Emergency Medicine – Critical Care Medicine Residency Program

Welcome to our Emergency Medicine-Critical Care Medicine residency — a novel concept, the first of its kind in the country. It is a five year combined program that integrates the training of two distinct, but intricately intertwined specialties. The program’s goal is to cultivate a dynamic and comprehensive environment that trains compassionate physicians adept in managing complex, high-acuity clinical situations, with an emphasis on collaborative efforts and expertise in systems processes between Emergency Medicine and Critical Care. Our institution is uniquely positioned to lead the development of a combined EM-CCM program, thanks to our established and distinct Emergency Medicine and Critical Care training programs. We have a strong team of over 15 EM-trained intensivists practicing across all subspecialty ICUs within our system, further enhancing the integration of these fields.

Upon completion of the program, our trainees will be eligible to sit for Emergency Medicine (ABEM) and Critical Care Medicine (ABIM) board exams, as well as be prepared to practice both Emergency Medicine and Critical Care Medicine in any clinical environment. We endeavor to train the next generation of national leaders in both Emergency Medicine and Critical Care who will continue to work towards providing seamless critical care between the ED and ICU.

We are thrilled to be pioneering this novel approach to Emergency Medicine and Critical Care training. Please feel free to reach out via email (anthony.devivo@mountsinai.org) for any questions or further information.

Program Goals

• Train physicians who exemplify excellence in complex clinical scenarios, as well as provide holistic, well-rounded care to all patients.
• Create leaders in the fields of both Emergency Medicine and Critical Care medicine who will go on to endeavor to enact systemic changes within the fields to improve individual clinical care and system processes at a national level.
• Foster innovation and collaboration between Emergency Medicine and Critical Care Medicine
• Prepare graduates for the evolving landscapes of the fields of Emergency Medicine and Critical Care Medicine, with the ability to practice in all clinical settings
• Participate in practice-changing research studies
• Impart upon our trainees the knowledge and experience to develop innovative, team based critical care rounding practices that allow for a collaborative and educational approach to critical care

Clinical Training Sites

• The Mount Sinai Hospital
• Elmhurst Hospital Center

First year

The first year of training is dedicated to laying a strong foundation for our trainees in Emergency Medicine, from both an academic and clinical perspective, as well as an enhanced junior house staff experience within the ICU. We aim to set a robust critical care foundation during the intern year where house staff will be encouraged to not only collect and report data, but also begin more aggressively translating that information into actionable plans that clinically impact patient care.

Rotation	Location	Duration
Orientation		4 weeks
Emergency Department	The Mount Sinai Hospital	16 weeks
Emergency Department	Elmhurst Hospital Center	8 weeks
PEM/Ultrasound	The Mount Sinai Hospital	4 weeks
CICU	The Mount Sinai Hospital	4 weeks
MICU	The Mount Sinai Hospital	4 weeks
Anesthesia	Elmhurst Hospital Center	2 weeks
Emergency Medical Services	Elmhurst Hospital Center	2 weeks
Obstetrics	Elmhurst Hospital Center	2 weeks
Orthopedics	Elmhurst Hospital Center	2 weeks
Vacation		4 weeks

During their second year, our trainees will continue to develop their clinical skills in Emergency Medicine, with the expectation of directly managing a larger, more critically ill patient load. This will occur both on their traditional emergency medicine shifts, as well as during their Resuscitation area and Trauma bay shifts, which they will begin as PGY2s. While in the ICUs, they will function as senior residents to their junior EM-CCM intern counterparts rotating within the ICU. During this time, they will be expected to function in an educational and supervisory role while developing complete plans for their patients and managing acute decompensations.

Rotation	Location	Duration
Emergency Department	The Mount Sinai Hospital	16 weeks
Emergency Department	Elmhurst Hospital Center	8 weeks
PEM	The Mount Sinai Hospital	8 weeks
Research/Elective	The Mount Sinai Hospital	8 weeks
CICU	The Mount Sinai Hospital	4 weeks
MICU	The Mount Sinai Hospital	4 weeks
Vacation		4 weeks

The third year of our program represents a significant milestone in residents’ training. In the latter half of their PGY-3 year, trainees will undergo an intensive critical care “boot camp” before transitioning to rotating in the ICUs in a fellow-like capacity. In collaboration with the attending intensivist, residents will take charge of ICU rounds, oversee and make all management decisions, perform or supervise major procedures, and directly manage their designated unit. They will lead a multidisciplinary ICU team, including junior house staff, APPs, and critical care nurses, guiding the overall care of all patients in the unit. Additionally, residents will continue to refine their skills in evaluating and managing a high volume of critically ill, complex patients in the Emergency Department, while also supervising junior residents in the Resuscitation and Trauma areas.

