Resident Training

About Emergency Medicine at Stroger Cook County Hospital
How to apply
Resident Orientation
Resident Rotations
Conferences
Ultrasound
Research
Resident Evaluation
Benefits and Compensation
Current Residents

RESIDENT LIFE        

Dear Residency Applicant, 

    There are a number of questions that all applicants have when they begin to evaluate emergency medicine residency programs. The Cook County Emergency Medicine Residency has prepared this site to allow you to begin to evaluate our program and compare it to others. 

     Please contact us if you have any questions. We also invite you to contact our Chief Residents for the 2007-2008 Academic Year: Andrew Osugi, M.D. aosugi@ccbh.org, Mike Schindlbeck M.D. mschindlbeck@ccbh.org, and Ethan Sims, M.D. esims@ccbh.org. If you live nearby or plan to visit Chicago, it's possible to spend a few hours of observation in the emergency department. Please contact our office at least one day prior to your arrival and we will make the necessary arrangements.

    After reading this information we hope that you'll consider applying to our program. Since interview spaces are limited, we can only grant interviews to individuals who have returned all of the necessary application materials via ERAS in a timely fashion.  We've worked hard to establish an exceptionally well-structured and comprehensive training program.

Sincerely,

Steven H. Bowman, M.D., F.A.C.E.P.
Residency Director

About Emergency Medicine at Stroger Cook County Hospital

The Cook County Hospital Emergency Medicine residency is committed to training emergency medicine specialists who can successfully compete for any position open to a residency graduate.  Our graduates are highly sought after for positions in both private groups and full time academic programs nationally.

The John H. Stroger, Jr. Hospital of Cook County (SHCC) (formerly Cook County Hospital) is a 480-bed, state-of-the-art, teaching hospital located on the near West Side of Chicago. The new hospital opened in January 2002.  The original Cook County Hospital was founded in 1855 to provide quality health care to the citizens of Cook County regardless of their ability to pay.  Today, the new SHCC is a world-renowned health care facility that has simultaneously continued to advance the frontiers of medicine and remained true to its original mission. 

Our Department of Emergency Medicine was founded in 1987.  Our program has been fully accredited by the EM-RRC of the Accreditation Council for Graduate Medical Education since its inception. Our current accreditation continues through 2011.

Stroger Cook County Hospital is an ideal learning environment for emergency medicine. Our emergency department combines diverse patient presentations, comprehensive faculty supervision, and excellent clinical teaching. Residents receive increasing independence and a greater degree of responsibility as they progress through the program. Twenty-eight full-time EM board-certified faculty provide a varied and dynamic knowledge base.

<--Top

How to Apply (New for 2007-2008!)

Beginning this year in the 2007-2008 interview season, the Cook County EM Residency will offer eight categorical PGY-1 positions as we begin our  transition from a 2-4 to a 1-4 training program. 

Our PGY-1 year will offer a broad range of clinical experiences, with an emphasis on subject areas relevant to emergency medicine practice, specialized didactics and early exposure to our department and faculty.   We expect to complete the transition to a full complement of 15 residents per class in three years.

The application process is essentially unchanged, except that now the Department of Emergency Medicine will sponsor its own internship year.

We are currently recruiting for PGY-1 positions beginning in July 2008 and PGY-2 positions beginning in July 2009. 

Interested candidates should apply to both of our NRMP tracts. 

The Categorical Tract is for candidates (i.e., medical students and residents) interested in a PGY 1-4 position that will begin in July 2008. 

The Advanced Tract (unchanged from previous years) is for candidates (i.e., medical students and residents) to begin as PGY2’s in 2009. Until we complete our transition, you must apply separately for a PGY-1 position at any ACGME accredited clinical program in the United States or Canada. 

The Physician’s Only Tract will be deleted.

As stated above, we expect to complete this transition in three years and at that time all of our positions will be categorical. 

