The four-year EM residency curriculum is designed to take advantage of the abundant resources at Harborview Medical Center, University of Washington Medical Center, Seattle Children’s Hospital, Valley Medical Center, and the University of Washington School of Medicine. The EM residents will spend the majority of their time at Harborview Medical Center while on ED and off-service months.
The resident schedule consists of 27 emergency department months, 5+ ICU months, 1 ultrasound month, 1 toxicology month, and 4 months dedicated to further career development, tailored to the individual resident.
The EM residency also includes an extensive EMS curriculum which is integrated throughout the 4 years.
*In the PGY2-4 years, shifts at SCH are scheduled as part of every HMC and UWMC ED block. This is equivalent to one month per year of Pediatric Emergency Medicine.
**In the PGY3 and 4 years, to further their long-term career plans, residents design and develop career development tracks (“CDT”) with specialty faculty, advisors, and residency leadership.
The University of Washington provides three weeks of vacation per year and one personal holiday for all residents in every specialty.
Harborview Medical Center ED (“HMC ED”) is divided into primary medical and trauma areas. Starting as a PGY2, residents have a unique role at the HMC ED: Transitioning from the intern role to one that provides online medical control for Seattle’s paramedics. While on the medicine service, acting as “Medic One Doc,” residents care for the most critically and medically ill patients, including transfers from the five-state WWAMI region (Washington, Wyoming, Alaska, Montana, and Idaho). On the trauma side of the ED, residents learn the role of “Trauma Doc”---they manage the trauma wing and run codes; oversee/teach interns and medical students; and manage patients, many of whom are transfers from WWAMI. With a radio in hand, the Medic One Docs and Trauma Docs have their fingers on the pulse of Seattle and King County, an experience that is intended to challenge and stretch residents, giving them an early learning opportunity of what it takes to run a busy ED.
Pediatric Emergency Medicine
The pediatrics curriculum is designed as an integrated longitudinal experience. Seattle Children’s Hospital is a nationally recognized hospital with top pediatric residency and fellowship programs. EM residents rotate in the pediatric ED several shifts every ED block which makes possible a continuous seasonal exposure to the pediatric population without degradation of skills. Residents also rotate through the pediatric ICU. At SCH, 25 percent of didactics time is focused on pediatric emergency medicine. Lectures are given by pediatric board-certified EM faculty and pediatric emergency medicine fellows.
The UW EM training program is committed to providing in-depth and longitudinal training in the use of bedside ultrasound. Built into the core schedule are rotations dedicated to ultrasound teaching by fellowship-trained emergency medicine faculty. Monthly didactics on ultrasound topics and quarterly ultrasound workshops are integrated into the resident conference series. At the end of four years, residents will have completed an estimated 200-300 scans and will be credentialed by the EM ultrasound faculty.
Critical care experience is essential to the training of Emergency Medicine residents. The University of Washington Emergency Medicine residency program provides extensive exposure to ICU medicine with training from faculty and fellows from multiple disciplines. Within the four-year curriculum there are over five months devoted to ICU care:
- Harborview Trauma ICU
- Harborview Cardiac ICU
- UW Medicine Regional Burn Center at Harborview (1 week)
- UWMC Medical ICU (2 months)
- Seattle Children’s Hospital Pediatric ICU
Residents have the opportunity to arrange additional critical care experience during their elective months.
Pre-Hospital Care Experience/EMS
The 5-fold disparity in long-term survival rates following out-of-hospital cardiac arrest among different communities suggests that the EMS medical director has a profound impact on the quality of care delivered to patients. Seattle and the surrounding areas of King County, WA have among the highest survival rates following out-of-hospital cardiac arrest in the world. In greater Seattle, meticulously trained firefighters and paramedics provide excellent medical care.
In Seattle and King County, changes in the approach to caring for specific illnesses and injuries are implemented deliberately and carefully measured to determine if they lead to an improvement or, perhaps, a deterioration in the system. This approach has demonstrated significant discoveries translatable to a much wider community. The essential design and foundational principles responsible for the success of Seattle’s world-class EMS system have not been widely emulated.
First-year emergency medicine residents spend a week riding with Seattle Medic One and Airlift Northwest to gain insight into the close relationship between Harborview Medical Center and the EMS system. During years 2-4 of the residency, EM residents continue to work closely with the Seattle and King County paramedics providing medical control and participating in paramedic training. Throughout residency, residents have numerous opportunities to participate in medical care at large events including Seattle Seahawks games, electronic music festivals, and marathons. An EMS elective is available to third or fourth-year residents. UW also sponsors an outstanding EMS fellowship.
Seattle Fire Department
The Seattle Fire Department Medic One program began caring for patients in 1970. The two-tier response plan was created shortly thereafter and continues as a core underpinning of the system design. Seattle Medic One is based at Harborview Medical Center and provides advanced life support EMS for the City of Seattle, population 750,000, using 7 advanced life support (ALS) ambulances each staffed with 2 of the 71 certified paramedics operating within the Medic One program. In addition, there is one Medic Supervising Officer on duty at all times. Basic life support (BLS) transport is provided under a contract with American Medical Response, ensuring timely transport for less critically ill and injured patients. Michael Sayre, MD, Professor of Emergency Medicine, is the medical director for Seattle Fire Department.
King County Medic One
The King County Department of Health provides ALS services for the 690,000 people living in communities within King County, south of City of Seattle, using 8 ALS ambulances. About 70 paramedics in the program work side-by-side with local fire agencies in a “third service” model. Emergency medicine residents interact with the King County Medic One paramedics at Harborview and Valley Medical Centers.
Airlift Northwest (ALNW)
ALNW operates five bases throughout Washington and Southeast Alaska. ALNW transports critically ill patients from one of the largest and geographically varied landmasses in the world – from isolated islands and coastal regions in Alaska, desert communities in Eastern Washington, and mountainous terrain in Idaho and Montana. The medical director of ALNW is Rich Utarnachitt, MD, an EM Faculty member. Second-year EM residents fly once a month during their ED months. An Airlift elective is available to third or fourth-year residents.
UW Paramedic Training
Based at HMC, the University of Washington/Harborview Medical Center paramedic training program accepts between 14 and 20 students from ALS agencies within the state of Washington. At program graduation, each paramedic student has performed endotracheal intubation for more than 40 patients, established at least 400 IV lines, and cared for no less than 800 patients during 2500 to 3000 hours of training between October and July. Dr. Sayre is the Medical Director for UW Paramedic Training.
We are confident that our residents benefit from an EMS system that is unique in the world.
Career Development Time
A unique and core part of every resident’s experience is the Career Development Time (CDT). The goal of this program is to provide trainees the time and resources for the development of advanced skills and expertise in an area of focus beyond the core Emergency Medicine training. Four months of the curriculum are dedicated to this program. Focused areas of study are determined by the resident but the time can be used to build clinical skills, explore a potential niche, or develop foundational skills for a future career.
Residents may decide to use their time to explore a variety of electives, or choose a specific Educational Pathway. Our current pathways are Global Health, Emergency Medical Services, Ultrasound, Aeromedical, Toxicology, Rural, and Quality Assurance/Quality Improvement.
For those interested in practicing Emergency Medicine in a rural setting, we have longstanding partnerships with St. Luke’s Wood River Medical Center in Ketchum, Idaho, and Peace Island Medical Center in Friday Harbor, Washington, where residents can experience working in a single-coverage, critical access hospital.
St. Luke's Wood River Medical Center, Ketchum, Idaho
Peace Island Medical Center, Friday Harbor, Washington
In addition to our formal tracks and rotation sites, a variety of electives in other clinical areas are available.