The University of New Mexico School of Medicine residency in emergency medicine is three-year training program with 12 residents per year and ACGME accredited Fellowships in Pediatric Emergency Medicine and EMS, plus a Sports Medicine Fellowship through Family Medicine, Palliative Care through Internal Medicine and a non ACGME accredited Wilderness Fellowship. The program was established in 1987 and is nationally known for its unique location and culture, its Critical Care training, innovative simulation center, injury prevention research, wilderness, disaster and international medicine, EMS activities, and strong focus on community service.
The “Land of Enchantment” is a land of diverse scenic beauty and cultural heritage. The geography ranges from rugged desert to high grassy plains, wooded hills and snow-capped mountains. Ancient ruins contrast with growing cities and high-tech industry. The food, architecture and art are all distinctive, as is the state's multicultural population with Native American, Spanish, Mexican, and Anglo cultures woven together. The mild climate and open spaces encourage outdoor sports and recreation.
University Hospital is the major teaching hospital of the UNM School of Medicine.
- Adult and child inpatient and outpatient psychiatric services.
ED opened in June of 2007 as part of new hospital wing.
- Separate Urgent Care center for lower acuity patients
These services are provided with the full support of advanced technology such as rapid helical computerized tomography (CT), magnetic resonance imaging (MRI), ultrasound, angiography, and dedicated emergency laboratory and radiology services 24 hours a day
It is provided through the collaboration of the trauma team and the emergency physicians. The trauma team is notified immediately of the arrival of any patient with unstable vital signs or penetrating trauma to the central area of the body. The ED physicians are responsible for initial resuscitation and airway management in all patients. Trauma patients are assessed and treated in collaboration with EM and Trauma. Patients not meeting criteria for immediate trauma consult are assessed by the ED. The trauma team is then consulted if the work-up reveals a condition requiring hospital admission or general anesthesia. 1,500 patients are seen in the trauma room yearly about 300 of which are pediatric.
It is open 24 hours a day and is located in its own separate space with 12 primary beds plus an additional 5 observation beds. All urgent or critically ill pediatric patients are seen in the Peds ED, including trauma. The medical director is part of the EM faculty and has a joint appointment in the department of Pediatrics. The attending staff is drawn from both the EM faculty. Residents from EM, pediatrics and family practice rotate through this facility.
The VA hospital in Albuquerque is actually the New Mexico Regional Federal Medical Center (NMRFMC) which cares for VA patients and Air Force personnel working at the adjacent Kirtland Air Force Base and their dependents. It is a newly completed 404 bed hospital. Its excellent emergency physicians participate in the training of EM residents.
The faculty has been growing in size over the last year and will continue to grow over the next year. Current faculty size is 57 full time faculty.
Our faculty includes:
- Two full-time toxicologists
- The EMS consortium physicians – 8 physicians who provide enhanced medical control to EMS providers throughout the state
- The largest EM/Critical Care faculty in the country – 9 double boarded EM/CC faculty providing 24 hr faculty coverage for our ICU’s.
- 3 MD/PhD’s heavily involved in translational research as it applies to Emergency clinical care. They have ties with the CDC, Sandia National Labs and Emerge ID.
- 6 education faculty who have completed the ACEP teaching fellowship and the UNM Medical Education Scholars program.
- A full-time RDMS sonographer available to perform ultrasounds with residents during their ultrasound rotations.
Faculty research interests include: Injury control and prevention, pediatric emergency medicine, Emergency Medical Services, disaster medicine, infectious disease, pain management, head injury and imaging modalities, including applications, triage, allocation of health resources, adolescent substance abuse, international emergency medicine, medical decision-making and ethics.
Goals for this year are to expose the resident to the broad range of conditions with which the resident will be confronted during his or her career. The first-year resident curriculum consists of 13 four-week blocks of the following rotations:
The goals of the block are to provide a smooth transition into residency, to understand how the ED, hospital and community work and to get to know your fellow residents and faculty. Some of the activities include: ATLS, a medical Spanish course, an EKG course, hospital tour, library tour and visits to community resources. Didactic sessions are given on relevant EM topics. The residents are introduced to programs related to emergency medicine including: the medical flight service, the disaster medical assistance team, the center for injury prevention and research and the urgent care center. Residents also work about 15 hours weekly in the ED.
