Clinical Rotations

Our curriculum aims to develop a resident’s capacity to provide effective and efficient medical care to high acuity, medically complex patients under the guidance of expert faculty. Through immersive and varied clinical experiences, residents gain the knowledge, skills and confidence to assume greater supervisory and care team leadership responsibilities as they progress through training.

We believe that training should be tailored to each resident’s unique needs, interests and goals. To this end, we invest significantly in resources and mentorship to ensure residents receive exceptional training that fosters personal and professional fulfillment while preparing them for successful careers. Our residents graduate as well-rounded physicians who can thrive in academic and many types of community practice.

Our program utilizes a block schedule consisting of 13 four-week blocks (view an example schedule). Residents receive four weeks of vacation annually, taken as one-week blocks.

Resident clinical shifts follow an 8+1-hour model, allowing for a period of overlap for signout and documentation with the oncoming team. Residents typically work 19 clinical shifts per block as a PGY 1, and 18 shifts per block in their second and third years.

PGY 1

Year one builds a strong knowledge base of critical skills related to the assessment and management of the acutely ill patient, rounded out by broad exposure to specialty care and off-service experiences.

Orientation: First 2 weeks
Main ED: 4 blocks*
Veterans Hospital ED: 1 block
Pediatric ED: 1 dedicated block
Anes/Ultrasound: 1 block
Cardiology: 1 block
Medical ICU: 1 block
Pediatric ICU: 1 block
ED/Ortho: 1 block
Ob-Gyn: 1 block
EMS: 0.5 blocks
Trauma: 0.5 blocks

PGY 2

Year two advances resident leadership and procedural skills and refines overall efficiency. Residents explore career pathways through an elective rotation and integrated pediatric and community shifts.

Main ED: 8 blocks*
Community ED: 1 block
Elective: 1 block
Medical ICU: 1 block
SICU: 1 block
Trauma: 1 block

*Integrated shifts in Pediatric & Veterans Hospital EDs

PGY 3

In year three, residents further develop leadership, teamwork and medical management skills during capstone experiences, and have ample flexibility to explore niche interests.

Main ED: 9.5 blocks*
Community ED: 1 block
Admin: 1 block
Elective: 1 block
Medical ICU capstone: 1 block

*Includes longitudinal shifts as trauma resuscitation leader & pre-attending

PGY 1 curriculum

Centers on Building Foundations: Intern year consists of six blocks in the emergency department at University Hospital where are two-pod model and innovative CareStart and Clinical Decision Units are staffed directly with by Emergency Medicine attendings (faculty and fellows), as well as integrated experiences on trauma, cardiology, anesthesia, and the medical ICU to introduce and strengthen foundational knowledge of specialty care in these areas.

First-year residents attend a hands-on workshop to learn the basics of ultrasound during their first month. After this, clinical ultrasound training is integrated into all three years of residency, starting with a dedicated ultrasound rotation (1 block) during intern year, which uses innovative asynchronous didactic content so more time can be spent at the bedside polishing skills with faculty.

PGY 2 curriculum

Centers on Critical Care & Exploration: The PGY 2 year focuses on implementing core knowledge from year one as residents assume leadership roles in complex resuscitations and increase their procedural skills and overall efficiency. Residents also begin exploring career pathways through their first elective rotation.

PGY 3 curriculum

Centers on Independent Practice: In their third year, residents gain experience in addressing operational challenges, managing department flow, and advanced patient care. The Trauma Resuscitation Leader role offers PGY 3 residents the opportunity to directly lead cross-functional trauma teams and develop confidence in managing resuscitations in critical cases. Resuscitation and critical care experience is emphasized through rotations in the Medical ICU (PGY3 capstone role) and SICU, and through attending shifts with UW Health Med Flight for residents interested in rotating with this service.

PGY 3 residents also serve as peer mentors supporting PGY 1 residents, and also teaching third- and fourth-year medical students through on-shift, near-peer mentoring.

