Electives at Harbor-UCLA

Resident experiences may vary depending on the interest of the learner and in discussion with the operations leaders, but should include attending departmental and hospital administrative meetings and working on a directed administrative project.

Resident experiences may vary depending on their interests and in discussion with the operations leaders. However, they should include attending departmental and hospital administrative, quality, process and improvement, and safety meetings; directed readings and video-based teaching; and working on a directed safety project.

By the end, a resident should have a better understanding of challenges in protecting patients from accidental injury during the process of care and the principles of patient safety, and be able to identify high-yield interventions that can improve patient outcomes.

Residents have varied experiences depending on their interests and in discussion with the EDQI leaders. However, they should include attending departmental and hospital administrative, quality, and process and improvement meetings, as well as working on a directed process and improvement project.

Gain procedural skills in pediatric airway management, endotracheal intubation and laryngeal mask airway placement, sedation, analgesia and anesthesia administration, and perioperative care.

Gain procedural skills in direct and video laryngoscopy with endotracheal tube intubation, supraglottic airway placement, effective bag valve mask ventilation, and procedural sedation.

Improve the understanding of burn management, wound care, burn center criteria, and the short- and long-term complications and prevention of inhalation injury and concomitant intoxication (CN, CO, etc.).

Gain additional critical care experience in ventilator management, fluid replacement, pain management and procedural sedation, antibiotic and medication stewardship and preventative care (DVT, GI, decubiti, etc.), and understand the importance of temperature control in burn patients.

Develop the ability to rapidly evaluate, diagnose, stabilize, and treat critically ill patients with primary cardiac complaints. Gain additional critical care experience in ventilator management, fluid replacement, and use of vasoactive medications. There will be procedural experience when available in intubation and central and arterial line insertion and management.

Participate in the care of patients in the Cardiovascular Open Access Rapid Evaluation (CORE) unit, including but not limited to, optimizing medical management of CAD and CHF patients, cardioversion, and rate control. Develop an efficient, thorough approach to EKG interpretation. Learn the basics of echocardiogram interpretation and risk stratification utilization. Complete a small project based on the resident’s area of interest.

Become familiar with general dermatology language and principles and gain exposure to general clinical dermatology, while also engaging in independent study of this complex specialty.

Gain a broad overview of disaster medicine, including the management of mass-casualty events involving biological, radiological, chemical, and explosive injuries. You will also cover decontamination and donning and doffing of personal protective equipment.

Learn the basics of aeromedicine, including the range, patient characteristics, and capability of providers of helicopter transport. Be able to describe patient situations which air transport may adversely affect.

Participate with the EMS Agency system in protocol development and revision, disaster preparedness activities, and mass gathering planning. If possible, we will arrange tours of the Disaster Staging Facility in Santa Fe Springs to better understand how the Los Angeles County Emergency Medical Services Agency has integrated our region toward better disaster preparedness.

Ever wondered about practicing Emergency Medicine at a large concert, sporting event, or mass gathering? Learn about considerations for delivering emergency medical care outside of the traditional hospital setting. Event staffing may include music festivals, local marathons, or other mass gathering events in the Los Angeles area.

Participants will learn to deliver emergency medical care in a mass gathering event setting. Topics covered include temporary medical facility set up and supplies, mass casualty incident management, and the clinical management of drug toxidromes and environmental diseases.

Develop the ability to rapidly and appropriately care for patients presenting with gynecological or early obstetrical complaints in an urgent care setting. These include common medical or gynecological complaints such as abnormal bleeding, infertility, contraception, abdominal or pelvic pain, breast concerns, and domestic violence.

Develop the ability to rapidly evaluate, diagnose, stabilize, and treat critically ill patients with primary medical complaints. Gain additional critical care experience in ventilator management, fluid replacement, antibiotic and medication stewardship and preventative care (DVT, GI, decubiti, etc.), and use of vasoactive medications. There will be procedural experience when available in intubation and central and arterial line insertion and management.

Gain experience caring for patients with common conditions such as asthma, COPD, cellulitis, chest pain, congestive heart failure, dehydration, electrolyte disturbances, pneumonia, pyelonephritis, and syncope in an Observation Unit setting using goal-based protocols and temporal landmarks.

Gain advanced knowledge of common ophthalmologic diseases, improve skills in ophthalmologic history and examination, understand the relation of the pathology of the eye to systemic diseases, and master the slit lamp exam.

