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overview

The four-year Emergency Medicine residency curriculum is designed to leverage the extensive resources of Harborview Medical Center, University of Washington Medical Center, Seattle Children’s Hospital, Valley Medical Center, and the University of Washington School of Medicine. Residents spend the majority of their time at Harborview Medical Center during both emergency department and off-service rotations.

Over the course of residency, the schedule includes 27 months in the emergency department, more than 5 months in various intensive care units, 1 month focused on emergency ultrasound, and 4 months dedicated to individualized career development tailored to each resident’s interests and goals.

HMC ED

Given the high volume and acuity of patients, Harborview Medical Center’s Emergency Department (HMC ED) is divided into primary medical and trauma areas. Beginning in the PGY-2 year, residents take on a unique role as they transition from the intern position to providing online medical control for Seattle’s paramedics.

On the medical side, residents serve as the “Medic One Doc,” caring for the most critically ill patients, including complex transfers from across the five-state WWAMI region (Washington, Wyoming, Alaska, Montana, and Idaho).

On the trauma side, residents step into the role of “Trauma Doc,” where they manage the trauma wing, lead codes, supervise and teach interns and medical students, and care for the sickest trauma patients.

Both the Medic One and Trauma Docs remain closely connected to Seattle and King County’s emergency response system. These roles are designed to challenge residents and give them early, hands-on experience in running a busy emergency department.

Pediatric Emergency Medicine

Approximately 16% of patients seen in the emergency departments at Harborview Medical Center (HMC) and the University of Washington Medical Center (UWMC) are children under the age of 17. To ensure residents maintain strong pediatric skills, the residents will rotate at Seattle Children's Hospital throughout their training to provide a comprehensive, longitudinal pediatric emergency medicine experience. All SCH faculty are fellowship-trained in pediatric emergency medicine.

During the intern year, residents complete a dedicated one-month rotation in the SCH Emergency Department, gaining concentrated training in pediatric emergency care. Beginning in the PGY-2 year, SCH ED shifts are integrated alongside shifts at HMC and UWMC, ensuring continued exposure throughout residency. In the PGY-3 year, residents also rotate through the Pediatric Intensive Care Unit (PICU), managing critically ill children in collaboration with pediatric ICU attendings, fellows, and residents.

In addition to training at Seattle Children’s Hospital, residents further broaden their pediatric experience through community-based emergency care at Valley Medical Center.

Ultrasound

The UW Emergency Medicine Residency Program is committed to providing comprehensive, longitudinal training in bedside ultrasound. The core curriculum includes dedicated rotations focused on ultrasound education, led by fellowship-trained emergency medicine faculty. In addition, residents participate in monthly ultrasound didactics and quarterly hands-on ultrasound workshops integrated into the conference series.

By the end of residency, each resident is expected to complete approximately 200–300 ultrasound scans and will receive credentialing from the EM ultrasound faculty.

ICU Experience

Critical care training is a cornerstone of the Emergency Medicine residency. Over the four-year curriculum, residents gain extensive ICU experience across multiple specialized units:

  • Trauma/Surgical ICU – 4 weeks
  • Medical ICU – 8 weeks
  • Pediatric ICU – 4 weeks
  • Burns/BICU – 4 weeks
  • Cardiac Care ICU – 4 weeks

The ICUs at Harborview Medical Center (HMC) and the University of Washington Medical Center (UWMC) care for the most critically ill patients in the WWAMI region (Washington, Wyoming, Alaska, Montana, and Idaho), providing residents with exposure to complex, high-acuity cases and advanced critical care management.

EMS & Pre-Hospital Care Experience

Seattle and King County, Washington, boast one of the highest survival rates for out-of-hospital cardiac arrest in the world, highlighting the critical role of EMS medical oversight in patient outcomes. Locally, highly trained firefighters and paramedics deliver exceptional pre-hospital care, and changes in treatment protocols are implemented deliberately, measured carefully, and translated into evidence-based improvements. The foundational principles that underpin Seattle’s world-class EMS system remain largely unmatched elsewhere.

Resident Experience:

  • PGY-1: First-year residents spend a week riding with Seattle Medic One and have the option to fly with Airlift Northwest to gain firsthand experience of the close relationship between Harborview Medical Center and the EMS system.
  • PGY-2 to PGY-4: Residents provide online medical control, work alongside Seattle and King County paramedics, and participate in paramedic training.
  • Residents also have opportunities to provide medical support at large events, including Seattle Seahawks games, music festivals, and marathons.
  • Third- and fourth-year residents may choose an EMS elective. UW also offers a prestigious EMS fellowship.
  • Seattle Fire Department – Medic One:
    Founded in 1970, Medic One provides advanced life support (ALS) for Seattle’s 750,000 residents. The program operates seven ALS ambulances staffed with two of the 71 certified paramedics per unit, overseen by a Medic Supervising Officer on duty at all times. Basic life support (BLS) transport is provided under contract with American Medical Response. Michael Sayre, MD, Professor of Emergency Medicine, serves as the medical director.

King County Medic One:

Serving approximately 780,000 residents in Seattle, King County Medic One operates eight ALS ambulances in collaboration with local fire agencies in a “third service” model. Residents interact with these paramedics at Harborview and Valley Medical Centers.

Airlift Northwest (ALNW):

ALNW maintains five bases across Washington and Southeast Alaska, transporting critically ill patients from remote and geographically diverse locations, including Alaskan islands, coastal communities, Eastern Washington deserts, and mountainous regions in Idaho and Montana. Second-year residents have the option to fly monthly during their ED months, with an elective available in PGY-3 or PGY-4. ALNW’s medical director is Rich Utarnachitt, MD, a UW EM faculty member.

UW Paramedic Training Program

Based at Harborview, the UW/Harborview Paramedic Training Program accepts 14–20 students annually from ALS agencies across Washington. Graduates gain extensive procedural experience, including over 40 endotracheal intubations, at least 400 IV placements, and care for 800+ patients during 2,500–3,000 hours of clinical training. Dr. Michael Sayre serves as medical director.

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 include Global Health, Emergency Medical Services, Ultrasound, Aeromedical, Toxicology, Rural, and Quality Assurance/Quality Improvement, as well as Medical Education.

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.

In addition to our formal tracks and rotation sites, a variety of electives in other clinical areas are available.

St. Luke's Wood River Medical Center, Ketchum, Idaho
St. Luke's Wood River Medical Center, Ketchum, Idaho