Clinical Rotations

Clinical rotations outside the Emergency Department (ED) account for 25 percent of the residency. Required rotations are: anesthesiology, obstetrics/gynecology, orthopedics/hand surgery, medical intensive care unit, coronary care unit, and neonatal intensive care unit. Residents spend some time off site at other rotations including Emergency Medicine at Mount Sinai Beth Israel, Pediatric Emergency Medicine at The Mount Sinai Hospital, Toxicology at the New York City Poison Center, and a trauma elective at a tertiary referral adult and pediatric trauma center.

Our critical care experience is augmented with a critical care consult rotation in the second year. On this rotation, ED residents act as the intensive care unit (ICU) consult resident for ED patients and present the case directly to the ICU attending and fellow. As patients wait for transition up to the ICU, the ED Critical Care resident guides the management of these patients providing relevant critical care experience in the first hours of the patient's course. In the medical intensive care unit, our residents have a fully functional team in the unit of our Emergency Medicine-3 and Emergency Medicine-1, giving our residents valuable critical care training and decision-making experience as a senior.

Another strength of our EDs is our unique team-based structure, which allows us to see patients quickly and effectively. The resident teams change as you progress through your training:

Interns either work on Red Team, which is run by the Third Year, or on Blue Team, which is a one-on-one team with an attending.
Second Years work only on the Green Team, which is a one-on-one team with an attending.
Third Years work almost exclusively on the Red Team, running an entire team and supervising and teaching the intern(s).
Residents also rotate through our Evaluation Unit, which serves lower-acuity patients.

Our nurses are integral to our success, and are also assigned to a team. Each physician and nurse always know who they're working with throughout a shift and there's no confusion about who is assigned to a specific patient. Teams' workstations are also all physically located near each other, so it's easy to relay information about a patient to the nurse or other physician on the team.

First Year Rotations

Block	Weeks	Description
Orientation	2	The first weeks of internship are designed to help the new residents integrate into the program and get acquainted with their colleagues. A series of lectures are given on core Emergency Medicine topics, as well as small-group teaching and training sessions. This is also when the ATLS course takes place. A significant part of this block is spent discovering the New York City night life.
MSM Adult ED	14	PGY-1 residents work ED shifts mostly at Mount Sinai Morningside either on Red team or Blue team. On Red, they are supervised by a PGY-3, and on Blue they work one-on-one with an attending. Interns also rotate through our lower-acuity evaluation unit.
MSBI Adult ED	6	Mount Sinai Beth Israel is the downtown campus of the Mount Sinai Health System. Interns rotate in the ED for six weeks under the supervision of Mount Sinai Beth Israel faculty. This provides exposure to a different patient population from our primary sites as well as continued high acuity in this stroke and STEMI center.
MSM Peds ED	8	The dedicated pediatric ED averages 20,000 visits a year and is located at Mount Sinai Morningside. It is staffed by pediatric emergency medicine board certified attendings. Residents will spend two blocks in the Pediatric ED during their first year.
MSH Peds ED	2	Residents spend two weeks in the Mount Sinai Hospital Pediatric ED. This institution provides a significant amount of complicated, tertiary care to sick pediatric patients. As a result, residents see a large complexity of patients with more exposure to sick children.
MICU	4	The medical intensive care unit is located at Mount Sinai Morningside. Residents spend one block of their first year on this busy service and have ample opportunity to perform invasive procedures such as central lines, thoracentesis, paracentesis, and more. They also benefit from bedside teaching on ventilator and pressor management, as well as the general care of critically ill patients.
CCU	4	The coronary care unit is located at Mount Sinai Morningside. This service receives all STEMI patients presenting at both sites. Residents spend one block on this service and learn about the management of acute coronary syndromes, dysrhythmias, and heart failure. The cardiology fellows dedicate two hours of every week day to teaching residents about ECG interpretation.
Obstetrics	2	The labor and delivery service at Mount Sinai West is the busiest in the city and allows residents to become comfortable in assessing women presenting in labor and performing vaginal deliveries. Residents are also welcome to scrub in for cesarean sections and to assist the Gynecology residents in their ED consults.
Anesthesia	2	The two weeks on anesthesia are spent entirely in the operating room. Residents learn and practice the essential principles of airway management, such as proper bag-valve-mask ventilation technique, endotracheal intubation, and the use of alternative airways such as the LMA.
Orthopedics	3	Interns spend three weeks on the orthopedic ED consult service. On the rotation, residents are paired up with a senior orthopedic resident and respond to all orthopedic consults in the Mount Sinai West ED. The ED residents have no responsibility for floor patients or the operating room. This is a great opportunity to evaluate orthopedic and hand injuries while practicing valuable skills like splinting, reductions, and complicated wound repair. Residents spend one day a week in the outpatient private practice of our Sports Medicine attending as well.
Ultrasound	1	One week of the first year of residency is dedicated to Emergency Ultrasonography. Daily scanning shifts are scheduled with the Ultrasound Division directors and fellows. Emphasis is put on core ultrasound applications during the first year which will be built on during the second-year rotation.
EMS	varies	One shift of every Adult and Pediatric ED block during the first year is dedicated to EMS ride-alongs. The residents are assigned to an ambulance crew that responds to the 911 system, and spend the day observing and assisting with patient management in the field. This is a great opportunity to become acquainted with the EMS personnel as well as to get a better understanding of how the NYC pre-hospital system functions.
Vacation	4	Split into two, two-week blocks.

