Mission

We believe in shaping the future of Navy emergency medicine by caring for anyone, anywhere, at any time and preparing graduates to function in any environment. Together, we are focused on preparing to support Fleet and Marine Corps efforts to provide care in Distributed Maritime Operations, Expeditionary Advanced Base Operations, or in garrison. We aim to achieve this by developing with cutting-edge research, education, policy, and military medical leadership.

Vision

• Our graduates will excel in any emergency department in the world, ranging from an urban academic trauma center to a single-coverage rural ED.
• Our graduates will save lives on the battlefield with their clinical skills and critical thinking.
• Our graduates will become innovators and leaders in our specialty.
• Our graduates will become emergency medicine educators; their skills and expertise will be shared to create a culture of health in our military.
• Medical Directors will actively recruit our graduates based upon our tradition of excellence.

Aims

Our program believes in providing amazing opportunities, aims for excellence, thoughtfully considers wellness, and ensures a ready medical force. This will be accomplished by demonstrating our graduates are:

• Lifelong learners and push to advance the science of medicine through our scholarly achievements and educational prowess.
• Leaders in the military and emergency medicine through our military accomplishments and national specialty society leadership positions.
• Provided access to novel and innovative clinical learning environments through our training rotations and access to military unique opportunities.
• The quintessential military officer and physician through their ability to lead by example, compassion, and ability to perfectly balance the needs of the military with their individual needs.
• The best versions of themselves through their achievements, successful careers, and impact on the military overall.

Didactics

• On-shift Teaching is typically led by EM PGY-3 and PGY-4 residents, faculty, or discussions regarding the sickest patients in the Emergency Department.
• Grand Rounds (GR): Grand Rounds is our didactics program that includes a combination of traditional lectures and flipped classrooms and prepares you for American Board of Emergency Medicine (ABME) written and oral qualifying exams.
• Asynchronous learning with supplementary readings and quizzes.

Emergency Ultrasound Curriculum

• Interns experience an introductory ultrasound course during their orientation month.
• This experience is reinforced by a 2-day regional point of care (POC) ultrasound course.
• A two-week block of ultrasound training with ultrasound procedural training, mastery of core EM US modalities, and emergency resuscitative ultrasound, weekly US didactics, quality assurance, scanning shifts, and journal club.  This rotation occurs during the PGY-1 year of training.
• Emphasis on incorporating ultrasound during shifts for diagnosis and resuscitation.  Residents provided immediate and quality assurance feedback on image acquisition in interpretation to enhance ultrasound skills.  

Emergency Medical System (EMS) and Disaster Medicine Curriculum

• Residents are required to participate in EMS ride-alongs, Border Patrol ride-alongs, and familiarization flights with the U.S. Coast Guard.
• PGY-4 training culminates in a Joint Emergency Medicine exercise with Air Force and Army EM residency programs at Fort Cavazos, Killeen, Texas.
• Residents will complete an EMS reading list, attend San Diego County EMS meetings, and complete a FEMA training course.

The NMCSD Emergency Medicine (EM) Residency Program is 4 years (48 months) in length and follows the training requirements outlined by the American Board of Emergency Medicine (ABEM) and the Accreditation Council for Graduate Medical Education (ACGME).

NMCSD blends military rotations (~35%) with civilian partner rotations (~65%) across ten (10) diverse health systems, providing exposure to healthcare disparities and the broadest training experience possible.

Emergency medicine rotations consist of Emergency Department (ED) rotations at NMCSD, Scripps Mercy, Scripps Chula Vista, Scripps Memorial, Sharp Grossmont, Tri-City Medical Center, Palomar Medical Center, University of California San Diego (UCSD), Rady Children’s Hospital, Children’s Hospital Orange County (CHOC), Arrowhead Regional Medical Center, and the Naval Hospital Guam. These rotations focus on building a foundation for professional emergency medicine practice. Residents are expected to be proactive in learning the art and science of emergency medicine and to attain a degree of proficiency in the profession to perform in an unsupervised setting upon graduation.

Additional rotations include Pediatric Intensive Care Unit P(ICU), Medical ICU (MICU), Burn ICU, Surgical Trauma ICU, Anesthesia, Toxicology, EM Electives, and OBGYN.

• Residents are authorized 4 elective rotations throughout the residency and participate in the Emergency Medicine Selective event in the PGY-4 year (can rotate at any affiliated ED).
• Elective Rotation options include Radiology, Ophthalmology, Dermatology, Research, Medical Spanish, Palliative Care, EM Law, Plastic Surgery, and Military Unique training course opportunities (Tropical Medicine, Division Officer Course, Intermediate leadership Course, etc.) or field exercises.

