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Program Structure

EM Sim Day - Dr. Josh Broder instructs EM residents in simulation

At Duke, resident training is aimed at developing outstanding clinical, research, and leadership skills through clinical rotations and educational programs. Our residency curriculum covers the core content of emergency medicine as well as cutting-edge emerging evidence for new diagnostic and therapeutic approaches.

Residents in the Emergency Medicine Department at Duke have access to numerous clinical and research opportunities to prepare them for independent practice. 

Pediatric Emergency Medicine

The Duke Pediatric Emergency Department provides outstanding care to 15,000 pediatric patients each year, including level 1 pediatric trauma patients. The faculty are diverse experts, with three faculty members who are fellowship-trained and board-certified in Pediatric Emergency Medicine.

Because Duke is a tertiary care medical referral center, trainees will see a tremendous variety of patients. Residents will see children presenting in respiratory distress due to congenital heart disease, vomiting in the setting of adrenal insufficiency, altered mental status due to ventriculoperitoneal shunt malfunction. As with any emergency department, residents will be repeatedly exposed to children with undifferentiated febrile illnesses, abdominal pain, asthma exacerbations, minor closed head injuries (concussions included), and skin lacerations. As such, residents will become very comfortable in the work-up and management of common pediatric complaints, but importantly, able to recognize and treat conditions in medically complex children. This is an ideal training environment for those seeking a well-rounded, robust education in preparation for emergency care of children in any setting post-residency.

Duke residents and attendings care for sick children with skill and compassion. In this video clip about a pediatric patient, family and healthcare workers recall and reflect on the care provided by the Duke Emergency Department and inpatient services. Andrew Parker, MD (Duke Emergency Medicine class of 2012) is featured at 1 minute and 17 seconds, and attending physician Jamie Fox, MD appears at 1 minute and 29 seconds into the clip.

Two notable awards were earned by Pediatric Emergency Medicine at Duke. The Master Teacher/Clinician Award was presented to James W. Fox, MD, Associate Professor of Pediatrics in the Division of Hospital and Emergency Medicine. The award recognizes individuals with superlative accomplishment and service in the areas of clinical care and teaching. Awards are given to recognize clinical practitioners who exemplify the highest standards of clinical care, pedagogy, and professionalism or to basic scientists who achieve distinction in pedagogy and professionalism.

In 2014, the Division of Hospital & Emergency Medicine received the Department of Pediatrics divisional teaching award. The Division has received this honor 5 of the 7 years it has been awarded.

Airway training

Airway management is central to emergency medicine, and Duke Emergency Medicine residents receive the best possible training. In our simulation lab, realistic airway mannequins allow residents to experience a range of airway anatomy with an array of equipment.  Our residents train in surgical airway techniques using percutaneous kits and surgical techniques, in both high fidelity mannequins and tissue models. Our simulation lab also features hyper-realistic bronchoscopy simulators, allowing residents to safely master flexible fiberoptic techniques for difficult airways. In our department, residents use the Karl-Storz CMAC video system, allowing training in direct as well as video-assisted laryngoscopy.

Simulation

Simulation is integrated into the residency curriculum, with a full conference day each month dedicated to procedures and resuscitation of pediatric and adult patients in our advanced simulation center. Since January 2013, our simulation center has been located in the new Mary Duke Biddle Trent Semans Center for Health Education. In this state-of-the-art facility, Duke Emergency Medicine residents learn and apply skills in a multi-bed emergency department setting.

Dr. Thoureen completed Emergency Medicine Residency at Yale University in 2002. She began her career as an educator at Duke before moving to the University of Maryland in 2004. She returned to Duke in 2013.

We are fortunate to have some great high tech tools at our fingertips at Duke. They include:

  • CAE iStan adult mannequin
  • Laerdal Simbaby
  • Central line trainers for subclavian, IJ, and femoral lines, ultrasound compatible
  • Traumaman for cricothyrotomy, chest tube, pericardiocentesis, DPL, needle decompression, and IV cutdown
  • Vimedix ultrasound simulator
  • Levitan airway mannequin heads
  • SonoSim laptop based ultrasound simulator
  • Cricothyrotomy trainers
  • Lumbar puncture task trainer
  • Sonosite ultrasound

These resources are also incorporated also into the resuscitation rotation during the first and third years of training and the ultrasound curriculum.  We also have a live tissue lab that is available for resident education.

Ultrasound Training and Innovation

Ultrasound is integral to emergency medicine at Duke. With 7 ultrasound machines in the Emergency Department, a full-time director of Emergency Ultrasound, and high-fidelity ultrasound simulators in our state of the art simulation lab, the residency provides the best in cutting-edge training.

Ultrasound Director Erica Peethumnongsin, MD

I trained at the University of Wisconsin - Madison Emergency Medicine Residency program, and became interested in ultrasound from day one because of great teachers in the field, and the ability of ultrasound to change the patient's entire course or diagnosis in a few moments of scanning. After residency, I completed a fellowship in emergency ultrasound at the Georgetown/Washington Hospital Center program, while spending a year working clinically in emergency departments in Washington, DC and Baltimore, MD.

