Mission

The Naval Medical Center Portsmouth, Emergency Medicine Residency Program is designed to prepare physicians to provide competent emergency care to Department of Defense beneficiaries anywhere in the world and under any circumstances. Our graduates master emergency medicine core competencies and are more adaptable and self-reliant to meet the challenge of providing tactical combat casualty care, prolonged casualty care, and damage control resuscitation in the austere operational environment. We recognize that success depends on more than medical knowledge and skill, so our mission includes building medical leaders by developing trainees in program management, mentorship, education, negotiation and conflict resolution, and identifying team dysfunction through a dedicated leadership curriculum.

Vision

To graduate residents who are prepared to deliver emergency resuscitation through all echelons of care and become leaders in Navy Medicine; while becoming the premier training program in the DHA enterprise through sustained excellence in academics, research, leadership, and clinical experience.

Aims

1. We aim to develop Navy EPs into competent emergency physicians with sound skill sets, including acute resuscitation and stabilization, identification of life-threatening conditions, application of principles of symptom relief, determination of disposition and appropriate level of follow-on care, management of emergency department patient flow, and resource allocation in order to be principled stewards of the public’s welfare and healthcare costs.
2. We aim to develop Navy EPs capable of providing expeditionary care by applying their cognitive expertise and procedural skill in any environment, including in-garrison care at military hospitals, the battlefield, and all austere environments in between.
3. We aim to develop Navy EPs with leadership and managerial skills to facilitate their success as champions and unit leaders within the U.S. Navy and civilian business world.

Our program provides protected time for a minimum of five hours per week of planned didactic experiences. Our weekly didactic experiences come primarily from weekly conferences every Thursday from 12 - 5 p.m. in the Emergency Medicine Residency Conference Room Additional faculty are scheduled in the ED during this event so that residents have time to attend. All residents, except those rotating in critical care and out-of-region rotations, have protected time for this educational experience and are excused from clinical duties during conference time. Our academic conference offers instruction in emergency medicine core content through a combination of traditional lectures, small group discussions, high-fidelity simulated patient encounters, field exercises, and internet-based medical training.

Every academic conference starts with a quiz of the core content weekly reading from Tintinalli’s Emergency Medicine: A Comprehensive Study Guide textbook. An electronic copy of the text, as well as many others, are available through NMCP’s Library Homepage available on the intranet. The weekly quiz helps identify those residents struggling to retain the core content, tests reading comprehension, and allows residents to practice test-taking strategies. The quiz is followed by a core content lecture covering the material from the reading to help residents distill the most important information from the text. The quiz is created by the program leadership team and the weekly core content is delivered by the residents. The material from Tintinalli’s text is covered over the course of a two-year cycle so that residents cover the core content twice during their 4-year residency training. Additional lectures during academic conference are delivered by residents and faculty which cover critical topics in emergency medicine, professional development, and wellness for the emergency physician.

• Residents have 3-4 months of elective time distributed throughout their training. Interns complete an operational medicine elective. EM 2-4s selective elective opportunities in line with their career goals and professional development.
• Options include operational electives such as working with Flight, Dive, Surface, or Marines. Senior electives include may be clinical (e.g. Ophthalmology, Dermatology, Dental, specialty ICU, or any other subspecialty of interest) or time can be used to perform research, engage in global health opportunities, attend military courses, or attend professional development courses.

We have a longitudinal Miliary Unique Curriculum that spans the four years of training.

EM1 – Orientation

This 4-week block not only introduces interns to emergency medicine, but also provides training on Tactical Combat Casualty Care (TCCC) and Joint Trauma System Clinical Practice Guidelines (JTS CPGs) which lay the foundation of deployment medicine. Interns get classroom exposure, and hands on training through all three-phases of care during an outdoor simulation exercise, which culminates in a half-day field exercise at a local base. This event requires teams of interns to navigate between simulation stations and provide medical care based on TCCC.

EM2 – REBIL

This 4-week block is positioned mid-way through the EM2 year to allow dedicated time for longitudinal coverage of operational medicine, Neonatal Resuscitation, and Resident as Educator Seminar. REBIL (Research and Evidence Based Instructional Learning) gives residents the skills they need to critically appraise scientific articles and perform research. It also includes a seminar to develop their skills as clinical teachers, prior to teaching juniors in the department. The EM2 year focuses on resuscitation and critical care, by having residents complete REBIL where they participate in field care lectures, simulation, and a final exercise of setting up a shock trauma platoon with Bravo Company of 2nd Medical Battalion.