If you have any questions please contact Dr. David Harter, Assistant Program Director, at dharter@ccbh.org.

The Cook County Emergency Medicine Residency Program participates in the Electronic Residency Application Service and we will not accept paper application materials. You may only apply via ERAS. 
 

Fourth year medical students should contact their medical school's Dean's office for more information. If you are not currently a fourth year United States medical student then contact the organizations below for more information.

In order to apply for our program we need to receive the following materials via ERAS: 

1.  NRMP Application
2.  USMLE Step I scores are required for all applicants
3.  Dean's Letter
4.  Official Medical School Transcript
5.  Three letters of recommendation. At least two should consist of Standardized Emergency
     Medicine questionnaires from emergency medicine faculty.

The annual application deadline is December 1^st.
 

Completed applications will be reviewed and interviews will be granted. Since the number of applications exceeds the number of interview slots, we regret that not everyone will be invited to visit our program and interview with our faculty and residents. We suggest that you complete your application as soon as possible to improve your chances of obtaining an interview.

Thank you for your interest in our program, we look forward to hearing from you. 
<--Top


Resident Orientation

     New residents begin with a four-week orientation during July. The major components of orientation include didactic sessions consisting of lectures and labs, closely supervised orientation shifts in the adult emergency department (AED), and social activities away from the hospital. 

     There are approximately twenty-four hours of lectures that cover the basics of emergency medicine. Lectures are given by our faculty and include topics such as management of acute myocardial infarction, approach to the poisoned patient, basic trauma evaluation, and ultrasonography. Two cadaver labs, a wound care/suture lab and several procedure labs allow residents to practice nearly all the procedures commonly performed in the emergency department. In addition, residents learn the splinting and casting techniques used in emergency medicine. Our department chairman, Dr. Robert Simon, nationally known for his textbooks on emergency orthopedics and procedures, teaches most of these labs. Residents are expected to be ACLS and BLS certified on arrival in order to participate in the ACLS instructor course during orientation. Emergency medicine provides most of the instructors for Stroger Cook County Hospital’s ACLS courses. We also provide a one-day base station course to introduce new residents to the structure of the Chicago EMS system and prepare them for radio control of pre-hospital medical care. 

     Besides the formal didactic sessions, all residents work seven introductory shifts in the AED. The new junior residents staff the AED with supervising senior residents and attending physicians. This has proven to be a fun and stimulating orientation to our emergency department and a good way to get to know fellow classmates, nursing, and support staff. 

     The Stroger Cook County Hospital serves as a hub of health care providers throughout Cook County. We introduce our new residents to the many community medical services that refer patients to the emergency department for evaluation, and to those to which we refer our patients upon discharge. 

     In addition to all the work, we still manage to squeeze in a few social activities such as the annual July orientation picnic; all spouses, significant others and children are welcome. Additionally the chief residents usually organize a department sponsored get-together for the new residents, old residents, and faculty.


Resident Rotations

     Residents work five or six four-week rotations in the adult emergency department (AED) during each year of the residency. Since our department has such a high volume, resident shifts are eight, rather than twelve, hours long. There are twenty shifts during each four-week rotation and scheduling usually allows for two weekends off per month. 

     Resident responsibilities increase from year to year to provide a maximal learning experience. The junior (PGY-2) emergency medicine resident provides primary patient care and learns how to evaluate the wide range of emergency patients. They are directly supervised by emergency medicine attending physicians and senior emergency medicine residents. In addition, they are primarily responsible for answering the telemetry calls from the Chicago Fire Department ambulances. The intermediate (PGY 3) emergency medicine resident is designated "team leader" for all resuscitations in the emergency department. The intermediate resident is responsible for directing the care of acutely ill patients. They are also expected to improve their efficiency and evaluate more patients simultaneously than during their junior year. The emergency medicine senior (PGY-4) resident supervises junior and intermediate residents, rotating residents from other services (medicine, OB/Gyn, family practice) and students. The senior emergency medicine resident and the attending share the responsibility of maintaining patient flow in the emergency department. 

