Emergency Medicine Clerkship Curriculum

“The good physician treats the disease; the great physician treats the patient who has the disease”
–Sir William Osler

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Download this in a PDF for easier viewing (EM Curriculum 2017)

1 Table of contents

Table of Contents
Description
Requirements
Materials
Evaluation & Grading
Milestones
Goals & Objectives
- Medical Knowledge
- Patient Care
- Interpersonal and Communication Skills
- Practice-Based Learning and Improvement
- Systems-Based Practice
- Professionalism
- Osteopathic Philosophy and Osteopathic Manipulative Medicine

Required Reading
1. Rotation 1
2. Rotation 2

EM Match Advice
Emergency Medicine Journals
Emergency Medicine Organizations
Emergency Medicine Educational Links

2 Description

Emergency Medicine (Fourth Year rotation): 2 blocks (8 weeks)
During your 8 week rotation you are expected to meet and exceed the following requirements and challenge yourself, to be proactive learners and ask questions. The Emergency Department provides an opportunity for significant clinical exposure and learning of many skills in the evaluation and treatment of acute diseases. The ED setting should give the student many opportunities to use their diagnostic reasoning, emphasizing the ability to recognize life-threatening situations and initiate resuscitation in a wide range of diseases with varying degrees of urgency. By the end their rotation the students should learn to appreciate the dynamic state of emergency medicine knowledge, the necessity for maintaining clinical competency and the means to do it. If there is a problem with one of the questions please email me directly, travis.smith@lecom.edu.

3 Requirements

Each student must complete a minimum of 160 hours during each of the two 4-week rotations (40 hours per week)
Complete all weekly reading requirements. Students are encouraged to supplement required readings with additional readings from Tintinalli’s Emergency Medicine text based on your specific rotation exposures.
Complete the Weekly Online Questions in the coursework section
Complete the online End of Rotation Quiz (Worth 20% of your final grade)
- If you are on your EM 1 rotation then you need to complete the weekly reading assignments, complete the questions of the day and the end of rotation quiz.
- If you are on your EM 2 rotation then you need to complete the weekly reading assignments, complete the questions of the day and the end of rotation quiz.
Students MUST adhere to the ACGME rules regarding the workweek, which include working no more than 80 hours per week, no more than 24 hours continuously, except an additional 6 hours may be added to the 24 to perform wrap-up duties, and have at least one of every 7 days completely off from educational activities.
Extended absences from the clerkship are not permitted. Any absence from the clerkship must be pre-approved by the regional campus dean prior to the beginning of the clerkship.

4 Materials: Required and Supplemental

Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, Seventh Edition Required Reading
First Aid for the Emergency Medicine Clerkship: Required Reading
ECG’s for the Emergency Physician : Supplemental: Need help with EKG review, although not required this book is highly recommended
Tintinalli’s Emergency Medicine: Just the Facts: Supplemental: This is a smaller version of the comprehensive study guide.
Roberts and Hedges’ Clinical Procedures in Emergency Medicine: Supplemental
USMLE Road Map Emergency Medicine, 1st edition, Scott C Sherman, MD and Joseph M Weber, MD, Lange Medical Books/McGraw-Hill, USA, 2008. Supplemental: This text gives a good overall foundation of Emergency Medicine, but is certainly not all inclusive.

5 Evaluation and Grading: (Effective June 2017)

80% based on rotation evaluation
20% based on completion of the end of rotation quiz (50 questions) and completion of the weekly quizzes (the weekly quiz grades will not factor into your end of rotation quiz grade).
The end of rotation exam is due on the last Sunday of your rotation by 10PM eastern and will not be accepted late!
- If you fail to complete the exam or fail turn it in on time (even 1 minute late), you are still required to take the make-up exam (while still receiving a 0% towards your grade)
- If you then fail the makeup exam (<70%) or fail to take it completely by the end of your next rotation then you will be required to repeat the entire rotation during your elective month.

6 Milestones

Be familiar with the history and founding of Emergency Medicine
- Introduction to the Specialty of Emergency Medicine
Recognizes unique nature of emergency medicine as a safety net in the health care system
Identify the critical steps to stabilize an acutely ill or injured patient
Know the Differences Between the Emergency Department, the Office, and the Inpatient Setting
Understand the Unique Educational Aspects of Emergency Medicine
Can perform directed history & physical, develop differential diagnosis, and propose management and treatment options for the most common chief complaints. (abdominal pain, chest pain, headache, shortness of breath)
Satisfactorily perform an oral presentation to house officers and attending physicians.

