throughout all three years, residents rotate in the emergency department at the VA hospital; interns spend a month in the VA Medical and Cardiac ICU.
The VA Medical and Cardiac ICU functions as both a cardiovascular intensive care unit and a medical intensive care unit, providing residents with a chance to manage complex cardiac patients. Common presentations to the cardiac side of the ICU include STEMIs, NSTEMIs, unstable arrhythmias, pericardial effusions, patients who are s/p cardiac ablations, acute on chronic decompensated heart failure, and patients presenting for heart transplant workup.
Residents learn management of Swann-Ganz catheters, observe cardioversions and perform many bedside echoes. The cardiology teaching in the VA Medical and Cardiac ICU is second to none. The focus on training in resuscitations as makes emergency medicine residents leaders in the ICU when a patient decompensates, and often, senior level medicine residents will turn to EM residents for guidance in these critical situations. Emergency medicine residents have right of first refusal for all procedures in the Medical and Cardiac ICU as well so there are plenty of opportunities to perform central lines, arterial lines, ultrasound guided IVs, paracentesis, and lumbar punctures.
Vacation (3 weeks)
Each academic year, residents will have three weeks of vacation, in addition to an extra five to six days over either Christmas or New Year holidays.
While residents may spend time traveling to see family or for a tropical beach vacation, there is plenty to do not far from Nashville. Road-trip to the Great Smoky Mountains National Park for hiking and camping, head up to Bowling Green, Kentucky, for bourbon tasting and a visit to the National Corvette Museum, or drive to Memphis for some blues and barbecue.
If you prefer a staycation in Nashville, hike one of the many trails at Percy Warner Park, rent a kayak to float down the Cumberland River, or try some local brews while listening to live country music. The possibilities are endless!