     Attending physicians provide on-site supervision 24 hours a day with double, triple, and sometimes quadruple coverage. Attending physicians are ultimately responsible for all care provided in the emergency department. They also teach house staff and medical students, solve administrative problems and provide primary patient care. At Stroger Cook County Hospital, the attending physicians have admitting privileges to the medical surgical, and OB/Gyne services. 

     Our Emergency Department includes a 24-bed Observation Unit. Patients are admitted to the Observation Unit from the emergency department for up to 24 hours. Emergency medicine and internal medicine jointly staff the observation unit. The unit's main purpose is to provide an effective and safe alternative to inpatient admission for patients who need short term diagnostic or therapeutic intervention. The most common patient diagnoses currently include asthma, pneumonia, cellulitis, diabetes and low risk chest pain.

Trauma Rotations
     The Cook County Trauma Unit is America's first unit dedicated solely to the care of the traumatized patients. Founded in 1966, it has served as the model for modern day trauma care across the United States. Rather than having trauma as an adjunct of general surgery, under the trauma unit concept, a team consisting of trauma surgeons, emergency medicine physicians, and a dedicated nursing staff function together to provide the very best of trauma care.

     The Cook County Trauma Unit is one of seven Level I trauma centers serving the Chicago area. Among the seven centers, the Cook County Trauma Unit is one of the busiest, with nearly 5000 annual admissions. Approximately 35% of the admissions are due to penetrating trauma, and more than 10% require operative intervention.

     The reputation of the Cook County Trauma Unit stems from the large number of patients it serves and from the extensive publications based on its experiences. In many areas, it has provided national leadership in formulating the policies of trauma care. In an effort to continue its prominence in the field of trauma, many active projects are currently under way. The participation in these projects are considered as an integral part of the resident's rotations through the Cook County Trauma Unit.

     In December 2002, the Cook County Trauma Unit entered a new era when it relocated to the new Stroger Hospital. We are now located in a new state of the art hospital. In addition to our 16-bed resuscitation area we have our own 10-bed observation area and 12-bed lCU.

     Cook County Eemergency Medicine junior and senior residents have one four-week rotation in the trauma unit; intermediate residents have a six-week experience. As juniors, our residents function as part of a trauma team that takes call every other day. On-call days alternate between the front room and the trauma ICU. Juniors learn to implement a wide range of protocols developed by the Department of Trauma's faculty for optimal patient management, and become proficient in the procedures commonly used in trauma management. Residents participate in trauma conferences and attend daily teaching rounds. Intermediate emergency medicine residents are on-call in the front room every third day and alternate admissions and "team leader" responsibilities with a second year surgery resident. Senior emergency medicine residents are on-call every third night, alternating call with the two PGY-5 surgery residents. When taking call, seniors have primary responsibility for directing the trauma teams and supervising junior residents.

Pediatric Rotations
     One of our program's goals is to provide a thorough background in pediatric emergency medicine. To accomplish this, residents spend a total of five and one-half months on required pediatric rotations during residency, three or four in pediatric emergency departments. The pediatric rotations are designed so that residents advance during residency from high volume/low acuity rotations to lower volume/higher acuity rotations. Additional pediatric Level I trauma experiences are available in the trauma unit, University of Chicago Children's Hospital, and Children's Memorial Hospital rotations. 

     The first pediatric rotation junior year is in the Stroger Cook County Hospital pediatric emergency department. This high-volume unit sees 30,000 children annually. Under the supervision of pediatric attending physicians, our residents become familiar with the diagnosis and management of common childhood disorders. Junior residents spend two months in the Cook County Pediatric Emergency Department.