Residents spend four months in the ED during the intern year and two months in the pediatric ED. Each month the interns work 18 shifts in the main ED and 17 shifts in the Pediatric ED. The role of the intern is to see patients in the main ED and to support the HO II/III residents in the critical care areas. Interns present all patients to an attending or teaching resident and are closely supervised.
The HO I TSI rotation will provide an introduction to the care of critical trauma and surgical patients. The resident will take call, round and work closely with the residents and faculty from the Department of Surgery and Critical Care. There is a series of weekly lectures, simulation and skills labs to augment the bedside teaching. Drs. Marinaro, Rollstin, Dettmer and Tawil are EM/Critical Care double boarded physicians and attend in the TSI 2-4 weeks out of the month.
Residents spend mornings in the New Mexico Poison Center participating in lectures from the medical director of the poison center, using the learning resources there and following calls to the poison center specialists. The residents also perform consults and follow-ups for the medical toxicology service. The resident will spend about 25 hours per week during afternoons and evenings attending ultrasound lectures and doing supervised ultrasound scanning shifts in the ED. This rotation is the first step in developing expertise in ED ultrasound. The US portion of this rotation is run by the ED US director, Dr. Gillian Baty.
Residents spend one month caring for patients in the OB Triage unit, Labor and Delivery and doing OB/GYN consults in the ED. The primary goal of this month is to learn the skills to assist with normal and abnormal vaginal delivery and care of common OB/GYN emergencies. The intern is expected to do at least 10 vaginal deliveries during this month.
Residents spend the mornings at the VA in the operating suite performing intubations/LMA placement/nerve blocks and other patient care under the supervision of the Department of Anesthesiology. In the afternoons, the resident works in the ED of the VA with EM board certified physicians.
Residents spend a fantastic month in the MICU as an intern. They are primarily supervised by the upper level ED residents in the MICU. This month builds the foundations for the ongoing critical care training during the residency. Call is every 4th night.
Residents spend two weeks on the cardiology consult service at University hospital learning about the care of acute/chronic cardiac conditions.
Following the Anesthesia experience at the VA which focuses primarily on adult patients the interns will complete a two week Peds Anesthesia experience. This rotation will allow the resident to learn skills in pediatric assessment and airway management. Procedures will include BVM, LMA, and intubation.
The PGY2 year is the critical care year. This is the time we expect our residents to become comfortable caring for critically ill patients. Second-year residents engage in eight emergency medicine rotations plus critical care experience in internal medicine, TSI, cardiology, and neurosurgery. Shifts in the Pediatric ED are done integrated in the ED months.
Second year residents are expected to see the critically ill patients in the emergency department. These patients include but are not limited to: major trauma victims, patients who are unconscious or with altered mental status, all patients with grossly abnormal vital signs, or a critical condition such as myocardial infarction or ischemia, pulmonary edema, status epilepticus, etc. During this year the resident also learns the EMS protocols and services and begins to communicate via the radio with pre-hospital personnel. Pediatric ED shifts are integrated into every ED month in the PGY II and III years.
This month is focused on gaining the core skills related to EMS through readings, ridealongs, and projects. The month begins with a meeting with one of the EMS faculty to orient the resident to the expectations. Advance planning is required to make the most out of the month – such as scheduling ride-alongs and meetings. Most of the EMS requirements can be completed during this month. The resident will also be spending about 20 hours during the month doing bedside ultrasound with the ED Ultrasound director and attending didactic US training sessions. This US experience builds upon the first year rotation allowing more autonomy and empahiszing the technically more difficult US applications.
Second year residents are the senior residents in the MICU and as such make admission and management decisions. Strong backup is provided by fellows and attendings. Call is every fourth night.
This fantastic rotation allows the HO II to run the critical care operations of the NSI. There is a significant amount of autonomy and one on one teaching from critical care faculty. In addition, the resident will learn about neurosurgical and neurological emergencies.
This month allows the HO II resident to build on the skills acquired during the intern cardiology month. The resident will be admitting and providing primary care for the inpatient cardiology service. This is a busy month with a high acuity patient load and a lot of opportunities to learn.
is included in the PGY2 year because we have found the PGY2 resident is given much more responsibility than a PGY1 resident, so has the opportunity to learn more from the experiential level. Orthopedics is quite busy at UNM, so the EM PGY2 gets to work independently in terms of manipulating bones and joints, suturing tendons, injecting joints, etc.