“I feel as residents we often don’t know how far our journey has taken us until we teach our junior colleagues and realize that we have come a long way since medical school.” –Sam Zidovetski, MD, MPH, ‘2016, reflecting on his experience teaching medical students

Electives

Residents are provided two dedicated elective months in order to explore sub-specialities within Emergency Medicine. Our program is also committed to diversifying residents’ learning experiences outside of dedicated elective blocks, even as PGY 1, through longitudinal elective shifts/short-rotations during Main ED blocks. Each residents’ learning pathways is individualized with input from Program Directors and the resident’s coach-mentor.

Residents may purse a well-established elective or can design their own elective opportunity. Our residents have engaged in elective opportunities within global health, prehospital medicine (EMS, Med Flight, disaster medicine), ultrasound, teaching, critical care, anesthesia, burn, palliative care, sports medicine, as well as focused practice in social emergency medicine and advocacy.

“I love the ability to customize elective shifts during my EM months to fit my future goals of an EMS fellowship.” –Haley Taormina, MD, ’22 (Dr. Taormina went on to match into an ACGME accredited EMS fellowship after graduation.)

Core EMS Rotation

During PGY 1 year, our residents complete a required two-week rotation in EMS. This includes opportunities to ride along with paramedics from Madison Fire Department, other busy EMS services in the metropolitan area, and UW Health’s Pediatric Neonatal Critical Care Transport Team. Residents will also complete training in incident management from the Federal Emergency Management Agency (FEMA), and shadow 911 dispatchers in the Dane County Public Safety Communications Center.

By providing this experience early in training, our residents have ample time to decide whether they would like to pursue a fellowship in EMS.

Prehospital Clinical Concentration

In recognition of the value of a structured, longitudinal experience to cultivate leadership experience and scholarly output, the Prehospital Division offers a Prehospital Clinical Concentration.

This opt-in program is available at the beginning of PGY 2 year and pairs residents with one of our EMS medical directors, who will serve as a career mentor for the remainder of their residency. Residents enrolled in this program will have the exclusive opportunity to be appointed as Resident Assistant Medical Director (RAMD) for one or more EMS agencies, allowing them to truly experience the administrative responsibilities of an EMS physician.

During PGY 2 year, residents will be focused on cultivating close relationships with their agency’s service directors and EMS providers by assisting the Medical Director with their duties. As residents transition into PGY 3 year, they will develop as leaders by taking a more autonomous role with their agencies and helping to supervise incoming PGY 2 RAMDs.

Residents enrolled in the Prehospital Concentration will be expected to devote a portion of their elective time to prehospital activities, will attend monthly meetings, and will be expected to focus their scholarly project on a prehospital topic. Though EMS experience is required for all residents in the Prehospital Concentration, individuals with a particular interest in helicopter EMS will be able to focus portions of their elective time to working with UW Health Med Flight as well.

Doc Ops Experience

Our residents are first exposed to the work of field EMS responders through a half-day immersion program. “Doc Ops” as created in 2010 to give interns an opportunity to walk in the boots of local firefighters and paramedics by participating in training exercises involving burning buildings, vehicle extrications and other mock emergencies as part of their orientation to residency. First-year residents come away with a new appreciation for the pressures facing emergency responders, which helps build strong relationships that ultimately improves communication, teamwork and patient outcomes.

Few residency programs in the U.S. have the expertise, resources, and collaborative relationship with fire-based emergency medical services to offer this type of unique and robust experience. We are proud to be able to provide this pivotal experience to our residents early in their training.

“Intern year off-service rotations provide invaluable opportunities to translate EM experiences into new clinical environments and bring lessons learned from those environments back into the ED. I was surprised at how quickly I adapted to previously intimidating clinical scenarios, and how much I learned in a short time working under our incredible Emergency Medicine and off-service faculty and fellows.”

– Tad Schmitt, MD, ’22

“My education at UW has been better than I could ever have expected. The support of faculty and senior residents, along with comprehensive onboarding and training that spans the first few weeks of intern year fully prepared me to walk into my first rotations outside of the ED. I have access to educational tools and resources, and the PDs are flexible to support with my personal learning style.”

– Rudi Zurbuchen, MD, ’23

At UW, residents can expect to experience training that is
rigorous but also supportive and collaborative.

#1 trauma referral center for the region

Three dedicated trauma bays at University Hospital bustle with near-constant activity.

