The first year of training provides residents with the skills and knowledge they need to become well-rounded physicians. We provide a comprehensive four-week orientation program, focused on emergency medicine core content, basic communication skills, procedural skills and cadaver labs, simulation sessions, shadow shifts and mentored shifts in the emergency department (ED). During this month, while first-year residents spend clinical time in the ED and complete a special lecture/hands-on series intended to orient them to emergency medicine, they also integrate with their classmates into the Johns Hopkins family and the city of Baltimore via social gatherings. After the orientation month, first-year residents receive clinical training in the specialty areas listed below to develop foundational skills in clinical decision-making, patient stabilization and resuscitation. While assuming primary responsibility for patient care, first-year residents receive close supervision and clinical teaching designed to permit them to reach their full potential as physicians.

Rotation Schedule

• Orientation - four weeks
• Johns Hopkins Hospital emergency department - 12 weeks
• Johns Hopkins Bayview emergency department - two weeks
• Johns Hopkins pediatric emergency department - four weeks
• Johns Hopkins Howard County Medical Center pediatric emergency department - four weeks
• Johns Hopkins coronary care unit (CCU) - four weeks
• Johns Hopkins medical intensive care unit (MICU) - four weeks
• Johns Hopkins anesthesia - two weeks
• Obstetrics/labor and delivery - three weeks
• Radiology/ECG - two weeks
• Ophthalmology/ultrasound - two weeks
• Advanced ultrasound - two weeks
• Toxicology - two weeks
• Emergency Medical Services (EMS) - two weeks
• Vacation - three weeks

The second year of training builds on the foundations established during the first year. Residents gain experience in caring for critically ill patients and receive specialized training in the areas listed below. Residents spend eight weeks staffing the Johns Hopkins Bayview critical care bay—often described as the quintessential emergency medicine training ground by residents. Second-year residents also begin to assume responsibility for teaching medical students and learn basic research skills so they can critically evaluate the results of published studies and use this knowledge to inform their clinical practice.

Rotation Schedule

• Johns Hopkins Hospital emergency department - 22 weeks
• Johns Hopkins Bayview emergency department - eight weeks
• Johns Hopkins pediatric intensive care unit - four weeks
• University of Maryland shock trauma anesthesia - four weeks
• Pediatric anesthesia - two weeks
• Orthopaedics - two weeks
• Johns Hopkins Bayview hand surgery - two weeks
• Johns Hopkins Bayview burn intensive care unit - two weeks
• Research - two weeks
• Vacation - four weeks

Third-year residents hone their clinical skills and continue the training needed to become qualified emergency medicine specialists. Residents continue to work in both academic and community settings, assuming greater autonomy in patient care and serving as team leaders in the ED. Each resident develops teaching, supervisory and emergency department management skills. Additional elective time is provided for further pursuit of clinical or research interests, which lays the foundation for the fourth-year FAST experience.

Rotation Schedule

• Johns Hopkins Hospital emergency department - 26 weeks
• Johns Hopkins Bayview emergency department - eight weeks
• Johns Hopkins Howard County emergency department - four weeks
• Johns Hopkins Howard County pediatric emergency department - two weeks
• Johns Hopkins Howard County intensive care unit - two weeks
• Johns Hopkins trauma consult - two weeks
• Elective - four weeks
• Vacation - four weeks

The final year of residency is individualized depending on the interests of the residents and the advice of their Focused Advanced Specialty Training (FAST) adviser(s). Each resident spends 1,080 clinical hours working in our EDs in both primary patient care and supervisory roles. This occurs simultaneously with a longitudinal professional development experience with the resident’s FAST.

The Schedule

• 1,080 total clinical hours per year
• Johns Hopkins emergency department - 46 weeks
• Johns Hopkins Howard County pediatric emergency department - two weeks
• Vacation - four weeks

The emergency medicine (EM) conference series covers the core content of the American Board of Emergency Medicine (ABEM) Model of the Clinical Practice while teaching residents how to integrate practical applications of knowledge. Cutting-edge literature is discussed, and the series focuses on career development. The core content is covered over a 24-month cycle, enabling it to be covered twice in the four-year residency format. Formal didactics occur every Friday morning. Residents are protected from clinical activity during almost all of their rotations, excluding in the intensive care units so they can attend weekly didactics. We use a variety of formats including faculty and resident lectures, small group discussions, case conferences, cadaver procedure labs and evidence-based reviews.

A brief description of each is listed below.

These three-hour sessions—approximately 20 per year—focus on EM core content. Led by EM faculty members and PGY-4 residents, they are designed to encompass all aspects of the topic—typically a chief complaint—being taught during the session.

Small Groups for PGY-1–3 Residents: Residents rotate through three 40-minute sessions with their respective PGY group and receive teaching specific to their training level. The sessions cover the more detailed aspects of the topic for the day, including treatment options, evidence supporting treatment and ancillary tests, literature review, podcasts and case-based teaching. These sessions encourage group interaction and discussion.