This year the goals are to help the resident learn supervisory and management skills in the ED, consolidate knowledge base, experience other models for the provision of emergency care in the community, and explore areas of special interest through electives.
The resident assumes supervisory skills through the teaching of students and PGY1's in the ED. He or she works with the charge nurse and attending to assure patient flow and troubleshoot. The PGY3 continues to supervise paramedics over the EMS radio. Pediatric ED shifts are integrated into every ED month in the PGY II and III years. The PGY III residents have significantly more autonomy in the ED. They are expected to see and present multiple patients to the attending at one time.
The residents performs high risk newborn assessments and resuscitation as part of the delivery team. They perform procedures in the NBICU including providing positive pressure ventilation through bag-valve-mask, clearing of meconium, peripheral IV cannulation, lumbar punctures and umbilical vessel cannulation.
Two blocks of elective are available of which one may be spent out of the state. Since the Department of Emergency Medicine is committed to working with developing countries, this residency program offers international health opportunities, allowing residents to acquire firsthand knowledge of disasters, border health problems and the application of U.S. emergency-care principles to problems of a developing country whenever possible. Our residents chose international experiences in: Mexico, Turkey, Nepal, Malaysia, Ireland, and Bosnia. Our faculty have contacts in Mexico, Turkey, Nepal, Guatemala India, Malaysia, and Costa Rica to aid in developing electives. Other residents have chosen to do away rotations in other medical centers across the country, including toxicology at San Francisco General Hospital, neurology at Duke University, cardiology at Dartmouth Medical School, and pediatric EM at Toronto Children's Hospital. Residents have worked in many venues in New Mexico, including EM and Surgery experience at Gallup Indian Medical Center, the medical clinic at Taos ski valley, and with the Public Health Department in Santa Fe. Local electives have included suturing and splinting, PHI Air Medical and Lifeguard Air Emergency Services, research, dermatology, sexually transmitted disease clinic, Office of the Medical Investigator, cardiology, infectious disease , Peds Anesthesia, Dental Clinic, and so forth.
The resident works in a variety of community EDs to gain experience with the “private world.” The PGY3 learns to work with private physicians, learns the constraints of working within different health plans which includes a managed care system, and sees a different patient population. The residents can choose from: Sandoval Regional Medical Center in Rio Rancho, Christus St. Vincent’s Hospital in Santa Fe, Holy Cross Hospital in Taos, Presbyterian Hospital or Lovelace Medical Center in Albuquerque. In a rural setting, residents learn the constraints of care in small towns without access to tertiary care.
Third year residents are the senior residents in the MICU and as such make admission and management decisions. Strong backup is provided by fellows and attendings. Call is every fourth night. This is the final cap to our extensive critical care experiences.
The students are encouraged to attend the resident’s core conference on Wednesday mornings. This conference is the centerpiece of the resident’s formal curriculum. Attending this conference is a great way to meet faculty, residents and to learn about the program as well as learn some great emergency medicine! Feel free to attend all or part of the conferences while you are rotating in the ED.
The Emergency Medicine Residency at UNM offers 5 hours per week of core conference from 11-4 on Wednesdays. The content for the conferences are based on the Model of the Clinical Practice of Emergency Medicine (MCP) and on the ACGME Core Competencies.
The conference cycle coincides with the weeks of the month:
a. 1st Wednesday: Core Content Review, ECGs, ED Administration, 1 hours of core material
b. 2nd Wednesday: Radiology, Toxicology, Peds Lecture, 1 hour of core material
c. 3rd Wednesday: Simulation, Small Group Sessions
d. 4th Wednesday: Board Review, Hot Topics/New Literature, Research, EBM to bedside
e. 5th Wednesday: Resident Presentations and Teaching Skills, 1 hour core material, Global Health
M&M/lunch conference. Two 30 minute slots are available every week. Interns are required to present one M&M case. This is a formal presentation which will include learning issues and researched answers to those issues.
The two Main ED pods are each staffed by an attending, a senior resident and an intern or PA/NP. The pods work relatively independently. Critical patients are seen in the resuscitation area and are split between the two pods except when there is a dedicated resuscitation team scheduled. Psychiatric or intoxicated patients are placed in a locked down unit and these patients are also split between the two Pods.