Gain practical exposure to clinical oral maxillofacial surgery outpatient care with the development of diagnostic skills and management of dental problems. Gain experience with dental blocks and participate with OMFS residents in consultations.

Gain exposure to diagnosis and management of patients with common orthopedic traumatic and non-traumatic conditions. Learn to apply splints and casts properly.

Gain practical exposure to clinical otolaryngology with the development of diagnostic skills and management of routine otolaryngologic problems as well as with an improved understanding of the roles of audiology and speech pathology in the management of head- and neck-related problems.

Gain exposure/experience in the practice of Palliative Care in adults and pediatrics (the pediatric component outside of Harbor-UCLA Medical Center). Improve knowledge of palliative care and symptom management, appreciation for the spiritual needs of patients with terminal cancer, cultural sensitivity, and the role of culture in influencing a patient’s experience of dying.

Enhance appreciation for a team approach to patient care, especially for the terminal patient. Appreciate the contribution of all health care professionals to the care of the terminal patient.

Gain clinical pediatric subspecialty expertise by rotating through any of the following clinics: Adolescent, Allergy and Immunology, Cardiology, Child Abuse, Development and Behavioral, Endocrinology, Gastroenterology, Genetics, Hematology/Oncology, Infectious Disease, Nephrology, Neurology, and/or Rheumatology.

As a member of the delivery team, attend all in-hospital deliveries and attend to the resuscitative needs of the infant. Care for patients in the nursery following delivery and gain expertise in newborn examination, high-risk screening, and perinatal care.

Refine and gain additional fundamental skills in the practice of Pediatric Emergency Medicine, including but not limited to performing an age-appropriate and complaint-focused history and physical exam, demonstrating an age-appropriate differential diagnosis for each complaint, recognizing and managing critically ill medical or trauma patients, developing and carrying out treatment plans and procedures through admission or discharge, and honing resuscitation and stabilization skills.

Develop proficiency in multi-tasking, documentation, time efficiency, and cost efficiency in a private practice community ED setting (CHOC site). Gain administrative skills by participating in a PED quality improvement project (Harbor-UCLA).

Develop the ability to rapidly evaluate, diagnose, stabilize, and treat critically ill neonatal patients. Gain additional critical care experience in resuscitation, ventilator management, fluid and nutrition management, and vascular access of neonates. There will be procedural experience when available in intubation, chest tube, and central/umbilical and arterial line insertion and management.

Develop the ability to rapidly evaluate, diagnose, stabilize, and treat critically ill pediatric patients. Gain additional critical care experience in ventilator management, fluid replacement, antibiotic and medication stewardship and preventative care (DVT, GI, decubiti, etc.), and use of vasoactive medications in the care of pediatric conditions. Residents will gain procedural experience when available in intubation, chest tube, and central and arterial line insertion and management.

Round with the pharmacy team and antibiotic stewardship team in the ICUs every day to gain expertise in medication reconciliation, antibiotic choice, adverse events, and medication reactions and interactions.

Gain experience with acute psychiatric illness along with a better understanding of the medical and legal aspects of involuntary holds (5150) and the pharmacology of common psychiatric medications.

Gain experience with acute child and adolescent psychiatric illness along with a better understanding of the medical and legal aspects of involuntary holds (5585) and the pharmacology of common psychiatric medications. Harbor-UCLA has a Child and Adolescent Psychiatry fellowship and a separate adolescent psychiatry emergency unit.

Develop an efficient and thorough approach to plain film interpretation and improve the interpretation of head CTs. A resident may also gain experience in areas of interest, including pediatric radiology and body CT.

Learn how to manage musculoskeletal/sports-related issues with up-to-date treatments in a community practice setting within the pediatric/adolescent age group. Become familiar with various musculoskeletal and sports medicine disorders in the pediatric population, including return to sports play criteria, athletic physical exams, and sports injuries.

Gain comfort with triaging various sports injuries and demonstrate knowledge in relevant anatomy and physiology. Learn about psychosocial aspects of pediatric sports/musculoskeletal medicine issues and become familiar with current literature and management of common conditions.

Develop the ability to rapidly evaluate, diagnose, stabilize, and treat critically ill patients with primary surgical complaints. Gain additional critical care experience in ventilator management, fluid replacement, wound management, and antibiotic and medication stewardship and preventative care (DVT, GI, decubiti, etc.) for the surgical patient. There will be procedural experience when available in intubation, chest tube insertion and management, and central and arterial line insertion and management.