As the primary trauma referral center for much of the region, our residents see the sickest of the sick and learn to function seamlessly as a team with surgery, anesthesia, orthopedics, and vascular and neurosurgery teams to rapidly intervene to prevent morbidity and mortality in all types of blunt and penetrating traumatic injury. Patient acuity is high, with a quarter of ED patients being admitted to critical care units.

High acuity, medically complex cases

The department’s providers deliver true emergency care as part of an operationally efficient health system. More than around 90 percent of the patient market is insured, and, therefore, lower-acuity patients have robust urgent care centers as alternative options to the emergency department.

At the University Hospital ED, Emergency Severity Index 1, 2, and 3 patients dominate patient visits. The admission rate exceeds 30 percent at this site. Because nearly 50 percent of inpatient admissions are generated from our EDs, performance of these units is a key driver in the overall success of the academic medical center.

Throughout their training, residents complete approx. 30 shifts in the community ED setting between their second and third years to round out their exposure to cases and case loads. Here they continue to work one-on-one with faculty while gaining significant independent clinical responsibilities.

Advanced critical care and prehospital capabilities

In partnership with UW Health Med Flight, we receive critically ill patients from across the region and frequently transport patients between facilities or from the scene of their accident or injury. Our ground ambulances transport patients of any age and are equipped as mobile ICU/NICU, and we operate busy air and ground Extracorporeal Membrane Oxygenation (ECMO) and organ donation transport programs.

The opportunity to fly with Med Flight extends the clinical environment for interested residents out of the hospital setting completely.

Referrals and transfers from quarternary care

Our clinical learning environment is enriched by patients referred and transferred for the quaternary care provided at UW Health, including complex burn care, neuroendovascular stroke intervention, transplant, pulmonary hypertension, VAD, TAVR, and CAR-T to name a few.

Pediatric emergency medicine

Our pediatric ED cares for approximately 17,000 pediatric patients annually—many with high acuity—and is staffed by a knowledgeable, growing group of fellowship-trained Pediatric Emergency Medicine (PEM) faculty. A dedicated team of specialized pediatric nurses and respiratory therapists also staff pediatric ED alongside 24/7 child life, pharmacy and social work services, with the department having a strong, collaborative relationship with pediatric/neonatal critical care transport teams.

Residents can expect to undertake intensive PEM-dedicated months PGY 1 and PGY 2 years, as well as longitudinal experience during PGY 2 and PGY 3 years and during all overnight shifts. The Pediatric ED is staff by PEM faculty from 8 am to 2 am 24/7/365.

Some of our exceptional PEM faculty include:

PEM Medical Director: Allie Hurst, MD, MS
Assistant Residency PD: Kiki Fabian, MD
UW Health Kids Medical Director for Quality & Safety: Nicholas Kuehnel, MD
UW Health Kids Chief Medical Officer: Joshua Ross, MD

Point-of-care ultrasound

Our Division of Emergency Ultrasound faculty are routinely identified as the point-of-care ultrasound experts at UW, with other specialties modeling our clinical and educational operations. And beyond core ultrasound faculty, almost all DEM faculty have active ultrasound privileges.

We consider practical training in emergency clinical ultrasound to be among the foundational components of residency, so we invest in a strong ultrasound curriculum and incorporate this training into clinical care. We have seven clinical ultrasound machines, which help build ultrasound expertise instead of spending time searching for “the machine.” Every scan performed by residents is reviewed for QA purposes, and we have three high-fidelity simulators.

We also offer a competitive, accredited advanced emergency medicine ultrasound fellowship designed to train newly graduated resident physicians to be expert sonographers, as well as leaders in point-of-care ultrasound education, administration, research, and global health applications.

Expanding ED footprint

In 2023, UW Health saw record numbers of surgeries and visits to emergency departments and clinics. In the last two years, emergency visits were up by 20% and surgeries increased by 9%.

To meet this growing demand, construction will soon be underway on considerable ED expansions at both University Hospital and East Madison Hospital, reflecting the institution’s recognition of the critical impact of emergency services on operational efficiencies within the health system.

The plans include a new six-story structure added to University Hospital housing 22 emergency department rooms and 22 flexible care beds, in addition to 48 new inpatient rooms. East Madison Hospital will add 20 emergency department rooms and four care rooms that can be shared between the emergency department and medical imaging.