• NMCSD ED Blocks are 8-hour shifts, with thoughtful waterfall scheduling to optimize resident wellness.
• PGY-1, PGY-2, and PGY-3 residents will typically average working 20 clinical shifts per month with at least five (5) scheduled admin days to equal 23 out of 28 days with planned activities.
• PGY-4 residents will typically average working 18 clinical shifts per month with at least (7) scheduled admin days to equal 21 out of 28 days with planned activities.
• Each resident will have at least one day (24 hours) per week free from clinical duties. The admin days will coincide with grand rounds, procedure lab, and call days to limit days off that do not feel like days off.
• During NMCSD ED blocks, residents are scheduled for one to two 24-hour "on-call" shifts to help cover unforeseen shift changes due to personal emergencies.

• Longitudinal and individualized military operational curriculum to prepare our residents for their first military assignment.
• Dedicated military-specific lectures are incorporated into the weekly academic conferences.
• Specific military unique procedures like whole blood collection, transfusion, Resuscitative Ballon Occlusion of the Aorta, IT Clamps, junctional wound injures, in addition to other critical wartime procedures are incorporated into simulation conferences and bioskills procedure labs.
• All residents attend the Combat Trauma Skills Management (CTM) Course at Camp Pendleton, a medical course that prepares them for combat readiness at point of Injury through higher echelons of care.
• After CTM residents have the opportunity to serve as an instructor for Naval Special Warfare TACMED TCCC lanes, USMC Whole Blood Valkyrie labs, Prolonged Casualty Care lanes with First Marine Division.
• Opportunities for additional operational experiences are possible. Previous operational experience includes participation onboard the USNS Mercy, Operation Steel Knight with 1st Medical Battalion, and ERSS Mass Casualty training at Naval Expeditionary Medical Training Institute.
• Capstone Operational Emergency Medicine Course/Emergency Medicine Exercise at Fort Cavazos (JEMX): This is a week-long tri-service field exercise during the last EM block of your residency. This course is set up to give the senior resident a working knowledge of the operational experiences they might encounter in their military careers. The course culminates with a simulated combat field exercise, giving the resident the opportunity to put into practice the theory of operational medicine in a more realistic setting.
• All residents attend the Combat Trauma Skills Management (CTM) Course at Camp Pendleton, a medical course that prepares them for combat readiness at point of Injury through higher echelons of care.

• All EM residents must maintain certification throughout their residency training in Basic Life Support (BLS), Advanced Life Support (ALS) or Advanced Cardiac Life Support (ACLS), and Pediatric Advanced Life Support (PALS).
• Required courses include a PGY-1 EM crash course during first month of residency, a Research Introduction and Evidence Based Medicine course during the PGY-2 year. 

Procedural Lab

• Provides an opportunity for residents to learn life-saving procedures not commonly done by civilian emergency physicians but may be essential in deployed environments. Procedures performed include but are not limited to thoracostomy, transvenous pacing, pericardiocentesis, resuscitative thoracotomy, cricothyrotomy, suturing techniques, lateral canthotomy, and other procedures.
• At least two (2) dedicated cadaveric or live tissue procedure labs are offered throughout the year.

Simulation

• Longitudinal 4-year curriculum starting intern orientation month and then weekly Grand Rounds and on-shift simulations. Residents utilize NMRTC SD's state-of-the-art Simulation Department and train on high-fidelity simulators.
• Weekly oral board cases and culminating EM-4 oral case review to prepare for ABEM Oral Board exam.
• Intradepartmental training with nursing, medics, and PAs, and interdepartmental simulation cases with other medical specialties.

A robust curriculum for developing leaders in emergency medicine and in the military. Opportunities start from day one and increasing levels of responsibility are nurtured over the 48 months of residency. The curriculum includes:

• Yearly professional development conference
• Leadership and team building exercises
• Peer mentorship
• Quarterly program leadership and mentoring sessions
• Progressive leadership responsibilities on shift, during medical resuscitations, and in the management of trauma patients
• Resident leadership roles, including educational, clerkship, research, wellness, etc.

Completing a scholarly project is a requirement for graduation from the residency program, but there are several ways to achieve this.

Master Clinician Track

The effort utilized our experienced staff to work with residents on Clinical Case Reports, Book Chapters, Letters of the Editor, Educational Content Development, Online Medical Education resources.