7 Goals and Objectives

During your rotation each student should achieve a vast clinical experience in the treatment of acute medical and surgical conditions in an emergency setting. This acute environment places an important emphasis on physical exam skills, diagnostic reasoning, emphasizing the ability to recognize life-threatening situations, and initiating resuscitation in a wide range of diseases with varying degrees of urgency. There are many topics in Emergency Medicine and it is impossible to cover them in a 4-8 week rotation but there are a few key topics and objectives that one must be familiar with and should be reviewed before your rotation starts.

7.1 Medical Knowledge

Demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. Be familiar with the following topics prior to starting your rotation.

- How to Get the Most Out of Your Emergency Medicine Clerkship
- Understand the Unique Educational Aspects of Emergency Medicine
- Be familiar with the Differences Between the Emergency Department, the Office, and the Inpatient Setting
- Gain an overall knowledge and understanding of how and when to apply the A.B.C.s in emergency conditions.

- Understand how to recognize evaluate and effectively manage all acute or life-threatening conditions in an emergency setting.
- Be able to evaluate and Stabilize the Acutely Ill Patient in the emergency room and Perform a Complaint-Directed History and Physical Examination
- Develop a Case-Specific Differential Diagnosis based on patient presentation and acuity and be able to list the worst-case diagnoses.
- Develop a Plan of Action based on your differential diagnosis and understand the meaning of Vital Signs
- Be familiar with common Diagnostic Testing in the Emergency Department, the Common laboratory studies
- Be able to construct an accurate and organized medical record.
  - Documentation of EM Encounters
- Develop and understanding and learn how to effectively interpret these laboratory studies as well as being efficient in Interpreting Brain Imaging and Chest Radiographs
- Learn what procedures and tests have to be performed during each clinical scenario and monitor the response to each therapeutic intervention.
- Gain an understanding of the pathophysiology of shock, its categorizations and treatment.
- Understand the mechanisms, pathophysiology and treatment of cardiopulmonary arrest.
- Understand the pathophysiology effect and management of blunt and penetrating trauma and of a patient with complex multi system injuries.
- Be familiar with acute pain control in the Emergency Department:

- - List the common classes of analgesics used in the ED and describe their mechanisms of action
  - Discuss the advantages and disadvantages of different analgesics and their routes of administration
  - Be familiar with commonly used local anesthetics and their characteristics
  - Describe the necessary safety precautions when performing procedural sedation and be familiar with commonly used agents

- Be familiar with the ACEP clinical Policies.

The following topics are a list of competencies that one should be familiar with before starting your clerkship. In addition one should review and be familiar with six CDEM core competencies:

- - Maintain a daily solid positive attitude and work ethic while exhibit honesty and integrity to patients and staff.
  - Display Professionalism in addition to maintaining a professional appearance and conduct
  - Be familiar with common Ethical issues in the ED
  - Be mindful of others while making sure to be sensitive to cultural issues (age, sex, culture, disability, etc.)
  - Do not prejudge a patients intentions based on prior visits
  - Be able to present cases in a complete, concise, and organized fashion
  - Develop appropriate disposition and follow-up plans.
  - Be familiar with the proper indications for diagnostic studies and laboratory tests including cost, risks, and evidence behind them.

The following topics are recommended for clinical exposures. Rotation coordinators are encouraged to provide lectures, conferences, topic talks or journal club, and also assign readings to students. A great introduction to these topics can be found at http://www.cdemcurriculum.org/

