The Emergency Medicine Residency Program at Advocate Christ Medical Center started in July 1977. At that time, six full-time attending staff and five residents comprised the department. Today, the program is approved for 33 residents (9-11 per year), with 29 full-time attending staff and more than a dozen part-time physicians. In 2000, the residency received its fourth consecutive five-year accreditation from the RRC-EM. Advocate Health Care is affiliated with the University of Illinois at Chicago (UIC) College of Medicine.

Patient care and the concurrent resident-attending interaction serve as the foundation of resident education. To provide an optimal educational environment, as many as three attending physicians staff the general care and critical care areas of the department. They also provide direct patient care as needed.

All residents are selected through the match at the EM-1 level. However, the three-year curriculum can be modified for residents with prior training in another specialty. Four-week rotations are arranged so that blocks of time spent in the emergency department are interspersed with outside rotations. Thus, no resident is away from the “homebase” for long.

EM-1 residents must staff all patients with an attending physician. EM-2 and EM-3 residents are granted progressive levels of clinical independence, but they are still expected to consult with the attending staff whenever they have a question regarding patient care. The degree of independence is determined by the individual resident’s level of training, clinical capability and clinical skills.

Because of the favorable ratio of attending staff to residents, the attending staff is aware of the actions of the residents even though they may not have been consulted. This is the basis for the term “observed independence.” Inherent in this concept is the ability of the resident to exercise independent clinical judgment in an environment that would prevent inappropriate action. Additionally, EM-3 residents function more autonomously, assist attending staff in managing the treatment area, treat multiple critical patients simultaneously, and teach medical students and junior residents.

The attending staff monitors all patient care provided. If a resident’s care plan provides satisfactory management, the attending will not interfere. However, the attending staff will maintain overall responsibility for patient care.

Residents are encouraged to follow up on difficult and complex admissions. These often form the basis for case-related presentations at the weekly conference. With a portable ultrasound machine in the emergency department, residents have the opportunity to incorporate limited bedside ultrasound into their daily clinical practice. With emergency medicine faculty supervision, residents can use ultrasound on their patients to help focus a diagnosis.

Emergency medicine residents are scheduled for eighteen ten-hour shifts per rotation in the emergency department. On outside rotations, emergency medicine residents’ call schedules are equivalent to those of other residents on that service; residents also are expected to attend educational conferences provided by that department. In addition, all emergency medicine residents are expected to attend weekly emergency medicine conferences.

Written evaluations are submitted upon completion of each outside rotation. Resident performance within the emergency department is evaluated every six months, with each resident meeting privately with the program director to review these evaluations. Similarly, residents evaluate off-service and emergency department rotations and attendings twice each year.

Each resident is expected to pursue his or her own special interest within emergency medicine. This may include EMS, administration, clinical research, medical education, a defined clinical subspecialty or another emergency medicine-related activity. Residents, working with faculty mentors, set their own goals for these activities.

All residents are required to complete a resident project. This can be done by writing a paper of publishable quality based on case report, topic review or their special interest activity. Alternatively, the resident may contribute to an existing resident project or CQI project within the department.