Second Year Rotations

Block	Weeks	Description
MSSL/MSW Adult ED	34	PGY-2 residents work ED shifts on the green team at both Mount Sinai Morningside and Mount Sinai West where they work one-on-one with an attending. They also rotate through the evaluation unit which sees lower acuity patients.
MSBI Adult ED	5	Mount Sinai Beth Israel is the downtown campus of the Mount Sinai Health System. PGY-2 residents rotate in the ED for five weeks under the supervision of faculty from the Mount Sinai Beth Israel residency program. This provides exposure to a different patient population from our primary sites as well as continued high acuity in this stroke and STEMI center.
MSSL Peds ED	2	The dedicated pediatric ED averages 20,000 visits a year and is located at Mount Sinai Morningside. It is staffed by pediatric emergency medicine board certified attendings.
MSH Peds ED	2	Residents spend two weeks in the Mount Sinai Pediatric ED. This institution provides a significant amount of complicated, tertiary care to sick pediatric patients. As a result, residents see a large complexity of patients with more exposure to sick children.
Trauma (optional)	4	As an optional rotation, we augment the resident's trauma experience with a dedicated month offsite at the R Adams Cowley Shock Trauma Center associated with the University of Maryland Medical Center in Baltimore in order to expose residents to trauma in a referral center with different population dynamics.
ED AC	2	This is a unique rotation where the ED resident functions as the ICU resident consult for patients being considered for ICU admission from the ED. After evaluation, the ED resident presents the case directly to the ICU attendings and fellow with direct one-on-one teaching related to the patients. The consult resident becomes responsible for the patient until they are moved into the ICU. This rotation allows residents to develop skills in the management of patients after their acute management is completed and during the initial course of their critical illness.
Ultrasound	1	One week of the second year is dedicated to Emergency Ultrasonography. Daily scanning shifts are scheduled with the Ultrasound Division directors and fellows. Emphasis is put on advanced applications during the second year or residency that build on the knowledge learned during first year.
Toxicology	2	On this rotation, residents rotate through the New York City Poison Control Center. Residents take part in follow-up calls made to the center as well as the didactics associated with the toxicology fellowship program and rotating resident curriculum. While on this rotation, residents take calls with the toxicology faculty in our department responding to any consults in the Mount Sinai Morningside and Mount Sinai West EDs.
Vacation	4	Split into two, two-week blocks.

Third Year Rotations

Block	Weeks	Description
MSM/MSW Adult ED	30		Residents work ED shifts at both Mount Sinai Morningside and Mount Sinai West and therefore benefit from exposure to two very different populations. Third year residents work on and own the Red team where they will supervise either an Emergency Medicine intern or an off-service rotator.
MSBI Adult ED	4		Mount Sinai Beth Israel is the downtown campus of the Mount Sinai Health System. Residents in the ED for four weeks under the supervision of faculty from the Mount Sinai Beth Israel residency program. This provides exposure to a different patient population from our primary sites as well as continued high acuity in this stroke and STEMI center.
MSM Peds ED	variable		The dedicated pediatric ED averages 20,000 visits a year and is located at Mount Sinai Morningside. It is staffed by pediatric emergency medicine board certified attendings. During the third year of residency residents are assigned to at least one Pediatric ED shift per block throughout the year.
MICU	4		The medical intensive care unit (MICU) is located at Mount Sinai Morningside. Third year residents will have their own team on the MICU service where they will learn to make critical decisions and supervise EM interns during their MICU rotation.
NICU	2		Residents will rotate through the neonatal intensive care unit (NICU) at Mount Sinai West for 2 weeks. This will expose residents to the critical care management of neonates as well as pediatric procedures. Residents will be part of the team to respond to deliveries and take part in neonatal resuscitations.
AC	2		Another unique rotation where the ED resident serves as the ICU resident consult for patients being considered for ICU admission from the floors. They also are part of the rapid response team for the hospital. This rotation allows residents to develop skills in the acute evaluation of patients with critical clinical changes and affords them practice in running codes in an unfamiliar and sometimes unprepared setting.
Administration	2		This two week rotation provides residents the opportunity to finalize scholarly activity as well as to take part in departmental administrative activities. This is also an opportunity to become involved with the QI process in a more formal way.
Elective	4		Opportunity for elective at Mount Sinai West, away institution or internationally.
Vacation	4		Split into two, two-week blocks.