EM3 –Operational Leadership

This 4-week block provides senior residents training and practical application of their leadership skills into the operational setting. This block includes classroom didactics and a multi-day field exercise. The field exercise requires residents to perform all the mission planning (e.g. food, equipment) as a team. During the field exercise residents participate in team building exercises as well as prolonged field care and en route care scenarios. JTS CPGs are reviewed, applied, and presented to peers. Residents also complete the Military Medicine Humanitarian Assistance Course and serve as Faculty at USUHS Operation Bushmaster.

EM4 – CAPSTONE

This 4-week block allows senior residents to prepare to transition to independent practice. We cover topics relevant to their careers as naval officers, such as award writing, FITREP writing, enlisted EVALs, department leadership, credentialing, moonlighting, deployment, operational leadership jobs etc. The block culminates in the Joint Emergency Medicine Field Exercise which takes place at Ft Cavazos in Killeen, Texas. This field exercise is a tri-service exercise, that includes EM residents from all three services. EM residents serve as team leaders of multidisciplinary groups that navigate casualty care from point-of-injury through role 1/2/3 facilities including austere operating rooms and both air and ground evacuation platforms.

Other Opportunities

Additionally, some residents chose to use their elective time to gain additional experience in military medicine. This has included attending operational courses (e.g. mountain medicine, cold weather medicine, Intermediate leadership course), volunteering with medical missions (e.g. JTF-B Honduras, USNS COMFORT missions), and teaching EM knowledge and skills to operational units.

Each year an EM4 is selected to leave the MUC. This collateral duty includes delivering MUC specific lectures during conference, MUC relevant topics during simulation lab and highlighting Navy Customs and Traditions.

The residency program supports four required rotations for residents to grow as military leaders. EM1s complete orientation which covers a crash course in EM, as well as dedicated training in military medicine and trauma combat casualty care (TCCC). EM2s complete evidence based medicine and prolonged field care. EM3s complete Operational Leadership which includes humanitarian response, local field exercise, and serving as faculty for medical student field exercise. EM4s complete Capstone which includes transition to practice didactics and a culminating joint field exercise with other military EM graduates. Residents are required to maintain certification in Advanced Life Support (ALS)/Basic Life Support (BLS)/ Advanced Life Support (PALS), and Advanced Trauma Life Support (ATLS). These are recertified periodically.

Residents participate in high fidelity simulation for our didactic session each block. This 3.5 hour session allows resident teams to rotate between cases that are linked to the reading topics for the block. Additionally, simulation is used in the MUC both in the hospital and during field exercises. During the final year of training, residents train under the EM faculty at how to run, debrief, and give feedback following simulation. There are opportunities to take advanced training courses in simulation education through the simulation center at NMCP.

Leadership is an inherent aspect of being a Naval medical officer. Navy emergency physicians are over-represented in U.S. Navy operational medicine leadership positions, particularly within the U.S. Marine Corps. Therefore, it is a priority of our residency training program to not just create competent physicians but to groom future healthcare leaders. Further, the ACGME expects the program, in partnership with the command, to provide a culture of professionalism which supports patient safety and personal responsibility. As such, the program has created a progressive leadership curriculum to facilitate our residents acquisition of the managerial and leadership skills needed to lead successful teams within healthcare. In addition to participation in clinical and educational activities common to many residency training programs that promote leadership development, our program includes the following leadership experience requirements:

Year of Training Leadership Experience(s)

PGY1

Operational Medicine Elective Rotation, Basic Readiness Officer Course

PGY2

REBIL (Research & Evidence-Based Introductory Learning) Course, Resident-as-Educator Symposium

PGY3

Operational Leadership Rotation, Instructor for Operation Bushmaster, Military Medical Humanitarian Assistance Course, EM Teaching Rotation

PGY4

Senior Resident Collateral Duty, Quality Improvement & Patient Safety Rotation, EM Teaching Rotation, CAPSTONE Rotation, Joint Emergency Medicine Field Exercise

Senior residents are expected to assume collaterals duties like all naval officers. These activities facilitate leadership development and demonstrate service to the educational mission of the program. Residents are mentored through leadership roles on hospital and national committees as desired.