All patient airways are managed by the Emergency Medicine team. Anesthesia, ENT or Trauma Surgery back up is available at the discretion of the EM team.
Chest tubes on Trauma activated trauma patients are placed by either the Trauma team or the Emergency Medicine team depending on the condition of the patient and experience of the residents involved. All chest tubes for non Trauma active patients or medical patients are placed by the Emergency Medicine team.
A dedicated Resuscitation team is scheduled every weekday evening shift to focus on the most critically ill and injured patients and allow the rest of the department to function smoothly. The team is made up of an attending, senior resident, and in the second half of the year, an intern.
All interns in the Emergency Department are treated equally in terms of schedule, responsibilities and authority. Interns generally see one patient at a time, present to the attending immediately, and develop a plan of care. They respond to resuscitations with their team to help develop the skills needed for the transition to the second year.
HO2 Emergency Medicine residents act as senior residents in the department. They are working on multitasking and management skills with guidance from the faculty. They are expected to manage several patients simultaneously, hone their resuscitation and procedural skills, and begin developing their situational awareness within the department.
HO3 residents in Emergency Medicine should begin to take more of a role in managing the ED while still having primary responsibility for a wide variety of patients in the ED. They provide Medical Control for EMS providers in the field. HO3 residents have much more freedom to manage their patients before presenting. In addition, the HO3’s help the attending triage incoming ambulances, triage patients to monitored beds, facilitate flow of patients in the ED and supervise procedures being done by more junior residents. HO3 residents are also expected to help to integrate EM interns into patient care in the trauma/resus areas. This is an opportunity to develop critical bedside teaching skills. To further facilitate HO3s supervising and teaching skills each resident does periodic teaching shifts during which time they do not see their own patients but focus instead on teaching the students and interns. HO3 residents should be familiar with all the patients on their side and take a very active role during rounds including teaching and filling in gaps on patients plans/condition.
We believe that Emergency Medicine is far more than just showing up for a shift. As residents, we want you to be exposed to and familiar with a wide range of opportunities related to Emergency Medicine. We want you to have the skills to practice in the ED setting of your choice and to broaden your experience and choose experiences in academic emergency medicine, fellowships, or other opportunities. Through these projects, residents can establish one-on-one relationships with faculty and establish skills for self learning and continuing self- education.
The faculty help our residents in devising meaningful research projects which can be completed and often presented or published within the time frame of the residency program. Research helps the resident become a critical thinker and reader of the medical literature. Having done research enables a person to better understand the process of hypothesis testing and research projects give a working knowledge of statistical analysis.
Our potential patient population is far greater than those who walk through our ED doors. We are much more effective if we can prevent the injury or illness, rather than treat it after the fact. We want our residents to get to know and to contribute to the community through a community project. This can take the form of education (through schools, churches, interest groups, etc.) service (providing health care in shelters, at community events, etc.) or through research (injury control, epidemiology, etc.) Resident community projects have led to ongoing programs, career focus and research grants.
The QA project should include development, implementation and assessment of a project to improve care, such as a clinical pathway, a patient satisfaction survey, or improvement of a recognized problem area. In addition to every resident completing a QA project they also have feedback on their clinical performance.This feedback includes compliance with core measures, billing/coding, and other QA measures.
The University of New Mexico School of Medicine welcomes visiting medical students to participate in final year elective clerkships. Clerkships for visiting students are coordinated by the Office of Medical Student Affairs. Medical students are eligible to participate in our program if they meet the following criteria, students must:
Residents participating in the EMS track will:
EMS Track Structure:
The EMS track will be longitudinal in nature. It will use the EMS elective month plus will be spread longitudinally over two years, so that track members may attend organized didactic or operational sessions as often as possible. Successful completion of the EMS track will satisfy residency requirements for the EMS rotation, scholarly project, evidence-based medicine lecture, and continuous quality improvement (CQI) project.
EMS track residents will be assigned a primary community partner affiliated with the UNM EMS Consortium in order to complete the EMS track curriculum. Specific examples include Albuquerque Fire Department, Bernalillo County Fire Department, Rio Rancho Fire Department, Sandoval County Fire Department, and Albuquerque Ambulance Service. Depending on specific interests, track residents may also be assigned to additional agencies, such as search and rescue teams and EMS specialty teams (DMAT, USAR, or others.)
