Curriculum Overview

A.  Curriculum

The post-graduate program will focus on a specific clinical module topic each month, in addition to focusing on a specific procedure each month.  Each day the residents will present a clinical case presentation with a case-based education seminar that will last approximately one hour, and during clinical shifts the residents will round on patients in the emergency department with faculty.  Each week there will be at least 9 hours of educational seminars, focusing on the month’s modular topic and core literature in Emergency Medicine.  This will include didactic presentations, journal club article reviews, simulation exercises, and guest speakers from senior consultants.  In addition to the overall curriculum structure, each resident will receive a monthly set of clinical and educational assignments and responsibilities.

The primary textbook will be Emergency Medicine: A Comprehensive Study Guide 8th edition edited by Judith E. Tintinalli.  In addition, Rosen’s Emergency Medicine: Concepts and Clinical Practice will serve as a supporting textbook, and Clinical Procedures in Emergency Medicine by James R. Roberts and Jerris Hedges will be used to teach necessary procedures in the emergency department.  Each module will end with a post-test to measure the residents’ level of comprehension and mastery of the materials during the module session.  The Society for Academic Emergency Medicine (SAEM) and the Council of Emergency Medicine Residency Directors (CORD) have developed a “Model Curriculum for Emergency Medicine” which serves as a basis for the post-graduate program’s curricular structure.   The full three year curriculum can be found in Appendix A.  The curriculum will be implemented on a rolling basis in coordination with other MEM programs in India to allow for streamlining and coordination.

The following table describes the curriculum details for the 36-month post-graduate program:

Table 1. Curriculum for Post Graduate Program in Emergency Medicine





Post Graduate Program in Emergency Medicine
3 Year Didactic Schedule
Module & Month Topic Tintinalli 8 Chapters (and additional resources) Procedures
Module 1 – July Orientation 11,14-17, 22-27; also Rosen's section 2 - Cardinal Presentations Cardiac/Pulm Arrest - Adult & Pediatric
Module 2 – Aug Cardiovascular I 49 -55 Transthoracic/Transvenous Pacing
Module 3 – Sept Airway 28-30, 247 ET Intubation/RSI
Module 4 – Oct Peds I 106, 109 - 113, 116 - 128 Lumbar Puncture
Module 5 – Nov Shock 12,13, 20, Rosens Chapter on Shock CVC
Module 6 – Dec Infectious Disease 149 - 155, 162 - 163 I&D
Module 7 – Jan Trauma I 254 - 259 Trauma resus - Adult & pediatric
Module 8 – Feb Gastrointestinal 71 - 87 G-tube replacement, hernia reduction, Anorectal Procedures
Module 9 – Mar Ortho I: Traumatic 267 - 278 Fracture Reduction/Splinting
Module 10 – Apr Toxicology I 176 - 200 A-line
Module 11 – May Neurology 164 - 175 Regional Anesthesia
Module 12 – June REVIEW REVIEW REVIEW
Module 13 – July Orientation see above Cardiac/Pulm Arrest - Adult & Pediatric
Module 14 – Aug Cardiovascular II 56 - 61 Defib/Cardioversion
Module 15 – Sept Trauma II 260 - 266 Tube Thoracostomy, Peritoneal Lavage
Module 16 – Oct Peds II 129 - 148 IO/Venous Cutdown
Module 17 – Nov OB/GYN 96 - 105 Vaginal Delivery
Module 18 – Dec Pulmonary 62 - 70 Vent Management
Module 19 – Jan Soft Tissue/Wound Care 21, 35 - 38, 39 - 47 Laceration Repair
Module 20 – Feb Psychosocial/Violence 286 - 295 4-point Restraint
Module 21 – Mar Peds III 136-148 Lumbar Puncture
Module 22 – Apr Endocrine 223 - 230 SVT Conversion
Module 23 – May ENT & Ophtho 241 - 247 Slit Lamp, Nasal Packing
Module 24 - June REVIEW REVIEW REVIEW
Module 25 – July Orientation see above Cardiac/Pulm Arrest - Adult & Pediatric
Module 26 – Aug Cards Crit Care 18 - 20 Cric/Transtracheal Ventilation
Module 27 – Sept Radiology Other resources, such as Schwartz - Emergency Radiology, Case Studies Bedside Ultrasound, Arthrocentesis
Module 28 – Oct Neonatology 107, 108, 114, 115 Umbilical Vein Cath
Module 29 – Nov Procedures / Research 31 - 34, Roberts & Hedges, ACEP Research Primer Procedural Sedation
Module 30 – Dec Ortho II: Non-Traumatic 279 - 285 Joint reduction, Compartment Syndrome
Module 31 – Jan Infectious Disease II: Tropical 156 - 161 Pericardiocentesis
Module 32 – Feb Renal & GU 88 - 95 Paracentesis
Module 33 – Mar Toxicology II, Environmental 201 - 222 Gastric Lavage
Module 34 – Apr Heme/Onc Derm 231 - 240, 248 - 253 FB Removal
Module 35 – May Administrative/Emergency Public Health 300, 302, 303 Thoracentesis
Module 36 – June REVIEW REVIEW REVIEW

