Rotation Schedule Overview

The PGY1 year is an exciting one with a focus on the approach to both emergency medicine and critical care. The goal of the intern year is to provide a solid foundation in the management of both medical and surgical emergencies. Interns spend roughly equal amounts of clinical time in the Emergency Department and on off-service rotations.

Prior to starting their clinical rotations, the intern class participates in a two week orientation. This orientation period offers interns an opportunity to get to know one another, while simultaneously attending several clinical courses. In addition to obtaining both BLS and ACLS certifications, interns receive an introduction to ED ultrasound, procedure workshops, an overview of wellness resources, and various other introductory lectures.

ED-Based Rotations:
In addition to spending 27 weeks in the Adult and Pediatric Emergency Department, interns complete a 2 week ED ultrasound rotation. During this time, they have the opportunity to practice their scanning skills under the direct supervision of ultrasound division faculty members and participate in ultrasound division didactics.

Off-Service Rotations:
Interns spend 2.5 months in the ICU setting, rotating through the CCU, MICU and SICU. Additionally, interns spend time in the orthopedics evaluation area, participating in urgent and emergent ED orthopedics consultations. On the anesthesiology rotation, interns have the opportunity to become familiarized with airway management in a controlled setting. An additional 2 weeks are spent in the Psychiatric Emergency Department, as well as on internal medicine’s general service.

2 weeks – Orientation to the DEPARTMENT OF EMERGENCY MEDICINE
27 weeks – Emergency Department (Pediatrics and Adults) – LAC+USC
2 weeks – EM Ultrasound – LAC+USC
4 weeks – Surgical Intensive Care Unit – LAC+USC
2 weeks – Cardiac Care Unit – LAC+USC
4 weeks – Medical Intensive Care Unit – LAC+USC
2 weeks – Internal Medicine Wards – LAC+USC
1 week – Psychiatric ED – LAC+USC
2 weeks – Anesthesia / Orthopedic Evaluation Area – LAC+USC
2 weeks –Selective – LAC+USC
4 weeks – Vacation

We understand the importance of self-care and reflection during training and provide ample opportunities throughout the year for residents to debrief on work-life challenges during residency. As a group, the PGY1 class will write a reflection piece during their orientation week, outlining their purpose, individual mission, and goals for residency training. Interns can also participate in our “opt-out” mental health counseling program (see below) and are introduced to other institutional and departmental wellness programs during their residency orientation:

Opt-out program: Our interns are all scheduled for an “opt-out” on-site mental health therapy session with an on-site mental health counselor to establish connections and care early on in their training.

Helping Healers Heal: Our institutional H3 team (Helping Healers Heal) is comprised of trained crisis response facilitators that are available to meet with residents after difficult cases or any challenging situation encountered during training.
Our institutional Wellness Director, Tobi Fishel PhD: all residents have free access to discuss any issues (mental health and non mental health related) with our phenomenal Director of Residency Wellness.

Our departmental Peer Family program: all residents join a family that consists of a PGY1, PGY2, PGY3, and PGY4 resident. These families meet regularly and longitudinally during protected time to discuss various projects and work/life challenges associated with training.

The PGY2 year is designed to provide supervised experience in the management of commonly encountered critical and non-critical illnesses. There is particular focus on developing procedural competence, resuscitation, multi-tasking, and increasing the sophistication of patient management.

The PGY2 year includes certifications in the ATLS, PALS, and ACLS-Instructor courses. In addition, all PGY2s travel to Catalina Island to participate in a course in hyperbaric medicine at the hyperbaric chamber run by the Department of Emergency Medicine.

ED-Based Rotations:
During their PGY2 year, residents begin working in both the Resuscitation area and the Jail Emergency Department. The addition of Resuscitation shifts pushes residents to hone their procedural and resuscitation skills. The Jail ED experience drives residents to begin expanding their independence in clinical decision-making. PGY2 residents also complete a second 1-week ED Ultrasound rotation. This rotation builds upon the foundation established during the PGY-1 year.

