Mission

The mission of the CRDAMC EMRP is to train and develop exceptional Emergency Medicine physicians who are dedicated to providing the highest standard of care in any environment. Guided by the principle "Always Forward, Always Together," we commit to advancing medical knowledge, fostering teamwork, and ensuring readiness for any challenge. Our program emphasizes resilience, innovation, and a deep sense of duty, preparing our residents to lead with excellence and compassion on the front lines of medicine and beyond.

Vision

• Excellence in Patient Care: Deliver rapid, accurate, and compassionate medical care in emergency settings, ensuring the highest standards of treatment for all patients.
• Critical Decision-Making: Develop the ability to make swift, informed, and effective decisions under pressure, utilizing both clinical acumen and advanced medical technologies.
• Leadership and Teamwork: Cultivate strong leadership skills and foster a collaborative environment, enabling seamless teamwork and coordination in high-stress, multi-disciplinary situations.
• Operational Readiness: Prepare residents to provide expert emergency medical care in austere, resource-limited, and combat environments, ensuring they are mission-ready at all times.
• Continuous Learning and Adaptability: Promote a culture of lifelong learning and adaptability, encouraging ongoing education, research, and the integration of evolving best practices to remain at the forefront of Emergency Medicine.

Aims

Graduates of the Carl R. Darnall Army Medical Center Emergency Medicine Residency Program will be able to:

• Provide initial resuscitation, stabilization, management, and timely disposition of all patients who present to the
  Emergency Department with knowledgeable and skillful care.
• Provide emergency care to manage and treat multiple patients simultaneously.
• Provide compassionate care for patients and their families, including emotional and social support, especially in
  dealing with the crisis of death and severe injury.
• Manage and direct pre-hospital care and function as a Base Station physician (medical control).
• Manage and direct mass casualty situations and participate in military and civilian disaster planning.
• Develop teaching abilities applicable to all levels of emergency care personnel (physicians, medical students, pre-
  hospital care personnel, hospital personnel, and the public).
• Effectively perform administrative tasks necessary to manage an Emergency Medicine department including
  scheduling, risk management, quality improvement, and addressing patient complaints.
• Understand basic research design, methodology, and statistics; be able to apply the knowledge in
  order to critically review Emergency Medicine literature; perform clinical and basic science research.
• Be able to successfully negotiate any operational obstacle that an emergency physician may encounter.

The CRDAMC EMRP has a robust didactic program that prepares its residents for the multifaceted role they will play upon graduation. Our program, in response to resident feedback, completely revamped our didactics in the 2021/2022 academic year. The program employs a standardized core content curriculum for EM residents that uses learner-centric educational strategies that have been shown to benefit learning such as small-group discussion, peer learning and individualized guidance. This program is woven into our protected weekly conference every Thursday (7 a.m. to 12 p.m.).

In addition, we have protected time for morning report cases Monday-Wednesday to prepare for the ABEM Oral Certification Exam, and protected simulation training with our accredited simulation program every Friday morning. We dedicate significant conference time for the month before the ABEM national In-Training Exam for “high-yield” didactics. Further, every resident is provided Emergency Medicine textbooks and a subscription to a question bank for Emergency Medicine.

Lastly, we have monthly family style Journal Club, where we learn how to critically appraise articles and spend time together socially, with families and significant others always welcome.

Residents are authorized 1-2 elective rotations throughout the residency. Options include:

• Additional community ER rotations
• Urban/underserved ER rotations
• Pediatric ER rotations
• Critical care/intensive care unit rotations
• Pediatric anesthesia rotation
• Ryder Trauma Center (Miami) rotation
• Burn ICU (BAMC) rotation
• Joint Hyperbaric Medical Officer Course
• Other military opportunities

CRDAMC residents have elected to have a dedicated Chief Resident devoted to generating an equitable, thought-out schedule for the entire year. This allows for efficient, planned schedules throughout the CRDAMC ED Blocks. Shifts are 8 hours in length with 1 hour for patient-centered turnovers. PGY1 residents will generally work approximately 20 shifts/block, PGY2 residents 18 shifts/block, PGY3 residents 16-18 shifts/block. Work hours are closely monitored, and each resident will have at least one day (24 hours) per week free from clinical duties. During a CRDAMC ED block, residents are scheduled for one or two 24-hour back up ‘on-call’ selections for resident illness/injury and extenuating circumstances (rarely used).

