Senior Tracks (also known as specialty tracks) are mini-fellowships that explore various topics within Emergency Medicine. The Mount Sinai Emergency Medicine Residency currently offers about 20 specialty tracks that residents can tailor to their specific backgrounds, interests and project goals. The tracks and their brief descriptions are below. Additionally, during the fourth year, residents will work on a scholarly project, which will be presented at a system-wide symposium prior to graduation. There is a dedicated four-week period for the specialty track, as well as an overall hours reduction in the fourth year schedule, intended to accommodate time spent on the scholarly project.
Our program offers countless opportunities for learning and participating in administration and departmental operations. Residents are welcome to participate in meetings regarding ED operations, both at the ED level at all three sites and at the hospital and system levels. Residents have been involved in most major operations projects, from ED renovations, to contributing to trauma protocols, and helping create a provider-in-triage model for our Emergency Departments.
Mount Sinai has long been known as a leader in critical care, and the clinical training experience is a large reason for this. The emergency departments at both the Mount Sinai Hospital and Elmhurst Hospital have emergency medicine (EM)/critical care trained faculty, a large volume of high-acuity patients, and designated critical care areas. A number of emergency physicians at the Mount Sinai Hospital have appointments in both the ED and ICUs, facilitating both knowledge translation and continuity of care and smooth transitions for critical patients. Those who select the critical care specialty track gain further experience during their PGY4 year by supervising PGY2s and 3s on their “resuscitation” shifts and working on a critical-care project. Many of our graduates have gone on to critical care fellowships for board certification at the leading programs across the country.
Diversity & Inclusion / Social EM
The SEM/DEI track is for residents who have an expressed interest in the intersection of social determinants of health as they relate to the practice of Emergency Medicine and for those who are considering a fellowship in Social Emergency Medicine. Residents in the SEM/DEI track will gain an understanding of current SEM population-based research and become familiar with Emergency Department and community-based projects and interventions aimed at improving the health of underserved communities. Objectives include participation in didactics, resident and medical student teaching, community outreach, developing SEM/DEI residency curriculum, participation and presentation at the SEM journal club, attending SEM and DEI monthly meetings and national meetings (ex. EMRA, ACEP, SAEM, or ADIEM). \he resident must complete a senior project which may include implementation of a community-based or Emergency Department project aimed at addressing social determinants of health.
EMS / Disaster Medicine
At Mount Sinai, our EMS and Disaster Medicine division is robust. Sinai EM faculty dominate the Mount Sinai EMS and system-level transfer roles, and therefore our EMS specialty track residents have the opportunity to gain an unrivaled experience. Residents who complete this track will not only learn the principles of EMS, but will gain experience caring for critically ill patients in the field on ride-along shifts, shadow on-line medical control, attend REMAC meetings, and complete an EMS-related scholarly project. Many go on to EMS fellowships and become EMS medical directors.
The Global Health track starts in the PGY-3 year. This allows residents to start projects during their PGY-3 elective month at one of the global health sites, then continue the project during their electives and/or senior track months PGY-4 year. The project-based curriculum is augmented by journal clubs and other activities. The program emphasizes creating sustainable care systems in under-resourced countries. Most recently residents have participated in projects in countries including Liberia, Haiti, the Dominican Republic and Laos.
The emergency department provides a unique window into the function, and at times dysfunction, of the healthcare system. Consistent with the Mount Sinai Department of Emergency Medicine’s overall ethos of engaging nationally in all aspects of emergency medicine, a number of Mount Sinai faculty use the vantage point of emergency medicine to perform health policy work in various forms including research. The residency has a health policy interest group and supports residents who are heavily involved in national organizations, such as EMRA and the AMA. The specialty track offers an opportunity to perform a deeper exploration of a single issue while learning about the pathways to creating change. Our graduates have gone on the Clinical Scholars Program (formerly Robert Wood Johnson) and other policy fellowships on their way to policy-focused careers.
Ever since the Mount Sinai Department of Emergency Medicine became the first in New York City to go paperless with an electronic health record, several informatics trained faculty have led Mount Sinai to national prominence in informatics. The Mount Sinai Department of Emergency Medicine has a tailored build of its electronic health records, which is continuously being updated for our needs. Our residents have opportunities to be involved in informatics projects at the department, hospital, system, and national levels. Recently this has included working on ACEP’s Clinical Emergency Data Registry. The informatics specialty track is truly a mini-fellowship in medical informatics.
Medical Education / Simulation
There are numerous opportunities for residents to be involved in teaching medical students and others, even during intern year. The medical education specialty track adds to these opportunities with journal clubs, curriculum development, and involvement in simulation and mentorship in medical education research. We have also supported many of our residents who have been accepted to the Harvard Macy medical education fellowship. A number of graduates of this specialty track have found Assistant Program Director or Clerkship Director roles straight from residency, and those opting to pursue fellowships place at the top of their list.