Gain experience in the initial management of the most common poisonings and envenomations. Understand the use of the most commonly employed antidotes in the management of poisonings.

Learn the basics of ultrasound theory, technique, and machine maintenance/troubleshooting. Prepare a teaching file interesting case to help teach future residents about the utility of ultrasound in Emergency Medicine. Achieve level II certification in as many applications as possible in the following order: FAST (pericardial effusion & abdominal free fluid), IUPs, AAA, gallbladder, hydronephrosis, ultrasound-guided procedures (femoral vein catheterization, internal jugular vein, catheterization, paracentesis, and abscess drainage).

Gain practical exposure to clinical Urology with the development of diagnostic skills and management of urologic problems, and gain experience with urologic procedures. Participate with Urology residents in consultations and the OR if interested.

We have structured the wilderness medicine elective to provide an overview of medical practice in an austere outdoor environment. The didactic curriculum includes an overview of wilderness travel planning, altitude disorders, survival techniques, water and food procurement, patient movement in a wilderness environment, and wilderness medical kit preparation. We expect participants to plan a wilderness expedition with a complete medical plan during the rotation.

The Social EM/Advocacy elective provides residents an opportunity to develop a good foundation of knowledge for opportunities in health advocacy, social determinants of health, structural vulnerability, health equity, and health and human rights. Residents will help in the development and administration of one of our many programs.

Areas of concentration include but aren’t limited to, substance use disorder/MAT, homelessness, food justice, trauma recovery/hospital-based violence intervention programs, social needs screening, immigration advocacy, and medical-legal partnerships for vulnerable patients.

Expand knowledge in one or more topic areas in consultation with the emDocs editorial team, prepare a post, and publish online.

Experience gained depends on a resident’s areas of interest and focus and may include teaching and curriculum development for paramedic trainees at the Paramedic Training Institute and Harbor-UCLA Department of Emergency Medicine or the Aeromedical Squad.

It may also include contributions to the EMS system continuing education update, presentation at Harbor-UCLA grand rounds, and development and preparation of EMS tape review or teaching for the Base Physicians Course.

Identify primary sources to learn about bedside teaching methods (specific to constraints unique to working in the emergency department). Develop and practice learned bedside teaching skills, the principles of effective feedback, and skills in delivering feedback while addressing the individual resident/medical student’s educational needs and interests.

Residents spend at least three to four “teaching ED shifts” per elective week (adult and pediatrics) and focus time on individual resident/medical student teaching needs (journal club, didactics, simulation, etc.). They also participate in sub-intern activities when scheduling permits.

Gain a better understanding of medical terms and phrases in Spanish through the completion of modules on the Google Chromebook asynchronous learning program, which residents may access by contacting the program coordinator.

Get the opportunity to express the challenges faced during medical school and residency and develop a creative outlet for the stresses we face as emergency physicians. This is an important skill that can improve career satisfaction and diminish burnout. Complete a total of four narrative medicine written pieces or audio podcast episodes, which we submit for publication to the Physician Grind.

We submit the written pieces for publication to Emergency Medicine News and Tincture. Podcast episodes make their way to the Physician Grind Podcast, and we also submit them for publication to Emergency Medicine News. Two Harbor-UCLA DEM alumni co-founded Physician Grind and nuMose.

Get actively involved in at least one ongoing project within the Department of Public Health, attend public health talks going on during the rotation period, and complete the reading and reference guide for public health rotators.

By the end of the rotation, residents should be able to: explain the relationship and interaction between clinical and public health practice, describe what a public health department does, understand what happens when a disease is reported to the Health Department, know who to call for disease control, describe various community activities in Los Angeles aimed at health promotion, understand the role of the Public Health nurse and how they can help the clinician, and explain how the Environmental Health unit protects health.

Simulation is an exciting teaching tool that can, when used appropriately and effectively, enhance active learning in curricula. In the simulation elective, participants will be able to design simulation cases that are appropriate for a range of learners, be able to functionally operate the simulation equipment, and implement best practices in debriefing techniques. Participants will design a case with one-on-one guidance from experts in simulation, implement that case, debrief with the learners, and get direct feedback on each of the steps.

Expand the knowledge in one or more topic areas of Emergency Medicine by publishing an update to the online medical reference WikEM.

The experience and schedule for this rotation will depend on a resident’s areas of interest and should focus on taking part in a novel or ongoing EMS research project.

The experience and schedule for this rotation will depend on a resident’s areas of interest and should focus on taking part in a novel or ongoing clinical research project.