With a dedicated Military Unique Curriculum Director and extensive faculty experience, our residents can feel confident they will leave CRDAMC prepared to take any Army role. All residents attend the Combat Casualty Care Course and Advanced Trauma Life Support Course at Joint Base Camp Bullis during their PGY1 year. With a simulation Role 2 setup adjacent to the CRDAMC ED, as well as two on-post Medical Simulation Training Centers, our residents experience quarterly military medicine days during conference where they will have realistic experiences focused on acute care at point-of-injury and the NATO echelons of care. Each week as part of Conference Rounds, clinical discussions include emphasis on military applications, austere care, and down-range medicine. The military curriculum culminates in the PGY-3 year with the Joint Emergency Medicine Exercise (JEMX) at Fort Cavazos. This massive international training event, run by leaders from the CRDAMC Emergency Department, allows trainees to receive professional classroom instruction along with practical training in Tactical Combat Casualty Care (TCCC), damage control resuscitation/surgery, care of Military Working Dogs (MWD), autologous fresh whole blood transfusion, burn management, and Critical Care Air Transport Team (CCATT) capabilities.

Faculty educators bring personal experience from their prior assignments such as FRSDs, ERSTs, Flight Surgeons, Brigade Surgeons, Battalion Surgeons, and various Special Forces units. Faculty have served in Central America, Africa, Iraq, Afghanistan, Syria, and the Baltics. CRDAMC EMRP has a proud legacy of supplying exceptionally qualified EM physicians to SOAR, JMAU, the Rangers, and other operational units.

• Intern EM orientation and airway course
• Advanced Wilderness Life Support
• ACLS, BLS, PALS, NRP, ATLS

The CRDAMC EM simulation curriculum is expansive over three years beginning with immersive cadaver lab experience during intern EM orientation. Cadaver tissue labs are held twice annually at University of Texas Health Sciences Center at the Texas Medical Center in Houston. Additionally, the program holds quarterly procedure labs at the Wilford Hall Medical Center on Lackland Air Force Base, San Antonio, Texas. Simulation cases are run every Friday morning in a resuscitation room with multi-disciplinary staff including nursing and respiratory therapy to help progress residents as clinicians and team leaders as well as dedicated quarterly simulation days during our conference time.

The CRDAMC EMRP has a longitudinal curriculum designed to cultivate strong, adaptable leaders capable of managing high-pressure situations in both military and civilian contexts. This program includes mentorship on decision-making, crisis management, and team dynamics, augmented by hands-on leadership simulations and mentorship from experienced military and medical leaders. Residents will also engage in reflective practices and leadership debriefings to continuously refine their skills and adapt to evolving challenges in Emergency Medicine.

The aims of the scholarly activity requirement are to ensure graduating residents understand the fundamentals of research ethics, experience the peer-review process, and know how to critically appraise literature while practicing evidence-based medicine. These three aims will be met through a longitudinal approach to scholarly activity, including monthly journal clubs, and supplemented with conference lectures.

Scholarly activity intends to advance residents’ knowledge and their practice of the scholarly approach to evidence-based patient care. All residents will complete the Collaborative Institutional Training Initiative (CITI) program during PGY1 year and, with our Research Director, satisfy the ACGME scholarly activity requirement.

Outside of CRDAMC, residents are encouraged and mentored in submitting speaking proposals and research submissions to national conferences and once accepted those residents are granted time off and TDY to attend. Every year we have multiple residents present at various conferences across the country.

Residents are required to complete one quality improvement (or quality assurance) project during residency. Quality improvement projects will aim to improve processes that affect patient case across multiple disciplines and/or departments, thereby encouraging multidisciplinary teamwork and input. The quality improvement project will have a written formal plan for execution and sustainment submitted to Resident Quality Improvement Director and Clinical Competency Committee by the end of the resident’s 2nd year. Residents will execute the project by early 3rd year.