Scholarly activity is an ACGME requirement for graduation. This scholarly activity may take many forms, including a formal research project, development of an educational computer program, authoring a textbook chapter or review article for publication, directing an educational program, participating significantly in a national/regional committee or other alternative scholarly project. Each such activity will be awarded points, depending on the level of work required and contribution given. Authorship order on a manuscript or poster does NOT impact points awarded. A total of 4 points is required for graduation. Every resident must have meaningfully participated in a scholarly project at the author level or have personally written a collective review or case report as part of their point requirement in order to graduate. The number of points awarded for a given scholarly project is decided by a panel consisting of the Program Director, Research Director, and class APD. The Program Director and other panel members maintain the ability to vary points awarded based on project complexity, effort expended and impact of final product. All publication submissions must be approved through command Research Publication and Presentation Approval process (RPPA). Additionally, all case report submissions to the ARC, AAEM, or other competitions must have a faculty member author who is expected to review and make critical edits.

Point Award Guidelines and Examples  

• 4 points – Successful design, application submission, execution and completion of a research project, from initial concept to submission for publication (the traditional research project).
• 2 points - Successful completion of an “Evidence Based Emergency Medicine Review”, acceptable for submission to a peer-reviewed MEDLINE-indexed medical journal. (Annals of Emergency Medicine format)
• 2 point – Successful development, completion, submission and selection for presentation of an “Innovations in Emergency Medicine Education” Project. (SAEM format).
• 1-2 points – Participation on a national committee (ACEP, AAEM, CORD, etc.).
• 1-2 points – Successful preparation, selection, and presentation of a scholarly research project at a regional or national meeting. (i.e. – oral presentation at a regional or national medical meeting.)
• 1 point – Successful completion of a case report / case series with detailed review of the literature, acceptable for submission to a peer-reviewed MEDLINE-indexed medical journal.
• 1 point – Successful preparation and execution of an SAEM/CORD-EM selected CPC case presentation.
• 1 point – Successful preparation, selection, and presentation of a scholarly abstract at a regional or national scholarly medical meeting. (i.e. – poster presentation at a regional or national medical meeting).
• 1 point – Participation on an institutional or regional committee.
• 1 point – Preparation and acceptance of case report to ARC, AAEM or other regional/national meeting (max 1 point for the same case report accepted to ARC and AAEM)
• 0-2 points - Assisting on a research project as an author may earn points depending on amount of contribution.
• 0-1 point – Contributing as an author to a peer-reviewed internet based scholarly website. (ex. – writing a PEPID article.)
• 0-1 points - Completion of an academic scholarly project that ultimately improves the training atmosphere or productivity of the residency or the ED. (ex. Creating a library of podcasts or screencasts addressing a specific topic, developing a radiographic teaching e-file, organizing a detailed inter-service grand rounds, etc.).

Scholarly Activity Progression

Every resident must have meaningfully participated in a scholarly project at the author level or have personally written a collective review or case report as part of their point requirement. These are assessed biannually by the APDs.

• A PGY1 is expected to complete 0.5 points or be AI/PI on protocol by year’s end.
• A PGY2 is expected to complete 1 point by year’s end.
• A PGY3 should have completed 2-3 points by year’s end.
• A PGY4 must have accumulated 4 points to graduate.

There is an EM resident representative to the command quality and safety committee. EM residents are invited to participate in RCAs and Swarms relevant the emergency department. Residents complete a 4-week rotation in Quality Improvement and Patient Safety. This rotation allows residents to learn the Quality Improvement (QI)/Patient Safety (PS) processes in place at the department and hospital level. It also provides residents with the knowledge and skills to fulfill the American Board of Emergency Medicine (ABEM) Process Improvement requirements for maintenance of board certification. By the end of the rotation residents will be able to:

• Demonstrate efficient use of institutional processes to identify patterns and trends of patient safety areas for correction.
• Apply investigative process to assigned patient safety events.
• Participate in interdisciplinary teaching as an avenue to improve safety and department processes.
• Demonstrate scholarly inquiry into quality assurance/process improvement measures.

• Sentara Norfolk General Hospital
• Sentara Virginia Beach General Hospital
• Sentara Leigh Hospital
• Riverside Regional Medical Center
• Bon Secours Maryview Medical Center
• Chesapeake Regional Medical Center
• Chesapeake EMS System
• Naval Medical Center Camp Lejeune
• OSF St Anthony Medical Center
• Children’s Hospital of Richmond at VCU
• Rocky Maintain Poison and Drug Safety

Emergency Medicine Clerkship – MS4 year

Students rotate at NMCP on both clinical shifts and shifts dedicated to clinical teaching (1:1 with senior resident). Students are exposed to the breadth of emergency medicine, including trauma activations. Students complete 14 shifts and attend EM didactics, EM journal club, and skills labs. Evaluation for the school is provided at the end of the rotation. Standard Letter of Evaluation (SLOE) is generated and submitted on request to ERAS/MODS. Students are encouraged to rotate during May-Oct to facilitate an interview during the rotation, but rotators are accepted during the entire academic year. Interviews can be accommodated outside planned rotation dates if needed.

