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.
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.
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