The Department of Emergency Medicine is one of the largest departments at Darnall Army Medical Center. This allows for our residents to engage as stakeholders at all levels of the hospital on various committees based on their interests. Within the department, PGY2 residents volunteer to be peer selected for leadership roles such as procedure lab coordinator, cadaver lab coordinator, and journal club coordinator. Moving to the PGY3 year, residents can apply for Chief Resident and are selected based on input from peers, ancillary staff, and faculty. Chief Resident selections are sent to the Annual Council of Residency Directors in Emergency Medicine conference which has a tract for best practices for Chief Residents.

• Baylor Scott & White Memorial Hospital (BSW), Temple, Texas
• Children’s Scott & White McLane, Temple, Texas
• The University of Arizona Health Science Center, Tucson, Arizona
• Dell Seton Medical Center (DSMC) - UT, Austin, Texas
• Dell Children’s Hospital, Austin, Texas
• Baylor Scott and White - Hillcrest Hospital, Waco, Texas
• St. Joseph Medical Center (BCS), Bryan-College Station, Texas
• Seton Medical Center - Austin, Texas
• Brooke Army Medical Center (BAMC), Fort Sam Houston, Texas

Our program offers ADT or non-ADT rotations to third-year and fourth-year medical students. Those requesting rotations from June 1 to November 1 should be 4th year students interested in applying to Emergency Medicine via the military match. Rotations are typically four weeks long (2- or 3-week rotations are possible) and include multiple clinical shifts, didactic opportunities, simulation experiences, and protected time for learning about the culture of the program and the hidden gem of Central Texas. Students interested in rotating with our program should contact dha.cavazos.darnall-amc.list.crdamc-em@health.mil.

If you would like to schedule an interview with our program, please contact dha.cavazos.darnall-amc.list.crdamc-em@health.mil.

CRDAMC EMRP graduates take the American Board of Emergency Medicine (ABEM) Qualifying Examination and Oral Certification Examination. These exams are offered annually, and the process is fully outlined to our residents during “transition-to-practice” conference lectures.  For additional information, please visit the ABEM website.

Residents will have ample teaching opportunities over the course of their residency. Junior residents have opportunities to teach physician assistant students, medics, and other learners in the Emergency Department. Senior residents will ‘staff’ medical students and all PGY-1 residents for the first six months of their PGY-3 year to solidify their skills and aide in their growth as teachers.

Residents can teach medics at the Ft. Cavazos Medical Simulation Training Centers (MSTC) as well pursue opportunities to teach Emergency Medicine and ultrasound skills to regional EMS systems. As above, the department and program encourage and mentor teaching opportunities at local, state, and national conferences.

Faculty Subspecialty/Fellowship Training

• Critical Care Medicine
• Pediatric Emergency Medicine
• Toxicology
• Emergency Medical Services (EMS) and Disaster Medicine
• Advanced Emergency Medicine Ultrasound

Faculty Advanced Training/Certification

• Healthcare Administration
• Dive Medicine
• Wilderness Medicine

Each resident is paired with a faculty mentor of their choosing to aid in their longitudinal growth as Army Emergency Medicine physicians. Residents are encouraged to volunteer to mentor medical students, to help foster mentor-mentee professional development.

Our program places a strong emphasis on wellness initiatives to ensure the overall health and well-being of our residents. We have a “Wellness” Chief Resident who focuses on residency group engagement opportunities to foster community and cohesion amongst the residents. Additionally, the program provides education on financial management, helping residents understand future financial planning. Sleep hygiene is a critical component, with strategies provided to manage shift work and ensure adequate rest. Nutrition education is also prioritized, as is education on the importance of hobbies and leisure activities to promote a healthy work-life balance. We have open and candid conversations about mental health and seeking care when needed. Each class, from interns to senior residents, benefits from an annual class retreat. These retreats serve as a valuable opportunity for team building, relaxation, and reflection, fostering a supportive and cohesive community among residents.