Chap 11 Fever**Reading from Rosen’s

Chap 14 Confusion

Chap 15 Coma

Chap 17 Headache

Chap 18 Dyspnea

Chap 19 Chest Pain

Chap 22 Abdominal Pain

B.  Educational Program

The residents will receive instruction from a combination of faculty from RRIEM/GWU and the host medical institution.  These educational experiences will include one-hour morning seminars with an emphasis on case-based teachings that will focus clinical management issues.  The residents will be given or themselves present a clinical scenario, and then the instructor will lead the residents through a discussion that includes: developing a differential diagnosis, ordering appropriate laboratory and radiology diagnostic tests, finding the diagnosis, and managing and treating the clinical problem.  It is suggested that this occurs in ‘oral boards style’. Instructors will then provide clinical teaching through bedside clinical rounds of specific patients.

Each week, the program will dedicate a total of at least 9 hours for educational conference. It is suggested that this occurs as a once weekly block of 5 hours of protected didactic time for the residents that will include didactic lectures, case conferences, journal article discussions, and guest lecturers in addition to the daily one hour morning conference four days a week described above.  During these conferences, the residents will be excused from clinical responsibilities, and will have protected time for their educational development. Fundamental components of the education program include:

  • Lectures on the modular topic of the month
  • Evidence-based medicine
  • Journal article discussions
  • Grand rounds and guest speakers
  • Morbidity and mortality (M&M) conferences
  • Follow up case discussions on patients admitted through the emergency department
  • Procedures and skills seminars
  • Presentations by the residents
  • Multidisciplinary case discussions

The content of the weekly seminars will also focus on the modular topic for the particular month.  Residents will be expected to prepare presentations for their colleagues on both the modular topics and related journal clubs. These presentations will improve the residents speaking and presentation skills. The Emergency Medicine faculty will also invite experts from other fields such as cardiology, surgery, and pediatrics to give guest lectures on important topics that are related to emergency medicine. Residents will be expected to read assigned chapters in their textbooks and to read relevant journal articles. 

In addition, residents will be encouraged to initiate and conduct research projects pertinent to emergency medicine, and they will be required to write a scholarly article that is worthy of publication. The residents will be expected to work on a research project with the faculty, and they will be required to submit one abstract or oral presentation at a medical conference.  The residents should also each submit one paper to a journal for potential publication.  Finally, successful graduation for each resident will require the completion of a thesis paper that may be based on the resident’s prior research presentations or published articles.

During the third year of training, residents selected by host medical center and RRIEM/GWU will have the option of spending 4 weeks at George Washington University Hospital working with the faculty in Washington, D.C. as an elective observership. These residents will be responsible for their airfare, housing, and meals during the elective.