Rotation	Location	Duration
Emergency Department	The Mount Sinai Hospital	12 weeks
Emergency Department	Elmhurst Hospital Center	12 weeks
PEM	The Mount Sinai Hospital	4 weeks
PEM/Tox	The Mount Sinai Hospital	4 weeks
PICU	The Mount Sinai Hospital	4 weeks
SICU	The Mount Sinai Hospital	4 weeks
TICU	The Mount Sinai Hospital	4 weeks
Research/Elective	The Mount Sinai Hospital	4 weeks
Vacation		4 weeks

During the fourth year residents will transition a substantial portion of their training time to critical care rotations where they will continue to function in a fellow capacity. They will rotate through various subspecialty ICUs, including Cardiothoracic and Neurosurgical units, allowing them to explore different critical care environments and start identifying potential areas for post-residency focus. Emergency Department rotations will shift primarily to a senior leadership role, where residents will be responsible for directly supervising the management of the entire ED team, while also maintaining their leadership duties in the Resuscitation and Trauma areas.

Rotation	Location	Duration
Emergency Department (Senior role)	The Mount Sinai Hospital	8 weeks
Emergency Department (Senior role)	Elmhurst Hospital Center	8 weeks
Research/Elective	The Mount Sinai Hospital	8 weeks
SICU	The Mount Sinai Hospital	8 weeks
CTICU	The Mount Sinai Hospital	4 weeks
NSICU	The Mount Sinai Hospital	4 weeks
STICU	Elmhurst Hospital Center	4 weeks
TICU	The Mount Sinai Hospital	4 weeks
Vacation		4 weeks

The final year of training will focus on skills in advanced critical care management of complex patients, ICU leadership, as well as deciding if there is a specific area of critical care they wish to specialize in. If so, there will be elective time that can be dedicated to spending additional rotations within the subspecialty ICU. In the Emergency Department residents will take on a new leadership role in the resuscitation area where they will be primarily responsible for the oversight of the entire ED-Critical Care area. They will be responsible for supervising junior house staff in the management of critically ill patients and will be expected to share their extensive ICU training and critical care knowledge to guide and mentor the junior residents.

Rotation	Location	Duration
SICU	The Mount Sinai Hospital	12 weeks
Emergency Department (RESUS)	The Mount Sinai Hospital	8 weeks
Research/Elective	The Mount Sinai Hospital	8 weeks
TICU	The Mount Sinai Hospital	8 weeks
CICU	The Mount Sinai Hospital	4 weeks
CTICU	The Mount Sinai Hospital	4 weeks
NSICU	The Mount Sinai Hospital	4 weeks
Vacation		4 weeks

EM-CCM Seminar

Our residents will follow the current EM and CCM academic training curriculum, attending the respective weekly conferences during those rotations. In addition, we have developed a monthly EM-CCM seminar, which will serve as protected academic time for all EM-CCM house staff. This seminar will be a case-based, interactive learning session, incorporating pre-assigned textbook readings, literature, and EBM articles related to the cases discussed. The goal is to provide consistent, longitudinal exposure to the integration of Emergency Medicine and Critical Care Medicine over the course of the five-year training program, while also fostering a collaborative environment where house staff can come together each month to learn from one another.

Electives

• Advanced Ultrasound
• Cardiac Anesthesia / TEE (Transesophageal echo)
• Community ICU
• Emergency Medicine Administration
• Hand Surgery
• Health Care Policy
• Hospital-wide Quality Improvement
• Medical Podcasting
• Mechanical Circulatory Support/Cath Lab
• NEMAT (Neuro-critical care emergency consults) / EEG
• NICS (Night Intensivist Coverage Service)
• Palliative Care
• Public Health Elective at the NYC Dept of Health
• Pulmonary/Bronchoscopy
• Radiology (2 weeks thoracic, 2 weeks abdominal, and/or 2 weeks neuro)
• Regional Pain Management
• RRT (Rapid Response Team)
• Rural Medicine (Emergency Medicine, South Dakota affiliate)
• Sports Medicine
• Wellness
• Wilderness Medicine
• Vascular Access Service/Tunneled Catheter Placement

Block Schedule comparison chart

Rotation	MSH 4 year EM Program	MSH 5 year EM-CCM Program
Emergency Department	114 weeks	96 weeks
Adult Critical Care	12 weeks	80 weeks
Pediatric EM/Critical Care	20 weeks	20 weeks
Elective/Research	20 weeks	28 weeks
Orthopedics	4 weeks	2 weeks
Anesthesia	2 weeks	2 weeks
Emergency Medical Services	2 weeks	2 weeks
Toxicology	2 weeks	2 weeks
Ultrasound	2 weeks	2 weeks
Medicine Floor	2 weeks	–
Obstetrics	2 weeks	–
Palliative Care	2 weeks	–
Teaching Resident	4 weeks	–
Orientation	4 weeks	4 weeks
Vacation	16 weeks	20 weeks

Please feel free to reach out via email (anthony.devivo@mountsinai.org) for any questions or further information.