     Intermediate residents spend four weeks in the University of Chicago Children's Hospital emergency department. Despite its lower volume of 20,000 patients annually, Wyler has a higher number of tertiary care patients than the Cook County Pediatric Emergency Department. U of C's Emergency Department is a Level I pediatric trauma center for the south side of Chicago. Residents gain valuable experience in the diagnosis and management of not only the common childhood emergencies but also emergencies in children with complicated congenital and metabolic abnormalities.

     During the senior year, residents spend four weeks at Children's Memorial Hospital emergency department. Children's Memorial Hospital is also a Level I pediatric trauma center for the north side of Chicago and sees 40,000 children annually. Lower acuity patients are seen in a fast track area staffed by pediatric residents and attendings. In the emergency department, the residents act independently under the supervision of board certified pediatric emergency medicine attendings. The residents' schedules are designed so that they can attend conferences at both Children's Memorial Hospital and SHCC.

EM-1 Rotations
Neonatology/Labor and Delivery
     During this four-week rotation, residents spend two weeks in the newborn nursery and two weeks in Labor and Delivery. The newborn nursery staff evaluates all newborns and is responsible for resuscitation and management of problem neonates until transferred to the neonatal ICU. Since 85% of the deliveries at Stroger Cook County Hospital are high-risk, plenty of experience in neonatal airway management and resuscitation is available. Our residents deliver between 10 and 20 infants during their rotation on the obstetrics service. 

Anesthesiology
     The two-week anesthesiology rotation is based at Provident Hospital, a Cook County Bureau affiliate. This rotation provides emergency medicine residents additional experience with advanced airway management and the use of pharmacologic adjuncts. During this rotation, our residents work with anesthesiology attendings and participate in the induction, intubation, monitoring and extubation of surgical patients. Residents become skilled in the proper use of neuromuscular blocking agents, narcotics, barbiturates and benzodiazepines. Practicing emergency medicine physicians must be familiar with these agents since they are commonly used in the emergency department in a variety of situations.

Emergency Medical Service
     This two-week rotation is based at Stroger Cook County Hospital with the Chicago Fire Department, which provides emergency medical services for the entire city. During this rotation, the emergency medicine resident is exposed to all aspects of pre-hospital care. In addition to ambulance rides, residents may gain experience in aeromedical EMS through observational helicopter rides. Flying is never required. Residents participate in didactic paramedic teaching and may take advantage of the many EMS research opportunities. 

Orthopedic Rotation
     The Orthopedic Rotation is based at Stroger Cook County Hospital from the Department of Emergency Medicine. Residents are responsible for the evaluation and care of urgent and emergent orthopedic problems seen in the adult and pediatric emergency departments as well as the trauma unit. The resident acts as a liaison between emergency medicine and the orthopedic service. The resident will have exposure to initial evaluation, management, and stabilization of orthopedic conditions. Focus will be placed upon indications for ordering imaging studies as well as their interpretation, techniques of fracture reductions and stabilization, techniques of joint reduction and stabilization, indications for hospital admission for orthopedic problems, and appropriate disposition of emergent orthopedic problems. The resident's daily activities will include morning report with the orthopedic service and then proceeding to primary evaluation of orthopedic conditions in our adult emergency department. Didactic teaching includes bedside teaching by emergency medicine and orthopedic faculty and formal afternoon lectures on focused emergent orthopedic problems by emergency medicine faculty. The resident has first-call for all orthopedic consultations in the above-named areas and will interact with the orthopedic service for all formal consultations. The resident schedule consists of either day or evening 8-hour shifts 5 days a week.


EM-2 Rotations
Medical Intensive Care Unit
     Cook County Hospital is the site of the nation's first Medical Intensive Care Unit (MICU). It is a very high acuity unit and nearly all the patients in this facility require ventilatory support and invasive hemodynamic monitoring. The MICU is a very popular rotation with our intermediate emergency medicine residents. During this four-week period, they function as the senior resident of an MICU service. The emergency medicine resident is responsible for supervising one or two medicine interns and every fourth day they take call as an admitting team. Our residents gain valuable experience in shock management, invasive monitoring, and advanced airway procedures. Critical care attending physicians make rounds twice daily with each team and ICU fellows supervise call. 