RRIEM/GWU will provide a faculty member onsite at host medical center for five days each month during the program for intensive academic instruction and for project oversight.  RRIEM/GWU faculty will also provide remote educational web-based resources monthly such as evidence based medicine articles, lecture presentations including video grand rounds, and journal clubs.

Students completing this program will be eligible to take the three-part MRCEM exam. Additional curricular elements during the three year course may be added as additional preparation for this exam such as regular OSCE practice sessions. Receiving MRCEM certification is not required, although it may provide some students additional job opportunities if they choose to complete the exam.

C.  Clinical Rotations

The residents will rotate through both the emergency department and other important clinical services.  The residents will spend 7/12 months each year in the Emergency Department and of the remainders of the time rotating through other services.  The rotations in the other departments will provide the residents with opportunities to develop important knowledge and skills in core subjects. Expected rotations will be as follows:

PGPEM Year I:

  • Emergency Department (7 months)
  • Research/Ortho procedures & wound care(2wk/2wk)
  • Pediatric Ward (1 month)
  • ICU (1 month)
  • CCU (1 month)
  • Anesthesia (1 month)

PGPEM Year II:

  • Emergency Department (7 months)
  • Research/elective (2wks/2wks)
  • ICU (1 month)
  • OB/Gyn (1 month)
  • Trauma (1 month)
  • Peds ED (if available)/PICU(1 month)

PGPEM Year III:

  • Emergency Department (7 months)
  • Research/elective (2wk/2wk)
  • ICU (1 month)
  • PICU/NICU (2 wk/2wk month)
  • Trauma (1 month)
  • USA ( 1month)/ or elective

D.  Evaluation and Assessment

The residents will be routinely evaluated to assess their continuous learning and incorporation of the emergency medicine knowledge and skills.  They will also be given an opportunity to provide feedback and assessments of the PGPEM and the instructors on periodic basis.  The residents will take monthly post-tests for each module topic, and a minimum level of performance will be required in order to complete the program.  In addition the faculty will conduct yearly written and oral exam that covers the core topics of Emergency Medicine.   A comprehensive final exam including both a written and an oral component will be given at the end of the residency program, with minimum requirements for certificate distribution.  The senior members of the Society for Emergency Medicine in India (SEMI) will also be invited to participate as oral examiners for the final exit exam at the end of year three.

In addition to Residents will be evaluated according to expectations of graduated experience, knowledge, and responsibilities as they progress in the 36 month curriculum.  Senior residents will be expected to provide bedside teaching, didactics, lectures, mentorship, and supervision of junior residents.  Rotating residents will be evaluated based on the expectations listed on the rotation guides given to outside faculty at the start of the rotation. Faculty are expected to return the resident evaluations at the end of each monthly rotation with specific feedback.

Residents will be evaluated using the evaluation forms every month by at least one attending, either an emergency medicine faculty or the main faculty supervising each outside rotation. At least one evaluation per year will be completed by members of the Emergency Department non-faculty staff (nurses, patient care staff) in regard to professionalism and interpersonal skills. Residents will be scheduled to review their evaluations, procedure logs, tests, and overall progress with the program director every six months.  During this session, residents will be given feedback on performance in the program, pointers on how to improve their performance, and an opportunity to discuss program-related issues with the program director.  This will also be an opportunity to review procedure logs and research projects. Residents will be expected to fill-out an evaluation form of the program every 6 months.  These evaluations will be reviewed by the program director as a way to continuously improve the program. Any feedback from residents regarding faculty or outside rotations will be provided to the faculty or outside rotations in an anonymous and constructive manner at the program director’s discretion. Residents will be able to review their own files and past evaluations at any point during the program by appointment with the program director. Either the resident or the program director can arrange a meeting at any point in the program to address issues pertinent to the resident’s education or progress.