The Third Year

Third year residents will have increasing autonomy in caring for patients and managing operations in the emergency department. They will take on a more supervisory role in managing flow in the emergency department, directing resuscitations, and overseeing junior residents, medical students and off-service rotators.

In the third year residents will complete their scholarly project and will be supported to present their work at a national EM conference. Residents will also participate in editorial reviews of manuscripts submitted to the Permanente Journal.

At the end of the third year of training, our goal is to have trained EM physicians who understand that the practice of EM is as much about competent and safe clinical care as it is about professionalism, communication and teamwork. Our residents will be prepared for a fulfilling career in emergency medicine with the skills to teach, learn, lead and thrive in any practice environment.

PGY-3 Goals:

  • The third year Emergency Medicine Resident will concentrate on mastering efficiency and management skills as they prepare to work independently in an Emergency Department. They will develop expertise in problem solving, operations management, patient disposition, efficient delivery of emergency medical care and teaching. Overseeing the operations of the Emergency Department and ensuring that all patients receive appropriate and efficient care are of paramount importance.
  • The resident is primarily responsible for the most critically ill patients in the area of the Emergency Department to which they have been assigned and acts as team leader and supervises and teaches members of the health care team during medical, pediatric and trauma resuscitations. This includes demonstrating mastery in clinical procedures, including advanced airway management, conscious sedation on extremes of age and patients with high ASA classification. Residents at this level should be able to manage and prioritize multiple critically ill patients and enlist appropriate resources for their care and, if needed, transfer.
  • PGY-3 residents assume more academic responsibilities, providing lectures and conferences as part of their regularly scheduled academic requirements. During this training year, the PGY-3 resident builds the confidence, expertise, and competence required to participate in the instruction of others (eg. junior residents and students) in patient management, identifying complications, and recognizing when more specialty care is required. Under the supervision of the attending, the PGY-3 resident assumes additional responsibility in teaching and precepting junior residents and medical students in guiding their patient management. In addition to mastery of the core concepts in Emergency Medicine, a key learning objective for this level of training is to learn to balance patient care with supervisory activities and teaching responsibilities. The senior resident must be able to recognize when junior residents or students require an increased level of oversight or guidance when clinical demands might exceed that resident’s or student’s level of expertise.
  • They will master the efficient use of the EHR and will be able to teach others in its use. They will participate in real time QI reviews at stroke codes and medical resuscitations and present their analyses at regular QI meetings. They will also participate as members in the department’s peer-review QI process. The resident will be able to enlist resources for the care of complex patients, disasters and emergency department surge phenomenon and be able to draft policies and procedures to improve patient safety and correct/eliminate root cause as well as develop systems to prevent medical error. The resident will complete their QI and Scholarly projects, prepare them for publication and present it at a local, regional or national academic conference. The resident will be able to critically analyze research of various types and will be responsible for selecting, analyzing and presenting journal club articles.