Toxicology
     Toxicology has taken a major role in the practice of emergency medicine. Stroger Cook County Hospital, Rush Presbyterian-St. Luke's Medical Center and the University of Illinois Hospital have formed the Toxikon Consortium. During the four week rotation, emergency medicine residents serve as toxicology consultants for the three hospitals, answer telephone calls for all regional toxicology consultations, and staff the regional poison control center. A strong staff of board-certified toxicologists and fellows provides an excellent conference series, and a state of the art, computerized reference system is available to residents. The resident presents a thirty minute case conference at a joint EM-toxicology conference.

Community Hospital Rotation/OLR
     Intermediate residents spend 6 weeks at Our Lady of Resurrection (OLR) Emergency Department. The OLR ED was recently renovated and expanded. It is a high acuity emergency department with a census of 28,000 patient visits per year. A large proportion of the highest acuity patients is cardiovascular emergencies. The department is staffed by a young and dynamic group of emergency physicians. This rotation is designed to expose residents to the working conditions in a non-academic emergency department. Residents work 40 clinical hours per week, which permits attendance at the Cook County Emergency Medicine morning conferences.

EM-3 Rotations
Pediatric Intensive Care Unit
     The pediatric intensive care unit (PICU) of Stroger Cook County Hospital provides care for critically ill medical, surgical and trauma pediatric patients. This unit sees approximately 500 admissions annually. Senior emergency medicine residents function in the same role as senior pediatric residents while on this service. Call is every fourth day and when on-call, residents admit patients to their service and cover the entire unit. There is close supervision by pediatric critical care attending physicians and pediatric intensive care fellows. 
 
Community Hospital Rotation/West Suburban Hospital 
     To further expand the community ED experience, senior residents spend four weeks in the emergency department at West Suburban Hospital in nearby Oak Park.  This hospital serves a diverse population and is approved by the State for comprehensive pediatric emergency care.  The physician group is entirely board certified in emergency medicine.  West Suburban currently has 52,000 annual visits of which 16,000 represent pediatric cases.  Residents work a total of twenty, 9-hour shifts during the rotation and interact directly with admitting and specialist attendings.  The rotation requires our residents to master chart dictation and to utilize a patient tracking system.  Residents work in the main ED at the highest volume periods and when low acuity cases are being sent to a minor care area.  As a result, the acuity level becomes quite high and this translates into plenty of significant procedures and complex management decisions.  Finally, residents experience an efficient, high-quality, private emergency medicine practice.

Administrative Rotation
     Senior residents spend four weeks learning to complete the various administrative tasks and projects that exist in all emergency departments. Residents design and complete one quality assurance project. Each resident selects an additional administrative problem (real or hypothetical) and solves it usually in project form. They attend departmental committee meetings, provide technical and administrative support during conferences, and participate in the resident selection process during the interview season. During this rotation, each resident presents a senior lecture and a morbidity and mortality conference.

Elective Rotations
     Residents have a five-week elective in their senior year. During this time they may either select rotations in which they have a particular interest or use the time to gain additional experience in areas in which they feel deficient. Electives may consist of a variety of rotations and may be done at Stroger Cook County Hospital or elsewhere. The residency directors must pre-approve all electives. Popular electives include oral surgery, ENT, podiatry, ophthalmology, and EKG interpretation. 

<--Top


Conferences

     Conference attendance is mandatory for all residents. There are five hours of conference each week. The format of the lectures varies with the topic presented. A weekly Grand Rounds presents current topics in emergency medicine. Potential speakers include faculty from our own department, visiting local or nationally known emergency medicine faculty, and faculty from other departments within Stroger Cook County Hospital. Monthly adult, pediatric, trauma and toxicology case conferences provide interactive sessions allowing residents to become involved with the cases presented. The emergency medicine chief residents present patient follow-up conferences. Spirited monthly morbidity and mortality conferences review controversies, errors in clinical decision making and patient management. 