The EMS Track will be overseen by the EMS Faculty. EMS providers, officers/supervisors, educators, and administrators from local EMS agencies may be invited to become adjunct faculty for the EMS track.
Residents pursuing the EMS track will complete their curriculum within the 4 core areas of EMS medicine identified by the ABEM:
a. Actively participate in the provision of care in the prehospital setting.
i. Understand the differences and limitations that prehospital providers work with on a daily basis.
1. Will participate in additional ride along shifts versus direct patient care (if holding a prehospital care certificate/license.)
2. The residency program will support residents pursuing prehospital care certifications/licensure (NREMT-B/NREMT-P).
ii. Understand the needs and appropriate skill sets for safe interfacility transfer.
iii. Understand the implications of special populations on prehospital care:
b. Understand resource allocation, dispatch issues, prearrival instructions.
i. Will participate in ride along shifts with supervisory staff as well as observation time in public safety answering points or dispatch.
c. Understand and demonstrate proficiency in prehospital procedures not routinely covered as a part of residency training.
i. Prehospital airway management:
1. Endotracheal intubation in the prehospital environment
2. LMA/King Airway/Combitube
ii. Prehospital spine injury protection procedures
iii. Prehospital traction splint devices
iv. Prehospital triage procedures.
d. Assist their assigned agency with company training in-services on new equipment, protocols, and policies as requested by the agency.
i. If interested, will arrange flight time with fixed and rotorwing services
a. Online Medical Control:
i. When working clinically, will provide attending supervised medical direction for all requests for online medical control by prehospital care providers.
b. EMS Education:
i. Will assist the continuing education coordinator on at least a quarterly basis with skills sessions, didactic lectures, drills, etc.
ii. Will assist the UNM EMS Academy on at least a quarterly basis including skills sessions, didactic lectures, drills, simulation/scenario, and examinations.
iii. Will assist EMS faculty in developing and delivering core EMS curriculum for non EMS track residents.
a. Continuous Quality Improvement:
i. Participate in the CQI system of his/her assigned agency, including attendance at regular CQI meetings, as well as addressing specific issues as identified by the agency’s medical director, CQI supervisor, prehospital care personnel, or the resident.
ii. Assist in compiling CQI statistics and subsequently developing an action plan for problems identified.
1. At least one CQI project should be directly related to the agency’s interface with the Emergency Department, and should be structured to satisfy the general EM residency requirement for a CQI project.
i. Will work with their assigned agency and the program faculty to identify EMS medical questions and projects requiring physician input. A minimum of one project of sufficient complexity and depth will be agreed upon between the EMS faculty and resident. This project will fulfill the residency scholarly project requirement.
ii. Understand the implications of consent in prehospital care research.
c. EMS Journal Club:
i. EMS residents will be responsible for presenting an EMS-relevant article(s) published in peer-reviewed EM and other major medical journals at an EMS Journal Club meeting. This monthly meeting is open to all local prehospital care providers.
a. Participate and, if necessary, help run disaster/mass casualty/mass gathering exercises with their assigned agency as well as the various health systems.
b. Will have an awareness of disaster resources including Disaster Medical Assistance Teams (DMAT), ChemPack, the Strategic National Stockpile (SNS), and other relevant state and local resources.
Residents may use an elective month to pursue further EMS interests, or may set up a longitudinal area of concentration within the EMS track. Electives may include in-program opportunities as well as off-site opportunities. EMS faculty will assist residents in setting up off-site electives. Possible electives include:
EMS faculty will provide regular lecture activities cover EMS topics, based on the NAEMSP medical directors course, such that major topics of the course will be covered every two years. Lectures will be supplemented with reading assignments in the required text, Emergency Medical Services: Clinical Practice and Systems Oversight (NAEMSP 2009.) EMS track members will also present topics to other track members on EMS topics of particular interest.
EMS track members will be provided with:
The resident will develop a portfolio documenting their activities within the EMS domain. This will include content delivered to both prehospital care providers as well as physicians. Feedback from both the EMS faculty mentor as well as key prehospital providers will be included within the portfolio.
Please contact the Education Office if you have questions: