Mission

Madigan Army Medical Center’s Emergency Medicine Residency Program is designed to produce board certified physicians capable of providing world class emergency care in any setting, from the battlefield to the military or civilian tertiary care medical center. Our program leadership and core faculty work to ensure residents develop the clinical, academic, and procedural skills required to accomplish this goal. Throughout this process each resident undergoes rigorous personal and professional development, as well as strong resiliency training to help combat the burnout so prevalent in this specialty. Finally, we look to provide graduates with the best chances for success in fellowship training, academic faculty positions and operational medicine. Each resident also leaves with excellent leadership skills and is prepared to succeed in the Army.

Vision

To graduate Army Officers capable of providing world-class emergency medicine for any population, in any setting with a diverse set of tools allowing for a full and robust career.

Aims

• Provide foundation of fundamental emergency medicine to the future military emergency medicine physicians.
• Balance the rigors of resident educational atmosphere with wellness principles necessary to enhance lifelong engagement in emergency medicine while maintaining individual personal values and family.
• Provide the opportunity to develop in areas of interest depending on the individual resident: military leadership, program leadership, hospital leadership, national organizational leadership, excellence in research, promoting wellness for the program, curriculum development, and facilitating change in the program to continuously seek out an improved culture for future applicants.
• Recruit emotionally intelligent, compassionate learners that we would be honored to work side-by-side in an austere environment and entrust with the care of our family and fellow soldiers.

In addition to bedside teaching and the learning that comes from daily patient encounters, Madigan boasts a robust curriculum of didactic, simulation, ultrasound, and tissue training. Weekly Grand Rounds are five hours of quality lectures, small group exercises, and faculty and resident feedback sessions. Quarterly, our traditional Grand Rounds are supplanted by hands-on practice at the Andersen Simulation Center, tissue training labs, and wellness sessions.

Daily Morning Report consists of Oral Boards cases, interdepartmental simulation events, and procedural discussion and practice. Senior residents also give brief whiteboard talks at every change of shift, three times daily. We bring in expert staff from around the hospital and special guest lecturers from around the country to share their expertise.

The results of our curriculum are evidenced by our first-time EM Board pass rate of over 95 percent, and over half of our residents iteratively scoring above the 90th percentile on the National In-Training Exam. Our program produces academic excellence. However, the priority remains recruiting candidates with character and integrity. Our residents excel as a result of evidence-based teaching techniques, residency leadership that is highly adaptive to feedback, and a learning climate that is safe and effective.

Resources available: Rosh, EM Reviews and Perspectives, Hippo Emergency Medicine, Peer, along with the expansive library access available through Madigan.

• Harborview Medical Center and University of Washington rotations take place in Seattle, WA (approximately 40 miles from Madigan) – housing available funded by GME, but not required to stay in Seattle
• Legacy Emanuel (Portland, Oregon) and Providence Sacred Heart Medical Center (Spokane, Washington) are funded away rotations.
• All remaining rotations and hospital are within 15-minute drive from Madigan and are community hospitals with a variety of patient populations with less competitive learners than at the larger academic medical centers.

Welcome to Emergency Medicine! No call unless you are on an ICU rotation. We do maintain a back-up contingency system for Madigan blocks in Emergency Medicine, but if activated, will not result in work-hour violations.

Our residents and staff come from a variety of backgrounds, and we understand that military unique curriculum is important for continued growth as a Soldier, physician, and leader. Every Grand Rounds lecture contains information describing military relevance of the topic at hand. We also include expert-led formal education on battlefield medicine, Tactical Combat Casualty Care (TCCC), Chemical, Biological, Radioactive, Nuclear, and high yield Explosives (CBRNE), and medical care in austere and deployed environments. As a DHA requirement, all residents are required to complete the Combat Casualty Care Course (C4) (or USU equivalent) prior to graduation.

All Madigan residents have centralized military unique curriculum refined over the past 20 years to enhance the professional development of military residents to enhance assimilation upon graduation. This includes intern lectures and resident core curriculum required prior to graduation. Additionally, all graduating residents participate in Madigan’s Capstone Graduation Symposium. This is a five-day event that incorporates a field exercise that exposes all graduating residents along the continuum of care for the Military Health System (MHS). The field portion allows small-team dynamics from point of injury extending through tactical field care, prolonged field care, a multi-casualty exercise, exposure to military working dogs, CASEVAC on non-standard platforms, MEDEVAC on both ground and air evacuation platforms, Role 1, Role 2, and Aeromedical Evacuation out of theater. This also incorporates surgical specialists to highlight joint capabilities of the different surgical assets down range. This is led by subject matter expertise of combat tested faculty across Army, Navy, Air Force, Active Duty, Reservists, National Guard, and from DHA, MEDCOM, FORSCOM, and SOCOM representatives. In addition to the field exercise, the symposium includes panel discussions on operational experiences, life as a leader in a variety of military positions, deployment considerations, as well as professional development in considerations of how to lead interprofessional colleagues.

In addition to the above, we also host a two-day symposium for the senior residents which cover a host of topics specifically geared to life in the military and expectations of staff emergency medicine physicians. This symposium provides dedicated time with the leadership of the program and passionate staff dedicating their time to the personal development and guidance to help with a successful first assignment post-residency.

None prior to entry into residency, however, BLS, ALS, PALS, NRP, Ultrasound Orientation Course, Intern Simulation event, Houston Airway Course, Wilderness Medicine course, and the Combat Casualty Care Course (or USU equivalent) are expected to be completed prior to graduation. Must maintain BLS.

Our simulation curriculum is leading the Army Central Simulation Committee in excellence. Led by faculty with highly specialized education medical simulation and the core underlying adult education learning theory, our curriculum has been present since the opening of the Andersen Simulation Center in 2007. We are lucky to have Certified Healthcare Simulation Educator (CHSE) designated experts with specialty training in comprehensive medical simulation through Harvard’s Center for Medical Simulation leading the development and iterative refinement of the curriculum. We use a variety of methods to enhance our educational curriculum through medical simulation – including in-situ, interprofessional, interdepartmental training events in our resuscitation bay, monthly grand rounds days dedicated to medical simulation scenarios, the use of high-fidelity trauma, neonatal, pediatric, and obstetric manikins, along with standardized patients.

While often highlighting rare, high-stakes medical scenarios, we utilize medical simulation to emphasize team dynamics, communication, and leadership in interprofessional scenarios to better enhance a learner’s foundation. Learners have the opportunity to participate in delivering bad news, confronting an impaired provider, or resuscitating a sick or traumatized neonate so when they encounter those scenarios with live patients, they can rely on a foundation to better execute during stressful events. We are fortunate to be with a highly supported simulation center that encompasses three different environments to learn – Just in Time (JiT) Center learning for hospital based in-situ learning, the main center which has multifunctional rooms that can be augmented to support an multitude of environments – from a labor suite, an ICU room, operative room, clinic rooms, and an ER bay, as well as the operational annex that supports more tactical scenarios at the point of care to role one level of care. We utilize all of these areas across the curriculum. Whereas the main site of the Andersen Simulation Center is on post nearby the hospital, the JiT is a smaller simulation area located within the hospital and where we verify procedural competency during your second year, and it also supports our monthly in situ simulation events. The main center is where our monthly grand rounds simulation events take place. The operational annex is utilized to conduct medic training and to reinforce Tactical Combat Casualty Care best practices for our residents when conducting military unique curriculum.

Our program offers a wealth of leadership growth opportunities. We, by design, give our residents ample leadership opportunities with increasing responsibility as they progress through their training. This includes chief resident positions, but also committee positions at the department, hospital, or at the national organizational levels.

On the staff side of things, we have departmental quarterly officer development sessions guided by a variety of faculty, while the hospital hosts the Faculty and Leadership Development Fellowship. This affords the opportunity to attend monthly didactic sessions as well as two leadership development courses per year to enhance the abilities of each faculty educator. These not only supply a wealth of usable and pertinent information to help faculty to be become better educators, researchers, and leaders, but many are also eligible for credit towards a teaching certificate offered through the USUHS.

We do have a research requirement – our program expects you to graduate with the ability to read literature, have a general sense if it is sound, and evaluate for yourself if the literature reviewed will impact your future practice. This will become incredibly important as you will often be the medical subject matter expert advising non-medical commanders; you will need to interpret information and convey, concisely, your recommendations that could impact the lives of your Soldiers. Publications and presentations are also not requirements for acceptance to our program. We do have minimum scholarly activity graduation requirement needed to provide that foundation, which is designed to be flexible and achievable. If you are passionate about research, we house one of the most receptive Departments of Clinical Investigation regarding support and guidance within the Department of Defense. Additionally, our Directorate of Graduate Medical Education actively supports our residents showcasing their research at national venues. In the past year, we have had more than 23 peer reviewed articles, $4.5 million in grant funding, more than 75% of our current residents have presented at national conferences, and more than 1/3 of our residents are associate investigators. If this becomes your niche, we have the history and experience to support you becoming a nationally recognized leader in military emergency medicine.

One graduation requirement for our program is to complete a quality improvement project. We generally recommend finding a project you are passionate about – particularly if you find a process that makes you frustrated – and work to improve it. By finding something you are passionate about, you will be more vested in finding a good solution. The process is meant to show how to impact change in your environment. Some projects the residents have implemented have simply made workflow easier for their colleagues. Others have resulted in curricular change, such as the implementation of trauma informed care simulation experience to enhance how we communicate to patients who have experienced sexual assault or domestic violence. Some have resulted in changes to national resources – including MHS Genesis workflow solutions, and the Joint Trauma System Clinical Practice Guidelines used by joint military providers across a wide array of operational environments. After graduation, this will be an essential leadership skill. Having experience in this arena will help you critically analyze problems, develop solutions, and develop buy-in from stakeholders whose support is necessary to effect positive change.

Our residents have various avenues to help them develop professionally. As mentioned above, Madigan has a centralized curriculum development. This was originally implemented to enhance military unique curriculum. However, over the past twenty years, it has refined to include an intern orientation, an intern lecture series, and a resident core curriculum series that provides professional development both from a military and a medical leadership perspective.

In addition to the centralized curriculum, our program also has a variety of opportunities to provide the opportunity for professional development and mentorship. Our program uses the first block of residency to host an intensive intern orientation geared to facilitate onboarding and ensuring the first block of seeing patients as a physician is met with the mindset of support and success, we all know our residents to be capable of. Additionally, the residents get one-on-one sessions with their advisors to ensure each resident has an independent learning plan. Residents also have quarterly one-on-one meetings with their Associate Program Director to go over progress, strengths, weaknesses, and identify avenues for continued growth. Twice a year, residents will meet with both the Associate Program Director and Program Director to reiterate growth and trajectory, as well as to obtain individualized feedback to continue to evolve the program for future residents.

More formally, every month there is the opportunity for class break-out sessions to perform more small group leadership professional development personalized to the residents in the class to provide more longitudinal growth during residency. In addition to the above, we host grand round lectures on leadership and military topics to provide more targeted advice and guidance. The faculty support residents by providing space and time away from clinical responsibilities during all graduating resident symposiums to ensure the graduating residents have the ability to fully engage and take advantage of the subject matter expertise available.

• Harborview Medical Center
• University of Washington Medical Center
• Mary Bridge Children’s Hospital
• Good Samaritan Hospital
• Saint Peter Hospital
• Washington Poison Control Center
• Saint Joseph Medical Center
• Legacy Emanuel Hospital
• Providence Sacred Heart Medical Center

We offer 2-4 week rotations in our Emergency Department for interested medical students. We also work in tandem with the EM Ultrasound Fellowship and have coordinated hybrid rotations. Our rotations consist of approximately 10-14 shifts, prioritizing participation in social events and special didactic opportunities available that month. Amongst those shifts, to introduce you to the department and to highlight the importance of our interprofessional colleagues, we start with a nursing orientation shift to give you a better understanding of all the ways nurses facilitate patient care and to enhance communication and safe patient care should you choose our residency program.

If interviewing, we prefer 3-4 week rotations so you can gain familiarity with the program and the clerkship director can fully evaluate you with an electronic standardized letter of evaluation, which will be submitted to MODS and AAMC in mid-September. It is hard to convey the excellent culture and amazing educational climate you can experience here through an info paper and website. We fully understand there can be extenuating circumstances that preclude a full rotation with us, in which case, please reach out to us as we can help coordinate alternatives, such as an abbreviated rotation, a non-clinical visit, or at minimum, a virtual interview. We have an incredibly passionate residents and faculty that are more than happy to share their experiences and some of the resident-perspective to get a true perspective of the program and coordinate virtual information sessions and more in-depth, personal discussions with those interested in learning more about our program.

