Starting An Emergency Medicine Residency Terry Kowalenko, MD, FACEP Program Director University of Michigan/St. Joseph Mercy Hospital Associate Professor Emergency Medicine University of Michigan Steven Bowman, MD, FACEP Program Director John Stroger (Cook County) Hospital Assistant Professor Emergency Medicine Rush Medical College

Objectives Introduce overall strategy to start an Emergency Medicine Residency Give a historical perspective (U.S. and Ghanaian experience) as a potential model for others Detail a “Needs assessment” Introduce overall strategy for curriculum development Identify ways to assess the success of your new program

Needs Assessment Terry Kowalenko, MD, FACEP Program Director University of Michigan/St. Joseph Mercy Hospital Associate Professor Emergency Medicine University of Michigan September 15, 2009 Valencia, Spain

Needs Assessment Patients Facility Faculty Administrative Support Residents Education Infrastructure

Needs Assessment Why do you need or want an Emergency Medicine Residency? Create a Mission Statement Does the institution and/or other services want an Emergency Medicine Residency? What kind of obstacles should you anticipate? What kind of opportunities are available?

Why? Improve patient care Improve patient outcomes (Morbidity/ Mortality) Improve triaging of patients Improve access to medical care Improve patient throughput

Needs Assessment: Patients How many? - ACGME Emergency Medicine Residency Review Committee (RRC): 30,000/year What kinds? - Adults - Pediatrics - Medical - Trauma/Surgical - Critical Care - Minor/Urgent Care

Needs Assessment: Patients Which procedures need/can be done in the Emergency Department (ED)? - Can residents perform them? How much work-up is necessary in the ED? Where do they go after ED work- up? - In-patients - Out-patients - Transfers (How?) How do they pay (if necessary) ?

Needs Assessment: Facility Do you have enough clinical space for patients, faculty, residents, nurses, staff? - Waiting Area - Triage Area - Patient Care Area - Resuscitation Bays - Monitored Beds - Pelvic Rooms - Pediatric Rooms - Observation/Holding Area - Inpatient beds

Needs Assessment: Facility Do you have enough support services/staff? - Nurses - Technicians/Transporters - Laboratory - Doctors/Consultants - Blood Bank - Radiology - Pharmacy - Security - Social Work - Housekeeping

Needs Assessment: Facility Do you have enough equipment? - Patient Care Equipment (IV’s, Saline, etc.) - Beds/Gurneys - Laboratory - ECG Machines - Cardioversion/ Defibrillators - X-Ray, CT, MRI, Ultrasound - Monitors

Needs Assessment: Facility • Is there adequate administrative space for faculty and residents? - Offices - Conference Room • How many hospital admissions come through the Emergency Department?

Needs Assessment: Facility What is the pre-hospital environment? - Ambulance Entrance - Emergency Medical Services (EMS) personnel - What role will the residents play? - Ride alongs? - EMS education? - Aero medical transport

Needs Assessment: Faculty How many? - ACGME Emergency Medicine RRC: 3:1 Residents to Core Faculty - “Core” vs. “Clinical” Who? - Which specialties will instruct until Emergency Medicine doctors trained? - Qualifications?

Needs Assessment: Faculty Scholarly activity/requirements? Protected time ($ ?) How many lectures/labs? Continuing medical education (CME) requirements ($ ?) Funding to present research? How and how much do you pay faculty?

Needs Assessment: Administration Who will lead/chair the division/department? Who will be the program director? Do you have space, funding, and appropriate office staff to support a residency? - Residency Coordinator If not a department, which department will you be affiliated with?

Needs Assessment: Administration Inter-departmental liaisons? Does your institution have a Designated Institutional Officer (DIO)? - Oversees/administrates all institutional training programs Does your institution have other training programs? - Don’t re-invent the wheel

Needs Assessment: Administration How will you fund the residency? - Faculty Support - Equipment - Scrubs/ White coats - Communication devices (beepers, cell phones, etc.) - Computer/Information technology (support services) - Educational Materials - Models - Labs - Books/On-line services (departmental library) - Residency Salaries/Benefits

Needs Assessment: Administration Does the government play a role? Is there a governing body for all training programs? - Accreditation Council of Graduate Medical Education (ACGME) - Rules/Regulations

Needs Assessment: Residents Will students be interested in Emergency Medicine? Where will you get them from? How will you let them know about and recruit them to your program? What criteria will you use to select them? Is there affordable and safe housing for them when they arrive? Will there be jobs for them when they graduate?

Needs Assessment: Education Are you affiliated with a university? - Does the school/Dean support Emergency Medicine Training? Will medical students and other residents rotate in the Emergency Department? - Roles and responsibilities Does the institution have a library?

Needs Assessment: Education Does the institution have educational laboratory/simulation facilities? Does the institution have research related support? - Do you have a faculty “champion or expert”? Is there a final accrediting body (like American Board of Emergency Medicine - ABEM)?

Needs Assessment: Summary Patients Facility Administration Residents Education Mission Statement