PGY-4 Small Group: PGY-4 residents attend a two-hour session that focuses on advanced learning. The first hour may include practice-based guidelines and their supporting evidence, case discussion, oral board review or review of literature. The second hour covers topics that all new attending physicians will encounter in their practice. These include billing, building a CV, malpractice issues, comparison of practice settings and career path opportunities, financial issues and other topics that residents suggest.

Large Group Session: This hour-long faculty-led didactic summarizes the most important learning points from the morning’s small group sessions on the day’s topic and how the details from the small group sessions are incorporated into the practice of EM. Often interactive, these sessions may focus on the differential diagnosis associated with the topic, use of ancillary tests, how to create a management plan for patients or evidence-based guidelines.

A monthly one-hour mortality and morbidity conference is held to discuss cases that are submitted by faculty members, residents or nurses, or that are obtained via our hospital reporting system. A PGY-3 resident leads the session in conjunction with a faculty mentor. These multidisciplinary conferences allow all members of our patient care team to follow the case presentation and discussion with an analysis of a standard set of factors known to contribute to error in the emergency department. This involves a systems-based approach, which is analyzed not only for errors in judgment or decision-making, but also for contributing factors such as breakdowns in teamwork and communication, availability of departmental and institutional resources, and societal factors that led to a particular outcome. These sessions are used to help make recommendations to our clinical leadership to remedy identified deficits.

Each PGY-4 resident is required to prepare one case conference—case conferences occur on a monthly basis. These 60-minute sessions allow PGY-4s to choose a topic and moderate a case-based discussion with practical teaching pearls for the audience.

In the second half of the year, each PGY-1 resident is required to present a five-minute snapshot on a clinical pearl. These brief sessions allow interns to choose a topic with a very narrow focus that is useful to the audience and develop a foundation for delivering large-group presentations in a friendly and low-stress environment.

In this series, PGY-2 and PGY-3 residents prepare lectures covering core content topics in emergency medicine. PGY-2 residents present a 30-minute talk, and PGY-3 residents present a 60-minute talk. All residents are given one-on-one guidance from a program director for content and slide preparation.

These interactive presentations occur during joint conferences between the Department of Emergency Medicine and the Department of Surgery’s Division of Acute Care Surgery. During the conferences, which take place quarterly, one resident from emergency medicine and one from surgery present a case for discussion by the audience. Each case has take-home pearls for diagnosis or management.

This series, which occurs monthly, is focused on teaching residents the basics of reading medical literature and determining the applicability to their practice. Each PGY-2 resident develops a PICO question (P - patient, problem or population; I - intervention; C - comparison, control or comparator, O - outcome) under the mentorship of our two EBM faculty members and works with the assistance of a medical librarian to find answers. They present an objective review of the literature and lead a discussion of the article with the group.

This series, which occurs quarterly, is focused on teaching residents basic research skills. Core research faculty members lead sessions on research, ethical conduct, Institutional Review Board (IRB) and basic statistics. In addition, short web-based didactics are available, which have been prepared by our faculty members to help educate residents about key areas of their research, such as study design, identifying study populations, and writing abstracts and posters.

Point-of-care ultrasound education during our weekly conferences is delivered through didactic and hands-on sessions, in small-group teaching sessions that are incorporated into our longitudinal, symptom-based curriculum, as well as in dedicated interactive workshops. This curriculum is designed to supplement the ultrasound experience residents obtain during their ultrasound rotations in the PGY-1 year and while they are working clinically in the emergency department.

Reviews are held annually for both oral and written examinations. All residents participate in simulated oral boards cases with faculty members during conference twice per year. Additionally, a full-day interactive session of high-yield content is held shortly before the annual in-service exam. Residents obtain electronic review materials via the education committee and the program director.

Grand Rounds lectures occur six to eight times per year. Experts in the field of emergency medicine are invited to discuss their areas of interest with the emergency department. Recent topics have included: “LGBTQ and Sometimes I,” “Improving End-of-Life Care in the Emergency Department” and “Gun Violence—A Biopsychosocial Disease: Roles of Emergency Physicians.”

This conference, held 12 times each year, is devoted to discussion of patients with interesting and/or difficult management problems that may involve deceptive presentations. Cases are presented by PGY-3 residents in a session co-run with the director of the Department of Emergency Medicine, Gabor Kelen, M.D. These sessions incorporate audience participation and input from a panel composed of EM faculty members and PGY-4 residents.

In addition to the sessions listed above, residents receive instruction in electrocardiogram interpretation, radiology reading and splinting, and participate in a departmental Clinical Pathologic Case (CPC) competition. Residents also participate in sessions on residents as teachers in the emergency department. A dedicated hour is also held quarterly in which residents can meet with their quality improvement (QI) groups during conference time.