University of Maryland Medical Center Intranet

May 7, 2018
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The Emergency Medicine/Internal Medicine Program (EMIM) at the University of Maryland was approved in 1995 by both the American Board of Emergency Medicine (ABEM) and the American Board of Internal Medicine (ABIM). Our first residents began in July 1996. Since its inception, our EMIM program has been a tremendous success. Recent graduates have quickly become assistant deans, residency program directors, featured speakers at national and international conferences, and recipients of several prestigious national teaching awards. Current EMIM residents are authors of several peer-reviewed publications, active participants in local and national committees, and intimately involved in teaching activities within the School of Medicine. In addition to their academic successes, EMIM residents routinely assume leadership roles on individual rotations, within both parent programs, and within the medical center.

The Curriculum
Our EMIM curriculum provides a structured and dynamic blend of both disciplines. Each year, the combined curriculum consists of 13 four-week blocks divided into quarterly segments. Depending on the time of year, quarterly segments range from 3 to 4 months in duration. Residents alternate between specialties such that an equivalent amount of training is spent under the supervision of both Internal Medicine and Emergency Medicine. As an example, residents who begin the academic year in Internal Medicine switch to Emergency Medicine during the fall, return to Internal Medicine during the winter months, and conclude the year in Emergency Medicine during the last quarterly segment. During the transition from PGY-3 to PGY-4, residents remain under the supervision of one specialty for approximately 6 months. This provides experience with the seasonal variation in illness, a necessary aspect of the practice of both internal and emergency medicine.

Our internal medicine curriculum provides a balance between inpatient and outpatient experiences. The inpatient experience comprises rotations in general internal medicine, subspecialty medicine, and critical care medicine. Approximately 13 months are spent on general medical and subspecialty units. Subspecialty rotations include infectious disease, primary cardiology, and oncology. An additional 2 to 3 months are spent on the night/day float teams. These teams provide general inpatient care and were created to comply with resident duty hour guidelines. Approximately 4 months of training are spent in the medical and cardiac intensive care units to provide critical care experience. Together, inpatient rotations account for 20 of the 30 months spent in internal medicine.

The outpatient internal medicine experience consists of four ambulatory block rotations; continuity clinic; and separate rotations in dermatology, endocrinology, rheumatology, and neurology. During ambulatory block rotations, EMIM residents gain experience in women’s health, outpatient orthopedics, ophthalmology, geriatrics, rehabilitation medicine, psychiatry, and otolaryngology. In addition, experience with managed care organizations and private practice groups are provided. While rotating on internal medicine, residents are expected to maintain their continuity clinic. Continuity medical clinic is one-half day per week and is located at the University Health Center. Residents do not attend continuity clinic while on emergency medicine rotations.

The emergency medicine curriculum of our EMIM program consists of 30 months of rotations in the emergency department, trauma, anesthesiology, obstetrics and gynecology, toxicology, ultrasound, and emergency management services. The emergency department experience covers 15 months in the adult emergency department at University Hospital, Mercy Medical Center, and the Baltimore VA Medical Center. Five months of dedicated pediatric emergency medicine experience is provided through two rotations at Children’s National Medical Center, two rotations in the pediatric ED at University of Maryland, and 1 month in the University of Maryland pediatric intensive care unit.

A highlight of the emergency medicine curriculum is four rotations at the R Adams Cowley Shock Trauma Center. Here, EMIM residents gain invaluable experience in the assessment and management of multi-system trauma victims. EMIM residents are an integral component of the trauma team and work side-by-side with trauma attendings, trauma fellows, surgical residents, and fellow emergency medicine residents. Airway experience is provided through two rotations in anesthesiology, one during PGY-1 year and the second during PGY-2. The PGY-2 rotation is in trauma anesthesiology and is performed at the Shock Trauma Center. Often, EMIM residents complete more than 50 intubations during this single rotation.

EMIM residents are given 2 months of elective time by each specialty. For emergency medicine, electives are taken during the fourth and/or fifth year of residency; internal medicine electives occur during the first and fifth years. During their elective time, EMIM residents are encouraged to perform research and develop an academic niche.

EMIM residents are given progressive responsibility throughout our curriculum. Beginning in PGY-2, EMIM residents manage an inpatient general medical team. Throughout the remainder of their internal medicine training, EMIM residents serve in a senior supervisory role. Senior-level supervision in the emergency department does not begin until PGY-3. During this year, EMIM residents manage our urgent care area as well as supervise and teach fourth-year medical students rotating in the emergency department. During PGY-4 and PGY-5, EMIM residents assume responsibility for the acute care areas of our adult emergency department.

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