Pediatrics experience
Pediatrics experience is incorporated into many rotations throughout the residency. The emergency department takes care of all of the critically ill children that present to Geisinger Medical Center. Although GMC has a Children’s Hospital, there is not a separate Pediatric ED. Therefore, the emergency department has a constant variety and mix of pediatric and adult patients. Twenty percent of ED visits are by pediatric patients. Emergency Medicine sees all pediatric patients who present with major or minor trauma, and residents gain significant experience in procedural sedation, pediatric orthopedics and wound repair. In addition to those presenting to the ED, many pediatric patients with acute medical complaints (fevers, gastroenteritis, rashes, otitis, etc.) are seen in the pediatric acute care clinic. Emergency medicine residents see these urgicare complaints during the outpatient pediatrics rotations of the PGY1 and PGY2 years. Pediatric care at the acute care clinic is supervised by attending staff from the Department of Pediatrics. The pediatric intensive care unit (PICU) was opened in 1995 when the pediatric facilities were moved into the new Janet Weis Children’s Hospital. The PICU rotation began in 1990. This pediatric intensive care month provides pediatric resuscitation and procedure experience for the Emergency Medicine residents. Additional pediatric exposure in the program includes the ability to spend several days of the anesthesia rotation performing pediatric intubations with the pediatric anesthesiologists, and emergency medicine residents fly for critical pediatric trauma cases that arrive at Geisinger. All residents receive an initial provider certification in Pediatric Advanced Life Support in the PGY1 year. Emergency Medicine research
The Geisinger Medical Center Emergency Department has maintained an active research program since 1977. David Dula, MD, is the research coordinator and is supported by the other full-time staff physicians. Dr. Dula also serves as a review editor for the Annals of Emergency Medicine. The department has the capability of conducting basic science research and has a research building on campus. The research building has a two-bay animal OR and is supported by on site statisticians, veterinarians and lab technicians. The emergency department also has a research fund and a dedicated EM research physician’s assistant, which can be used to support projects and fund statistical work. It is expected that each resident will conduct a scholarly project prior to graduation, although acceptance of this work as a publication is not a requirement for graduation. The required scholarly project can be tailored to each resident’s interests, and can take many forms such as original clinical research, publication of a case report, development of clinical guidelines, or authorship of a textbook chapter. Although only one is required, some residents have successfully completed 5-6 projects leading to national presentations and publication. During the third year of residency there is an annual emergency medicine research seminar which gives residents an opportunity to present their work. Geisinger Medical Center also provides support for residents to present their research work at state and national emergency medicine meetings Adult intensive care
All patients admitted to the adult ICU are managed primarily by the critical care medicine service with consultation from other services. Residents rotating on this service care for critically ill or injured trauma patients, medicine patients, surgical patients, neurosurgical patients, and obstetric/gynecologic patients. Residents receive extensive experience in ventilator management, invasive hemodynamic monitoring, resuscitation and many procedures pertinent to emergency medicine. Responsibility is graduated, and PGY-2 residents gain increased patient management responsibilities and supervisory roles. The clinical experience is augmented by didactic lectures from the critical care medicine staff. Anesthesia
Airway management is a vital skill for emergency physicians, and PGY1 residents spend a month on anesthesia to gain initial airway skills. These skills become the airway management basics that allow the residents to handle the most difficult emergency and traumatic airways. During the anesthesia rotation the resident spends time in a busy surgical suite performing mask ventilation, airway adjunct uses, endotracheal intubation and pediatric endotracheal intubation. Residents average 80-120 intubations during this rotation. Residents also spend several days with the oral surgeons mastering oral/facial nerve blocks. The basic airway skills are honed during the remainder of the residency, as residents become very comfortable with rapid sequence induction and controlling the most difficult airways. The Life Flight® experience allows residents to perform many intubations in the challenging prehospital setting. Residents are exposed to multiple airway adjuncts in the ED, including fiberoptic lighted stylets, supraglottic rescue airways, and wave-form end-tidal CO2 monitoring. The emergency medicine residents and staff have the primary airway management responsibility in "trauma alert" and all other ED patients. Cardiology/CCU
