Louisiana state university health science center new orleans emergency medicine residency program policies to supplement lsuhsc house officer manual

Job Description - EM house officer

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Job Description - EM house officer

All house officers enrolled in the LSUHSC Emergency Medicine Residency training program function under the direct supervision of Emergency Medicine board certified faculty physicians.
Emergency Department attendings are ultimately responsible for supervision of the House Staff while they are performing clinical activities as part of their Graduate Medical Education.

House Officer I

The intern will spend approximately 3 months at University/MCLANO ED, 1 month in Ochsner’s ED and one month in the Ped ED at West Jefferson during the first clinical year. The intern is expected to evaluate and manage patients presenting to the emergency department under the direct supervision of the emergency medicine (EM) faculty and senior resident. All patients should be discussed with the supervising physician and/or senior resident before any treatment or tests are ordered, unless patient care is in jeopardy. The intern should focus on the fundamentals of emergency care including performing a focused history and physical, and developing an appropriate differential diagnosis and basic treatment plan.

Patient care and management within the Emergency Department include the following procedures with indirect faculty supervision or upper level resident supervision: venous and arterial blood sampling, venous cannulation, nasogastric tube placement, splinting of extremities, simple laceration repair, incision and drainage of subcutaneous abscess, foley catheterization, extremity anesthesia, local anesthesia, slit lamp operation, and supervision of medical students.
Additionally, first year house officers may perform and interpret waived tests which include vaginal wet preps, microscopic urinalysis, urine pregnancy tests, interpretation of stool for occult blood, and rapid Strep tests.
The following procedures may only be performed under direct faculty supervision: endotracheal intubation, tube thoracostomy, paracentesis, thoracentesis, central line placement, pulmonary artery catheterization, arthrocentesis of the knee, arthrocentesis of the shoulder/wrist/ankle, transthoracic pacing, transvenous pacing, electronic defibrillation, major trauma resuscitations, major medical resuscitations, relocation of joint dislocations, sexual assault exams, conscious sedation, vaginal deliveries, on line medical control, and cricothyroidotomy.
During their first year of training, house officers complete rotations in the emergency department, medicine wards, surgical wards, anesthesia, OBGYN, medical intensive care units, and community emergency departments.

House Officer II

The resident will spend approximately 7 months in the emergency department at UH/MCLANO, 1 month at either West Jefferson or Ochsner and 1 month in the Peds ER at OLOL. The second year resident is expected to evaluate and manage patients presenting to the emergency department under the direct supervision of the emergency medicine faculty and/or senior resident. The second year resident will have more responsibility and autonomy in the ED after successful completion of their internship, and is expected to learn how to function as a charge resident. Second year residents will be able to initiate management and treatment decisions before their initial discussions with their supervising physicians. The second year resident is expected to manage multiple patients of varying different acuity levels thus learning appropriate organizational and patient flow skills. The second year resident is expected to recognize and stabilize unstable ED patients especially arriving by ambulance. They will also participate in the management of the airway on trauma, medical and pediatric code patients, and act as the team leader of trauma codes. The second year resident will be expected to provide appropriate on-line medical command for ground EMS units.

At the House Officer II level, the resident functions as a junior charge resident. The resident continues to have primary patient care responsibilities of the House Officer I, but also assists the upper-level charge residents in the management and supervision of interns and medical students and leading rounds in the Emergency Department.
Responsibility for on-line medical control for local EMS services begins during the second year of training.
The following procedures may be performed with faculty supervision: rapid sequence induction and endotracheal intubation with sedatives and paralytic agents, conscious sedation, tube thoracostomy, cricothyroidotomy.
During their second year of training, house officers rotate in the ED and with EMS services as well as at Children’s Hospital in the pediatric ED.

House Officer III

The resident will spend a approximately 7 months in the ED at UH/MCLANO, one month at either West Jefferson or Ochsner, and one month in the Pediatric ED at Children’s Hospital. Third year resident will have more responsibility and autonomy than the second year resident in patient care decision making. The resident is still responsible for involving the ED attending physician as early as possible during the patient’s care. The Third year resident is expected to supervise junior level housestaff and medical students rotating in the emergency department. The third year resident will be expected to provide appropriate on-line medical command for ground EMS units.

Graded responsibilities increase in the third year of training. The resident continues to have primary patient care responsibilities, but assumes the role of the upper-level charge resident, in managing patient through-put in the ED.
The upper-level charge resident responsibilities include online medical control of ems, working knowledge of all patients in the ED, including those awaiting a bed in the Main ER, leading rounds, and supervising junior charge residents, interns and medical students in the ED.
Patient care and management within the Emergency Department to include all of the procedures granted to a House Officer Two including the supervision of lower level residents.
During their third year of training, house officers complete a rotation in MICU.

House Officer IV

The resident will spend approximately 4 months in the ED at UH/MCLANO, one month at either West Jefferson or Ochsner, and one month in the Pediatric ED at OLOL. Fourth year residents will have more responsibility and autonomy management and patient flow in the emergency department. The resident is still responsible for involving the ED attending physician as early as possible during the patient’s care is expected to supervise junior level housestaff and medical students rotating in the emergency department. The fourth year resident will be expected to provide appropriate on-line medical command for ground EMS units.

Patient care and management within the Emergency Department to include all of the procedures granted to a House Officer Three including the supervision of lower level residents. During their second year of training, house officers complete rotations on toxicology, and the emergency department.
During the PGY4 year residents are strongly encouraged to commit their elective time to a focused area of expertise with a goal of developing a niche in the arena of Emergency Medicine.

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