     Residents are responsible for preparing case conferences in their junior and intermediate years and are required to give one core conference during their intermediate year. Journal club is organized by a pair of intermediate residents on a rotating basis and takes place eight times each year at faculty member's home. Seniors must give a formal senior lecture presentation and one morbidity and mortality conference. Residents receive instruction to aid the development of strong lecture skills. We provide workshops in slide making and videotape mini-lectures to provide feedback on speaking style. The residency directors and faculty provide a written evaluation and critique on the content, delivery, audiovisual aids, and overall quality of resident lectures. 

<--Top


ED Ultrasound

Introduction:
     The Department of Emergency Medicine views Limited ED Ultrasound as an extension of the physical examination in the emergency department. Limited ED ultrasound expedites patient care and can provide critical information during the resuscitation of patients. The Department of Emergency Medicine has an active Emergency Ultrasound Program. Ultrasound lectures are given early in the residency program to help jump start the residents in their ultrasound certification process.

Credentialing Process: 
     The credentialing process for residents passes through three phases: Level I (Introductory phase  12 weeks), Level II (Learning phase  12 months), and Level III (credentialed). Level I sonographers cannot perform ultrasounds independently. The Level I sonographers are in the process of becoming acquainted with the ultrasound machine and anatomy. All of the Level I scans must be supervised by a Level III sonographer. Level II sonographers can perform ultrasounds independently but they cannot be used for patient clinical decision-making. Level II sonographers must perform 25 ultrasounds for each body area (OB transabdominal, OB transvaginal, gall bladder, aorta, kidney, trauma) using the ultrasound documentation guidelines. After satisfactory review of the 25 ultrasounds in any of the above areas according to the ultrasound documentation guidelines will qualify the practitioner to be a Level III sonographer in that area. Level III sonographers can perform limited ED ultrasounds independently and the results of the ultrasound can be used in patient clinical decision making.

Ultrasound Documentation Guidelines:
OB Transabdominal:
            -Sagittal overview including bladder, uterus
            -Transverse overview including bladder, uterus
            -Demonstration of intrauterine pregnancy via yolk sac, fetal pole or fetus
            -Measurement of cardiac activity via Mmode if fetus is present
            -Measurement of gestational age is optional
            -Demonstrate presence of absence of free fluid
OB Transvaginal:
            -Midline sagittal overview including the fundus of the uterus and the posterior portion
             of the bladder
            -Transverse overview including of uterus
            -Demonstration of intrauterine pregnancy via yolk sac, fetal pole or fetus
            -Measurement of cardiac activity via Mmode if fetus is present
            -Measurement of gestational age is optional
            -Demonstrate presence of absence of free fluid

Gall Bladder
     Visualized the gallbladder and the adjacent main lobar fissure and portal vein Demonstrate gallbladder in 2 views Determine presence or absence of peri‑cholecystic fluid Identify and measure of common bile duct if visible Level 11 Credential Requirement:
• Identify stones and shadowing in a minimal number of 10 patients
• Measure the gall bladder wall thickness in 10 patients

     Aorta Sagittal view of aorta from superior mesenteric artery to bifurcation Transverse view at superior mesenteric artery, midway to bifurcation and at bifurcation Measure sagittal diameter Two measurements in transverse diameters Level H Credential Requirement: * Two abnormal exams
Kidney Visualize kidney of presumed pathology Measure long axis of kidney and identify abnormalities in size Recognize varying degrees of hydronephrosis (mild, moderate and marked) Recognition of abnormal cysts and masses is encouraged but optional Level II Credential Requirement:
• Demonstrate hydronephrosis in 5 patient
• Minimum of 10 scans of left kidney