Quality Assurance

Provides and avenue for residents to become familiar with Lean Six Sigma methodology and translate process improvement work into publication or presentation.

Combat Trauma Research Group (CTRG)

The Combat Trauma Research Group (CTRG) is a unit level research group concept involving the five core specialties identified by the 2017 National Defense Authorization Act (NDAA). The CTRG performs research aimed at preserving life on the battlefield. Efforts are focused on evaluating problems and knowledge gaps identified by the Committee on Tactical Combat Casualty Care (TCCC) and feedback from providers in current theaters of operations. Examples of prior resident lead research include:

• Intraosseous Blood Transfusion Strategies
• Whole Blood Collection Validation
• Pre-Rapid Sequence Intubation Resuscitation Strategies
• Sterility of Field Drawn TCCC Medications
• Low Light Condition Vascular Access
• TCCC Procedures Under Night Vision
• Ketamine Use During Conflicts in Afghanistan and Iraq
• Special Forces Medics Infusion Strategy Preferences
• … and many more

Residents participate in helping to improve the healthcare system for our patients. Residents will be educated in quality improvement and patient safety (QIPS) principles through the completion of the NMCSD EM QIPS core curriculum and participate in yearly process improvement teams.

While developing excellent emergency medicine skills, the NMCSD EM Residency also focuses on developing future military EM leaders through mentoring and modeling.

Funding for residents to attend at least one professional conference during residency when presenting a scholarly activity. Residents have given national lectures, research podium presentations, held national leadership board positions, and taught procedural courses at ACEP/EMRA, AAEM, SAEM, GSACEP, SOMA, MHSRS, AMOPS, CORD, AANP, AFPARC, and other professional societies.

• Children's Hospital of Orange County (CHOC)
• Naval Hospital Camp Pendleton
• Naval Hospital Guam
• Naval Special Warfare Training Center – San Diego
• Marine Corps Recruit Depot (MCRD) - San Diego
• Palomar Medical Center
• Pioneers Medical Center
• Rady Children's Hospital
• Scripps Chula Vista
• Scripps Green Clinic
• Scripps Mercy Medical Center
• Scripps Memorial Medical Center
• Sharp Grossmont Medical Center
• Tri-City Medical Center
• University California San Diego (UCSD) - Jacobs
• University California San Diego (UCSD) – Hillcrest
• Veterans Affairs Medical Center (VAMC) La Jolla

Our program offers rotations to fourth-year medical students interested in applying for an Emergency Medicine residency. Third-year medical students may apply for a rotation, but consideration is made based on space availability. Rotations are four weeks (one block) long and include multiple clinical shifts, didactic opportunities, simulation experiences, and catered time for learning about the values and culture of the program.

Please visit our Medical Student Rotation informational page to see a listing of available medical student rotations offered at NMCSD.

If you would like to schedule an interview with our program, please contact: dha.san-diego.San-Diego-NMC.list.nmcsd-em@health.mil

Program graduates take the American Board of Emergency Medicine (ABEM) qualifying examination and oral exam. These exams are offered annually. To become fully board certified, applicants are eligible to take board certification exam 3 months after graduation. To be eligible to take specialty board exams, graduates must complete all pre-requisites required by the ABEM by October 31st. Board eligibility is described on the ABEM website. Graduates remain board eligible for up to two five-year periods following completion of the residency.

Residents are expected to assume increasing levels of responsibility as teachers to their peers in the department throughout their time. This progression of responsibility begins in the late PGY-2 year.

Residents offered opportunity to teach courses and local, regional, national, and international conferences including ultrasound, emergency procedural skills, and lecture military and emergency medicine.

• Advanced Emergency Medicine Ultrasound
• EMS and Disaster Medicine
• Pediatric Emergency Medicine
• Wilderness Medicine
• Hyperbaric Medicine
• Toxicology
• Research
• Administration

Residents are split into mentor groups with assigned faculty. Mentor families participate together during grand rounds, flipped classroom, journal club, and offsite wellness events.

• The entire residency program and its curriculum have been restructured to ensure maximal opportunities for resident wellness consistently over the course of the 36-month residency. We have worked to consolidate all official activities in such a manner as to maximize off time without reducing the maximal opportunities for training.
• Residents will be afforded four (4) Resident Wellness Days every academic year.
• Residents can participate in an optional Wellness Committee geared at optimizing program wellness and involvement with hospital-wide peer wellness and support groups.