The inpatient cardiology services include a CCU, an intermediate unit and dedicated telemetry-monitoring floors. More than 3,000 patients are admitted to these units annually. The rotating resident serves on a team consisting of a PGY1, PGY2, a cardiology fellow, and a staff cardiologist. The team follows cardiac patients on all of the units and during consultations/ admissions in the emergency department. Residents study the pathophysiology of cardiovascular disease and gain an increased understanding of ECG interpretation, thrombolytic administration, cardiac catheterization, echocardiography, and stress testing. Residents on the cardiology rotation also serve as members of the in-house "code team", and the PGY2 resident serves as "captain" of the code team when on-call. Geisinger is an accredited chest pain center, and offers a 24 hour “Level I STEMI” program for surrounding hospitals. LifeFlight Orientation/EMS/Ultrasound
During this one month rotation, PGY1 residents receive an introductory exposure to ground EMS, the Life Flight® air medical program, and emergency medicine ultrasound. Residents spend two days per week riding with Danville Ambulance Service. This allows residents to experience emergency medical care in the field and also introduces residents to the local EMS personnel. Residents observe emergency medical dispatch procedures, BLS and ALS pre-hospital care, and participate in EMS quality improvement projects. An additional two days per week are spent with the Life Flight® crew. The resident receives mandatory flight safety briefings and becomes familiar with operational procedures. This introduction and observational flights allows the resident to function as an integral part of the crew during the PGY2 and PGY3 years. Ultrasound has been a formal part of our curriculum since 1991. During the month, the resident spends time in the ultrasound department and ED performing emergency ultrasound exams. Time is spent with ultrasound technicians practicing scanning techniques, with radiologists interpreting scans, and with ultrasound educational videos. As one of a few EM programs with the MedSim Ultrasound Simulator, residents have access to hundreds of simulated EM ultrasounds. The emergency department houses two dedicated ultrasound machines for focused emergency medicine exams of ED patients, and residents continue to gain ultrasound experience during all ED rotations. All residents complete between 150 and 350 ultrasound exams during the program. Trauma Surgery
Geisinger Medical Center is designated as a Level 1 regional resource trauma center – the highest level attainable in Pennsylvania. In addition, our hospital is also designated as a Pediatric Trauma Center. Trauma patients are treated in a tiered system of response. Critically ill patients are handled as "trauma alerts" and are cared for by a team consisting of attending physicians from emergency medicine and trauma surgery, residents from emergency medicine and general surgery, and ancillary staff. The emergency medicine resident and staff physician have the primary responsibility for airway management. Trauma patients that do not meet trauma alert criteria are evaluated by emergency medicine, and a "trauma consult" is obtained if admission or additional care is required. During the PGY2 year, EM residents rotate on the trauma service and provide inpatient care to trauma patients admitted to the Adult Intensive Care Unit. Obstetrics
This PGY1 rotation provides procedural experiences in evaluating pregnant patients in labor and performing deliveries. Residents are also exposed to neonatal resuscitation and evaluation. Residents may also gain additional experience with Obstetric-related ultrasound. Electives
Emergency medicine residents have two elective rotations in the PGY3 year. Electives at Geisinger Medical Center include radiology, outpatient pediatrics, pediatric intensive care, dermatology, occupational medicine, EMS, orthopaedics, ophthalmology, and many others. Other electives can be tailored to a resident’s interests. A toxicology elective is offered at Pinnacle Hospital Toxicology Center. The toxicology service is led and staffed by emergency physicians sub-specialized in toxicology. The staff has an in-patient toxicology service. An extensive didactic program bolsters the elective experience. Housing is available for this rotation. An Indian Health Service EM elective is available at the Tuba City, Arizona emergency department. | 