1. Start early. You should be inquiring about audition rotations in the December/January prior to audition season.
2. Ask each site you rotate at for a Standardized Letter of Evaluation (SLOE). EM does not offer letters of recommendation.
3. Try to interview (zoom/phone/in person) at every active-duty site.
4. Program directors, residents, staff etc. should never ask where you are ranking #1 or your preferences. You can tell programs where you are ranking them, but it is not required. If you elect to do so, this should truthfully be told to only one program. The program leadership all talk to each other – we all want you to be successful at the place best suited for you to matriculate and transparency can facilitate our ability to support you, if genuine.
5. Attributes that always foster success.
   • Be enthusiastic and engaged.
   • Remain humble but confident: we are more interested in someone who shows they can learn over the course of the month than if you know all the answers all the time. Growth, grit, and interprofessional teamwork mean a lot to this program.
   • Take part in social activities – we want to know you, not just who you are on paper.
   • Ask questions.
   • Stay in contact.

Residency is awesome – but challenging. Find the residency that fits you best to help you thrive. This includes staff/residents where you feel you can be your authentic self, a location you could see yourself/your family living, and picking a program that best suits your learning style and family needs. Some will thrive at seeing the majority of care at high volume institutions with every subspecialist available. Some thrive more when they can see the continuum of emergency healthcare, from community hospitals where competitive learnership is less of a challenge, to larger academic centers and level one trauma centers. There is a lot to consider when making your selection – be inquisitive and ask all questions you have in order to make the best choice for you and your family.

Program graduates take the American Board of Emergency Medicine Qualifying Exam and the American Board of Emergency Medicine Certifying Exam (new in 2026). This exam is offered biannually. To become fully board certified, applicants are eligible to take board certification exam 4 months following graduation. To be eligible to take the Certifying Exam, you must first pass the Qualifying Exam. Details may be found on the American Board of Emergency Medicine website.

Our residents have ample teaching opportunities with increasing responsibility as they progress through residency. They participate as instructors and proctors in combat medic training, medical student didactics, simulation cases, morning oral board cases, as well as community outreach to local EMS groups. Second year and senior residents are able to teach at the annual Wilderness Medicine course, Intern Ultrasound course, and various airway courses offered throughout the year. Uniquely, they are offered regular opportunities to teach and participate in training with Special Operation Forces and conventional units on post.

Our senior residents take on primary staffing responsibilities of interns, rotating medical students, physician assistant students, and off-service physician rotators and present daily whiteboard teaching at every shift change. Every resident has a minimum of two required grand round lectures per year that are curated with the assistance of an attending with particular interest in that field of medicine.

You will have the opportunity to train with dedicated core faculty with extensive operational and deployment experience, many with sub-specialty training in areas such as Austere and Wilderness Medicine, Emergency Medicine Critical Care, Pediatric Emergency Medicine, Ultrasound, Clinical Informatics, and Leadership and Faculty Development. We are fortunate to exist on a large base with a Core headquarters, Division headquarters, 62nd Medical Brigade, the Multi-Domain Task Force, and the Special Operations Forces (1st Special Forces Group, 4th Battalion of the 160th Special Operations Aviation Regimen, and the 2nd Ranger Battalion). This means many of our faculty have prior experience or are currently aligned with Forward Resuscitative Surgical Detachments, Field Hospitals, Battalion or Brigade level surgeons, or are actively holding special operations positions and continue to engage as academic faculty. Many have niche expertise in areas such as medical simulation, chemical warfare, ethics, health equity, and are selected to work here as they are passionate about the development of future emergency medicine colleagues.

Words matter. Mentorship is a special relationship in which the mentee seeks out a mentor for a particular area. What we provide are a wealth of passionate staff with a variety of life experiences, all who actively engage in mentorship. We assign an advisor upon arrival – an experienced faculty who is outside of your rating chain and assists you develop an individual learning plan and find your footing through residency. They are your advocate in staff meetings, and your first resource when things get challenging. But any of our faculty are willing to mentor – asking for who the best may be given a certain developmental, personal, or professional goal would be the best way to ensure you get aligned with someone that works for you.

We recognize for you to thrive professionally, you need the time and opportunity to spend time with family, pursue passions outside of Emergency Medicine, and reset. We support this in several ways, including monthly wellness grand rounds and retreats. We offer a supportive environment with resident well-being in mind and will always work with the resident to support any family or medical needs that may arise.