Rotation Schedule Overview

The PGY1 year is an exciting one – with a focus on emergency medicine and critical care. The goal of the internship year is to provide a solid foundation in the management of both medical and surgical patients. Interns spend roughly equal amounts of time within the Emergency Department and on outside rotations.

Intern year begins with a two-week orientation. This orientation allows the class to get to know one another while going through several special courses. These courses include: BLS, ACLS, and introduction to ED ultrasound, concepts relating to wellness during residency, as well as various other introductory lectures.

ED-Based Rotations:
In addition to 24 weeks in the Adult and Pediatric Emergency Department, Interns complete a 2-week dedicated ED ultrasound rotation. Interns have the opportunity to practice their scanning skills under the direct supervision of ultrasound division faculty members as well as participate in US division didactics.

Off-Service Rotations:
Three months are dedicated to ICU training in the CCU, MICU and SICU. Additionally, interns rotate through the ED orthopedics evaluation area participating in urgent and emergent ED orthopedics consultations. On the anesthesiology rotation, interns become familiarized with airway management under more controlled and expected conditions than those in the ED. Two weeks are spent in the Psychiatric Emergency Department participating in emergent psychiatric consultations.

2 weeks – Orientation to the DEPARTMENT OF EMERGENCY MEDICINE
22 weeks – Emergency Department (Pediatrics and Adults) – LAC+USC
2 weeks – EM Ultrasound – LAC+USC

4 weeks – Surgical Intensive Care Unit – LAC+USC
4 weeks – Cardiac Care Unit – LAC+USC
4 weeks – Medical Intensive Care Unit – LAC+USC
4 weeks – Internal Medicine Wards – LAC+USC
2 weeks – Psychiatric ED – LAC+USC
2 weeks – Anesthesia – LAC+USC
2 weeks – Orthopedic Evaluation Area – LAC+USC

4 weeks – Vacation

Wellness:
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 training in a peer-facilitated small group setting, to practice mindfulness and to participate in community outreach to enrich their training. As a group, the PGY1 class will write a reflection piece during orientation week outlining their purpose, individual mission, and goals for residency training. Interns also are introduced to our institutional and departmental wellness programs during orientation that includes:

  1. Our institutional H3 team (Helping Healers Heal): trained crisis response facilitators can meet with residents after difficult cases or after any challenging situation encountered during training.
  2. 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 Wellness Coordinator
  3. Our departmental Peer Family program: all residents join a family that consists of a PG1, PG2, PG3, and PG4. The families meet regularly during protected time throughout residency to discuss various work/life challenges associated with training.
The PGY2 year is designed to provide supervised experience in the management of all the commonly encountered critical and non-critical illnesses. There is a particular focus on developing procedural competence, resuscitation, multi-tasking, and increasing the sophistication of patient management.

The PGY2 year also includes special courses and certification in ATLS, PALS, and ACLS-Instructor Course. All of these courses occur during protected time. In addition, all PGY2s go 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 the PGY2 year, residents expand their clinical responsibilities to both the Resuscitation area and the Jail Emergency Department. The addition of Resuscitation pushes the residents to hone their procedural and resuscitation skills. The addition of the Jail ED drives the residents to expand their independence. In addition to the clinical rotations, PGY2s complete a second two-week ED Ultrasound rotation. This rotation builds upon the foundation learned in the PGY-1 year.

Off-Service rotations:
To round out their year-long focus on resuscitation and critical care, PGY2s spend one month in the Medical Intensive Care Unit (MICU) acting as an integral part of the MICU team, as well as one month in the Pediatric Intensive Care Unit (PICU) at Long Beach Memorial Medical Center / Miller Children’s Hospital. Additionally, residents complete a 3-week OB rotation at Good Samaritan Hospital to gain experience in vaginal deliveries and management of the peri-partum and post-partum patient.

33 weeks – Emergency Department (Pediatrics and Adults) – LAC+USC

3 weeks – Obstetrics – Good Samaritan Hospital
2 weeks – EM Ultrasound – LAC+USC
2 weeks – EMS
4 weeks – Medical Intensive Care Unit
4 weeks – Pediatric Intensive Care Unit – LBMMC/Miller Children’s Hospital

4 weeks – Vacation

Wellness:
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 training in a peer-facilitated small group setting, to practice mindfulness and to participate in community outreach to enrich their training. As a group, the PGY2 class has both a winter and summer 3-day class retreat as a venue for bonding as well as an opportunity to provide career mentoring.

The PGY3 year provides supervised experience in the recognition and management of the major critical clinical entities, which present to an Emergency Department and promotes an even higher level of competence and confidence in non-critical patient management. Training also continues in other pertinent medical specialties.

The PGY3 year in Emergency Medicine is a year of increasing responsibility both in the emergency department and throughout the hospital.

In addition to individual patient care responsibilities, the PGY3 has responsibility as the Resident-in-Charge (aka 2 Star) in West. As the 2 Star, the resident must oversee the flow of patients through the area from triage to final disposition, make decisions regarding resource utilization within the area, and supervise junior residents, physician assistants and students. The Resident-in-Charge is in direct communication with the Resident-in-Charge in the Major Resuscitation Area, a position always held by a PGY4 resident.

In addition to the responsibilities in the ED, PGY3 Resident in Emergency Medicine is the leader of the hospital-wide cardiac arrest (Code Blue) team. As the leader of the Code Blue team, residents respond to all emergency resuscitation codes throughout the entire hospital, including the Intensive Care Units and Outpatient Clinics.

36 weeks – Emergency Department (Pediatrics and Adults) – LAC+USC
5 weeks – Elective – LAC+USC
3 weeks – Toxicology

4 weeks – Community Emergency Department – USC Verdugo Hills Hospital

4 weeks – Vacation

Wellness:
With increased responsibility, there is also increased import for self-care and reflection. The PGY3 residents are provided opportunities throughout the year to practice mindfulness and participate in community outreach to enrich their training. Residents utilize their Elective rotations to focus on projects that hold personal significance and purpose as they become more aware of their self and direction as clinicians. The PGY3 class also has two protected 3-day retreats in the winter and summer months, as a venue for bonding, reflection and opportunities for career mentoring. In addition, all PG3’s are protected in the Fall to attend the annual ACEP Scientific Assembly.

The PGY4 year is designed to provide for the continued refinement of independent clinical judgment and the development of sophistication in both critical and non-critical patient management; to promote the development of academic, teaching, research, managerial and administrative skills; and to provide opportunities for training 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.

The PGY4 year in Emergency Medicine is designed to raise the knowledge and skills developed with a specific emphasis on the development of leadership skills.

While in the Emergency Department at LAC+USC, the PGY4 residents serve as the Senior Resident-in-Charge (aka 2 Star) in the Resuscitation Area. They are responsible not only for the major resuscitations, but also for overseeing the flow of patients throughout the entire department, including the Jail, West and North areas.

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

32 weeks – Emergency Department (Pediatrics and Adults) – LAC+USC
5 weeks – Elective – LAC+USC

3 weeks – Community Emergency Department – Verdugo Hills Hospital
4 weeks – Pediatric Intensive Care Unit – Miller Children’s Hospital/Long Beach Memorial Medical Center
4 weeks – Community Pediatric Emergency Department – Miller Children’s Hospital/Long Beach Memorial Medical Center

4 weeks – Vacation

Wellness:
With increased responsibility, there is also increased import for self-care and reflection. The PGY4 residents have the opportunity to facilitate our small group peer to peer small group debrief sessions. PG4’s also have ample time for electives and career planning with close residency office mentorship and guidance.


*PGY – Post-Graduate Year