Our simulation program is robust, with faculty at all three sites involved. Both the Mount Sinai Hospital and Elmhurst Hospital have state-of-the-art simulation centers. A number of our faculty have post-residency training in simulation, and we have a full-time coordinator of simulation at Mount Sinai. Residents who have chosen to focus on simulation as part of the medical education track have completed projects and designed curricula that have been presented and disseminated nationally.
Mount Sinai hospital has a very large palliative care department – a team-based medical specialty which provides an added layer of support to seriously ill patients, their families, and their healthcare providers. Residents in the palliative care senior track will improve their skills and knowledge in end-of-life discussions and palliative care best practices by spending time alongside MSH palliative care fellows and attendings. Residents will also have the opportunity to work on improving access to palliative care within the ED and to collaborate with Mount Sinai palliative care researchers on their ground-breaking research.
Our pediatrics curriculum is led by seven knowledgeable and highly experienced, fellowship-trained pediatric emergency medicine faculty. They teach, supervise, and provide our residents with well-rounded exposure to pediatric care and to patients of all ages. Residents do dedicated rotations in the Pediatric ED and, during later years of training, PEM shifts distributed throughout their ED blocks. Residents also spend time in the Pediatric Intensive Care Unit (PICU) at Mount Sinai Kravis Children’s Hospital. Residents who have completed our pediatrics specialty track have gone on to complete some of the best PEM fellowships in the country.
All residents participate in the resident-run Clinical Quality Review which informs the departmental QI process. QI-interested PGY-4 residents run the program. A number of those choosing this specialty track have been hired directly from residency into administrative leadership roles in community and academic centers.
The Mount Sinai Department of Emergency Medicine is known as a leader in research, and is consistently one of the top-funded departments of emergency medicine. Our department is one of a small number of sites chosen for a K-12 grant training program which consistently successfully launches junior faculty into funded careers. All residents have a mentored research experience during their 2nd year research rotation, and most incorporate research into their specialty track project. The department has a wealth of research-related resources which facilitate resident projects, from IRB submission to data collection to completion. We have an impressive number of research faculty and they are always interested in mentoring our residents on the research specialty track. During the specialty track, residents will be integrated into our research department, attending weekly research meetings and working closely with our research faculty. A number of these residents have gone on to the Clinical Scholars Program and other research fellowships.
Residents will attend sports-medicine clinic and learn alongside our fellowship-trained sports medicine and orthopedic physicians. Residents also may have the opportunity to be involved in the medical oversight of NY marathon, NYRR races, and football games. Sports medicine track residents will be expected to teach students and co-residents during orthopedic splinting workshops. They will also be expected to participate in national groups such as EMRA’s sports medicine committee and SAEM’s sports medicine interest group. In addition to completing sports-medicine related scholarly project, many residents who complete this track opt to complete a sports-medicine fellowship.
Telemedicine is a newly emerging field of Emergency Medicine and Mount Sinai is at the forefront of innovation in the field. Residents who opt to do the telemedicine track will help understand and further develop our various telemedicine platforms, including MSNOW and Click4Care, which have seen increased demand during the COVID-19 Pandemic.
With multiple toxicologists at both Mount Sinai Hospital and Elmhurst Hospital, residents have ample opportunity to explore this field. Our toxicology track involves toxicology simulation sessions, running journal clubs, involvement in national interest groups, and case-based teaching of our residents. A number of residents have presented their toxicology scholarly projects at national and international meetings. Our residents who have sought toxicology fellowships have gone on to the most highly renowned fellowships around the country.
Mount Sinai Emergency Medicine Residency has many ultrasound faculty at all our sites, including our vice-chair of education at MSH. We have several ultrasound machines at all of our sites, and all are continuously available for bedside diagnosis and procedure guidance. Dedicated US didactics and hands-on experience further ensure that every resident is comfortable with the technology. Ultrasound is among the most popular Senior Specialty Tracks. Several residents each year take advantage of additional clinical exposure to ultrasound, the administrative experience in ultrasound QA, policy and program infrastructure, as well as the opportunity to teach medical students, residents, and faculty. All ultrasound track residents are involved in ultrasound-related research projects. Some residents who complete this track go on to do ultrasound fellowships, while others use this as an opportunity to become more skilled within the field of ultrasound and take these skills directly to clinical practice.
The Wilderness & Environmental Medicine track focuses on medical care in remote and austere settings and the unique pathology and technical skills with which it is associated. The track begins as a PGY-4 but select residents may choose to begin as early as PGY-2 to obtain advanced educational opportunities and training. Residents assist in conducting the ‘Intro to Wilderness Medicine’ course through the medical school, which includes 1 week of field exercises while backpacking the Appalachian Trail. The track prepares graduates to create and/or lead a wilderness medicine program at their future institution and works to make interested residents competitive in obtaining fellowship positions. Prior residents have gone on to complete formal fellowships at top programs. Residents can also choose a focus (e.g. medical education, altitude/mountain medicine, dive medicine) within the field to further their interests and goals.