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To define emergency medicine, Dr. James Giglio, assistant clinical professor of medicine at P&S, borrows a colleague's birthday cake analogy. The whole cake symbolizes the range of medicine and each slice represents one of the traditional medical specialties. Emergency medicine is the icing because it covers almost every aspect of medical care—but only for the first 30 minutes of that care.

Doctors need to master a diverse set of skills to be the "icing." The breadth of experience and activity of the emergency room are two of the draws for recent medical school graduates, who increasingly seek residencies in emergency medicine. P&S students mirror the national trend of emergency medicine's rising popularity. Ten years ago, only about 1 percent to 2 percent of the students who graduated from P&S every year chose to pursue emergency medicine. That figure has increased to between 6 percent and 8 percent during the past five years.

Partly in response to increased demand for such programs, NewYork-Presbyterian Hospital in July 2003 will begin its first emergency medicine residency program, in which residents will be trained at the Columbia-Presbyterian and New York Weill Cornell medical centers.

The two medical centers did not have their own emergency medicine residency program until now because the field of emergency medicine had not matured enough, according to Dr. Giglio, who also is chief of emergency medicine at Columbia-Presbyterian Medical Center. The field began in public, city, and county hospitals only 30 years ago, a short time in the evolution of new medical disciplines, he says. The area gained legitimacy as top-tier medical centers started establishing emergency medicine residency programs over the past decade.

Columbia, Weill Cornell, and the hospital started building the foundation for the residency about five years ago with the support of Dr. Herbert Pardes, then dean of P&S and now president and CEO of NewYork-Presbyterian Hospital, and Dr. Antonio Gotto, dean of Weill Medical College at Cornell University. Dr. Gerald Fischbach, current executive vice president and dean, has continued that support since his tenure began almost two years ago.

The first step in creating the residency program required the expansion of the emergency medicine faculty by recruiting junior level faculty. But the program needed a leader. Last July, Dr. Giglio and Dr. Neal Flomenbaum, professor of clinical medicine at Weill Cornell and emergency physician-in-chief at NewYork-Presbyterian Hospital at New York Weill Cornell, recruited Dr. Wallace Carter from New York University/Bellevue Hospital Center to become director of the new emergency medicine residency and adjunct associate professor of clinical medicine at P&S and associate professor of clinical medicine at Weill Cornell.

The residency program, which just received accreditation in September, begins training its first group of residents in July. Each year, 10 residents will be accepted into the four-year program. "The residency program and the new fourth-year subinternship in emergency medicine should offer students world-class training drawing on the strengths of each campus," Dr. Flomenbaum says. The new subinternship will be offered to both Weill Cornell and P&S medical students and supplements the current subinternship at Columbia-Presbyterian Medical Center, based at the Allen Pavilion.

The residency program should benefit residents and students at Weill Cornell and across the Columbia Health Sciences Division as the added emphasis on training, education, and research will foster a better learning environment, says Dr. Thomas Q. Morris, vice president for Health Sciences and vice dean, who also helped found the program.

P&S students currently have opportunities to rotate through the emergency room as part of their first and third year courses and clinical training. Even when assigned elsewhere in the hospital, students often spend a considerable amount of time in the emergency room observing patients about to be transferred to other parts of the hospital, Dr. Carter says. Medical students now will be able to interact with the ER residents, when before they dealt with attending physicians who admitted patients to the ER.

Master's degree students in the acute care advanced nurse practitioner program in the School of Nursing have clinical rotations in the emergency room, where contact with the residents and faculty should enhance the nurses' education, says Sarah Cook, Dorothy Rogers Professor of Clinical Nursing and vice dean of the School of Nursing.

The Mailman School of Public Health, which already collaborates with the hospital's emergency medicine department on academic programs in epidemiology and research projects, expects such opportunities to increase as the new residency program gets under way, says Dr. Andrew Davidson, senior vice dean at Mailman.

The School of Dental and Oral Surgery will also work with the new emergency medicine residents and help train them in facial and oral trauma and head and neck infections, says Dr. Sidney Eisig, William Carr Professor of Clinical Dentistry and director of the SDOS Division of Oral and Maxillofacial Surgery.

Emergency residents are required to do clinical research projects that likely will provide new insights into optimal patient care, Dr. Carter says. Research activity also is necessary for the residency program to maintain its accreditation.

"In emergency medicine, doctors and residents must ask how treatments can be studied to determine the best practices," Dr. Morris says. "We expect the residency program to generate new knowledge and influence the development of the field of emergency medicine."


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