In 2013, the Duke Emergency Medicine Residency received a Graduate Medical Education Innovation Grant, co-sponsored by the Duke Department of Surgery, for ultrasound simulation systems.  Residents train using multiple high-fidelity ultrasound simulators, enabling them a unique opportunity to learn image acquisition and interpretation. The residency will be conducting a randomized controlled trial of the two systems, improving our understanding of the requirements for acquisition of ultrasound skills.

Below, the Vimedix and SonoSim simulators provide additional hands on training and a range of pathology for Emergency Medicine residents.

Toxicology

Medical toxicology focuses on the diagnosis, management or prevention of poisonings. It encompasses a wide range of topics including: pharmaceutical misadventures, drugs of abuse, occupational exposures, envenomations and environmental exposures, radiation, and bioterrorism.

Duke Emergency Medicine has a long history of outstanding clinical care and scholarship in key areas of toxicology: dysbarism and disorders of dive-related supraphysiologic nitrogen absorption (learn more about the hyperbaric center at Duke), carbon monoxide poisoning, and snakebite. We are a leading center for a multicenter study of antivenin for copperhead snakebite, led by Charles Gerardo, MD.

Undersea and Hyperbaric Medicine

Duke has a long and storied history in the specialty of Undersea and Hyperbaric  Medicine. Learn more about our hyperbaric center and fellowship opportunities.

Partnership with Durham EMS

The Duke Division of Emergency Medicine is an acknowledged leader in emergency care, trauma, and transport services. The program is nationally recognized for education and research, and is the center of choice among patients, families, referring providers, and the community.

Duke Life Flight 

Duke Life Flight is the critical care transport program for the Duke University Health System. This program provides critical care and emergency air and ground transport to the entire population of North Carolina, as well as portions of South Carolina, Virginia, West Virginia, and Tennessee. 

Life Flight is available to transport critically ill or injured adult, pediatric, and neonatal patients 24 hours a day, seven days a week.

The Duke Emergency Medicine Residency Program integrates the services of the Division of Emergency Medicine and Duke Life Flight services with the Durham EMS program to provide a complete educational experience for the emergency medicine residents.

Duke Emergency Medicine residents will do ambulance duty and optional Life Flight ride-alongs. Residents will spend one block (four weeks) doing an EMS/Admin rotation as a third year resident. And they will have the opportunity to teach the medics of the various Durham EMS squads.

Durham County EMS

EM-3 resident Dr. Kevin Gurysh evacuates a patient during a Durham County EMS active assailant training exerciseEM-3 resident Dr. Kevin Gurysh evacuates a patient during a Durham County EMS active assailant training exercise.

During their training, Duke Emergency Medicine residents work directly with Durham County EMS. Durham County's EMS system provides advanced life support paramedic ambulance service throughout the county. Durham County EMS is certified as a local “teaching institution” by the North Carolina Office of EMS.

Durham County's EMS system includes the City of Durham Fire Department, Durham County Fire – Rescue, and three private, non-profit fire departments – Bahama, Lebanon, and Redwood – as well as Duke University Emergency Medical Services, a student-run volunteer campus first-responder service.

The fire departments serve as medical first responders in the 911 system, responding to critical emergencies with EMT- or AEMT-level personnel.  All fire response apparatus are equipped with automated external defibrillators and drugs appropriate to the credential level of the fire personnel.

Durham County EMS is the sole provider of emergency ambulance service in Durham County, staffing 19 ambulances at peak hours of the day (1200-1800), scaling down to 10 ambulances overnight (1200-0600).  EMS also provides a number of various support vehicles, including supervisor vehicles, paramedic quick response units, a major incident response vehicle (MIRV-1, with advanced responder rehabilitation and mass casualty capabilities), a bicycle-response team (BERT), a tactical emergency medical support (TEMS) unit which provides medical support to the Durham Police Selective Enforcement Team (SET), the Sheriff’s Emergency Response Team (SERT), and a CBRNE EMS unit that provides medical support to the Durham Police Department’s Biological-Chemical Emergency Response Team (B-CERT).

This coordinated approach to prehospital care is unique in the state, and continues to set the pace for others who want to provide optimum service at maximum efficiency.

Medical Student Education

Medical student education is a major priority in our residency. Our residents routinely teach students in the emergency department and in classroom and simulation settings.

Associate Professor David Gordon, MD serves multiple key roles: Associate Residency Program Director for Emergency Medicine, President of the National Clerkship Directors in Emergency Medicine, and Medical Director for the Clinical Skills Lab, which teaches all Duke Medical Students the fundamentals of performing a history and physical exam. Dr. Gordon is a nationally recognized expert in cognitive errors in emergency medicine.

In this video, Dr. Gordon shares secrets to effective emergency medicine presentations for medical students.

Below, Chief Resident for the Duke Emergency Medicine Class of 2014 Scott Evans teaches medical student during a simulation activity, "Haunted ED." Dr. Gordon developed this concept and presented this as an educational innovation at the annual meeting of the Council of Residency Directors in Emergency Medicine in 2014.