Off-Service rotations:
To round out their year-long focus on resuscitation and critical care, PGY2 residents spend 1 month in the Medical Intensive Care Unit (MICU) acting as an integral part of the MICU team. They also spend 3 weeks rotating in a community hospital emergency room at the Verdugo Hills Hospital of USC. Finally, residents complete a 3-week OB rotation at the Good Samaritan Hospital gaining experience in vaginal deliveries and the management of peri-partum and post-partum patients.

34 weeks – Emergency Department (Pediatrics and Adults) – LAC+USC
3 weeks – Obstetrics – Good Samaritan Hospital
1 weeks – EM Ultrasound – LAC+USC
1 week – EMS
4 weeks – Medical Intensive Care Unit
3 weeks – Community Emergency Department – USC Verdugo Hills Hospital
2 weeks – Elective – LAC+USC
4 weeks – Vacation

As a group, the PGY2 class embarks on two separate 3-day retreats in both winter and summer to engage in career mentorship and class bonding.

The PGY3 year provides supervised experience in the recognition and management of higher-acuity clinical emergencies and promotes an even higher level of competence and confidence in non-critical patient management.

This training year provides residents with increasing responsibilities both in the emergency department and throughout the hospital.

In addition to individual patient care responsibilities, the PGY3 resident is in charge of overseeing the ER West pod, while acting as “2 Star”. As 2 Stars, residents must supervise the flow of patients through their assigned area from triage to final disposition, make decisions regarding resource utilization within the area, and enhance clinical teaching of junior residents, physician assistants, and students.

Beyond their responsibilities in the ED, PGY3 residents begin to carry the “code bag”, responding to hospital-wide cardiac arrest and airway codes activations, where they are charged with leading the resuscitation team and efforts. During their PG3 year, residents also spend one month in the Pediatric Intensive Care Unit (PICU) at Long Beach Memorial Medical Center / Miller Children’s Hospital

33 weeks – Emergency Department (Pediatrics and Adults) – LAC+USC
2 weeks – Toxicology
4 weeks – Pediatric Intensive Care Unit – LBMMC/Miller Children’s Hospital
4 weeks – Elective – LAC+USC
4 weeks – Vacation

With increased responsibility, there is also greater emphasis on self-care and reflection. Residents utilize their Elective rotations to focus on projects that hold personal and professional purpose as they become more aware of their identities as physicians. The PGY3 class also has two protected 3-day retreats in the winter and summer months that provide an opportunity for bonding, reflection and career mentoring. In addition, all PGY3 residents are protected to attend the annual ACEP Scientific Assembly in the fall.

The PGY4 year allows the continued refinement of independent clinical judgment, honing the sophisticated management of both critical and non-critical patients. It also encourages the development of academic, teaching, research, managerial, and administrative skills and provides residents with opportunities to train in areas of highest interest. Its purpose is to produce emergency physicians who can practice at the highest level of clinical Emergency Medicine and who can integrate all aspects of the specialty into a balanced professional career.

Overall, the PGY4 year is designed to augment clinical knowledge and skills with a specific emphasis on the development of leadership capabilities.

While in the Emergency Department at LAC+USC, PGY4 residents serve as the 2 Star in the Resuscitation pod. They are responsible not only for highest acuity medical and trauma resuscitations, but also for overseeing the flow of patients throughout the entire department, including the Jail, West, and North clinical areas.

The 2 Star has the authority to make decisions that have far-reaching implications, both within the department and throughout the Medical Center. Specifically, they oversee the utilization of resources and personnel, the movement of patients from triage into the various clinical areas, CT scanner prioritization, and the influx of patients being transferred into LAC+USC from surrounding hospitals. This intensive clinical experience is meant to produce specialists with the highest level of proficiency in Emergency Medicine.

36 weeks – Emergency Department (Pediatrics and Adults) – LAC+USC
4 weeks – Community Emergency Department – Verdugo Hills Hospital
4 weeks – Community Pediatric Emergency Department – Miller Children’s Hospital/Long Beach Memorial Medical Center
4 weeks – Elective – LAC+USC
4 weeks -Selective
4 weeks – Vacation

PGY4 residents have ample time for electives and career planning with dedicated residency office mentorship and guidance.

*PGY – Post-Graduate Year