Emergency Medicine Ultrasound – MS4 year

Students rotate in the EM Ultrasound division. They receive didactics, hands-on bedside scanning, participate in image review, and gain an understanding of program requirements. This rotation is arranged at the availability of the division for additional learners and may not be available at all times, please inquire about availability.

All applicants to Emergency Medicine are encouraged to interview with both Portsmouth and San Diego.

Interviews are typically scheduled during the applicant’s rotation at the hospital, even if not rotating in EM. We support virtual interviews for any student not rotating at Portsmouth.

Candidates should be in Summer Whites or Service Dress Blues (based on uniform change over date). If you have not attended ODS, you should interview in business attire.

Program graduates take the American Board of Emergency Medicine (ABEM) qualifying (written) and certifying (oral) exam. The qualifying exam is offered annually in the fall; graduates typically take the exam the fall after graduation. After passing the qualifying exam, applicants are scheduled to take the certifying exam. Following successful completion of the certifying exam, graduates are board certified. The current oral exam is offered virtually three times per year, but ABEM announced a planned transition back to in-person oral exams. The time course and frequency of this has not been announced.

All residents participate in the Resident as Teacher Seminar that provides didactic and hands-on training for evaluations, assessments, feedback, and bedside teaching. EM3 and EM4 residents are required to lead a team in the department and provide teaching during their NMCP emergency rotations. Residents complete two 4-week blocks dedicated to clinical teaching where they orient rotators to the department, teach emergency department procedures, and have dedicated time to clinical teaching separate from clinical obligations.

• Residents are able to attend USUHS Faculty Development trainings during their final year of training.
• Residents are able to attend advanced simulation courses and/or do elective time in the simulation lab.
• Senior residents provide procedural teaching during skills labs.

• Critical Care
• Emergency Medical Services
• Global Health/Disaster Preparedness
• Pediatrics
• Toxicology
• Ultrasound

We have both a formal and informal mentorship program. Each class in residency has specific challenges unique to that year of training; thus each class has a dedicated assistant program director (APD) who provides mentorship and guidance to the individuals in their class. However, we know that the most robust mentorship relationships occur when residents connect with a mentor vice being assigned. Thus, our aim is to create an environment where like-minded individuals can come together and form these organic mentorship relationships. This is done through Focus Track meetings, journal clubs, and faculty involvement. Additionally, the residents are split into four squads with members of each PGY group in the squad. Squads have time to meet and offers additional opportunities for mentorship across year groups.

Psychological, emotional, and physical well-being are critical in the development of the competent, caring, and resilient physician and require proactive attention to life inside and outside of medicine. Well-being requires that physicians retain the joy in medicine while managing their own real-life stresses. Self-care and responsibility to support other members of the health care team are important components of professionalism; they are also skills that must be modeled, learned, and nurtured in the context of other aspects of residency training. Emergency medicine residents and attending physicians are at particular risk for burnout and depression. We have a responsibility to address well-being as other aspects of resident competence. Physicians and all members of the health care team share responsibility for the well-being of each other. Three times each year the Journal Club time is utilized for residency wellness and maintaining Navy customs and courtesy events (e.g. Hail and Bail).

The Wellness Curriculum provides education in physician wellness. It begins during orientation and continues with monthly wellness sessions integrated into our educational curriculum. Although topics will vary, the curriculum is based on the American College of Emergency Physicians’ An Evidence-Based Longitudinal Curriculum for Resident Physician Wellness: The 2017 Resident Wellness Consensus Summit published in 2018. Each week our academic conference includes a wellness-related core content lecture, physical wellness activity (cardiovascular fitness, resistance training, or yoga), a consultant services combined activity (see EM BROS), or a simulated difficult patient scenario that may impact wellness. Additionally, the ACGME has approved the use of four of our academic conferences exclusively for activities designed “to enhance the meaning that each resident finds in the experience of being a physician.”

Residents receive the following amount of leave: PGY1s have three weeks of leave and PGY2-4 have four weeks of leave.