7.2 Patient Care

Provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Demonstrate the ability to completely evaluate problems via appropriate medical history, physical examination, and laboratory/radiological and other modalities of evaluation
Balance proper use of investigations and treatment for patients with a social obligation to control health care costs
Formulate biopsychosocial hypotheses into a differential diagnosis, provisional diagnosis and working diagnosis
Identify patients at highest risk for serious morbidity and mortality
Present cases clearly and concisely to preceptors and others
Write legible, concise, accurate and timely notes
Perform skills and procedures relevant to the most common conditions seen during this rotation
Demonstrate an ability to involve other relevant caregivers into patient care decisions and plans
- Learn the basic principles Basic wound management, suturing, and the management of tissue infections, where drainage is required or when antibiotics alone are sufficient.
- Become proficient in understanding the indications for and proper techniques in performing common the most common Emergency Department procedures:
  - Vascular Access (IVs, central lines, and arterial lines)
  - Abscess incision and drainage
  - Lumbar puncture
  - Foley catheters
  - Rapid sequence intubation
  - Chest tubes
  - Suturing
  - Gastric lavage
- Laceration repair
- Regional anesthesia
- Casting/splinting techniques
- Reduction of uncomplicated dislocations
- Removal foreign bodies
- Interpretation of diagnostic imaging
- Nasal packs/cautery
- Legal and therapeutic indications for blood-alcohol testing
- Incision and drainage of abscesses
- Appropriate tetanus prophylaxis
- Appropriate immunization procedures

7.3 Interpersonal and Communication Skills

Demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates.

Demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates
- Communicate effectively with patients, their families and other members of the health care team
- Adhere to the principles of openness, honesty, completeness and responsibility in communication
Demonstrate an ability to effectively communicate difficult/bad news
Provide effective patient education and anticipatory guidance
Respect confidentiality
Demonstrate willingness and ability to receive and act upon feedback from colleagues, other health care workers and their families and caregivers
Demonstrate empathy with patients
Utilize touch when appropriate and within the boundaries of an appropriate doctor-patient relationship
- Appreciate the interdisciplinary approach in managing the acutely ill patient.
- Learn how to effectively communicate with staff (nurses and technicians), patients, family members, and other members of the health care team (consultants and admitting services).
- Be able educate patients and provide anticipatory guidance as necessary related to the patient’s chief complaint in an effort to ensure a comprehensive discharge plan as well as arranging appropriate close follow-up with primary team or specialists.
  - Disposition of the Emergency Department Patient
  - Discharge Instructions

7.4 Practice-Based Learning and Improvement

Investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices.

Practice and apply the principles of evidence-based medicine to all patient care encounters
Collect and analyze patterns of practice and compare/contrast these individual patterns with established clinical guidelines and norms (best practices)
Access, in a disciplined way, sources of new information pertaining to the practice of medicine
Apply the basic principles of continuous quality improvement to the practice setting
Recognize and accept one’s own limitations in the practice of medicine

7.5 Systems-Based Practice

Demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

For the problems most commonly encountered on the rotation, list the indications for referral, consultation and transfer (to others and from others)
Demonstrate respect and honor for the roles of the many health care professionals required for collaborative care
Utilize the network of health care facilities, providers, agencies and institutions available for the diagnosis, management and support of patients and their families
Acknowledge and act in accord with payment issues involved in medical care
Advocate for patient and family issues
Take into consideration issues related to the cost and supply of pharmaceuticals in medical decision-making
Describe and identify emergency medical services for pre-hospital care within the community, i.e., paramedics, ambulance services, communications systems, first-aid programs, poison control, public education programs, abuse/homeless shelters, and disaster planning
Discuss the myriad relationships between the emergency room physician and primary care physician on the one hand and the consultant specialists on the other hand

7.6 Professionalism

Professionalism should imbue all aspects of your performance. Medicine as a whole will continue to evolve and change but this aspect of your character will stick with you forever. Each student should understand and be able to demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population.

Practice with compassion
- Respect the privacy and dignity of patients and their families
- Respect confidentiality
- Remain present to the overwhelming concerns of patients and families who are receiving bad news for, perhaps, the first time

- Displaying good manners
- Showing discernment while avoiding deception when communicating with patients and their families
- Effectively communicates empathy
- Puts patients’ needs above own (altruism)
- A commitment to caring for all patients regardless of their medical diagnoses or social factors.
- Displaying sensitivity to cultural differences

Convey humility
Demonstrate tolerance for issues related to cultural, religious, spiritual and socioeconomic diversity
- Act in accord with the unique surgical issues raised by groups such as Jehovah’s Witnesses
Maintain honesty and integrity in all relationships centered on the provision of surgical care
- Communicate honestly regarding potential surgical risk and potential benefits from surgery
- Report all conflicts of interest that may impact on surgical decision making, for example ownership relationships with surgical centers or specialty hospitals
- Treat all patients, staff, and colleagues with respect.

- Avoiding confrontations
- Demonstrate a positive attitude towards learning by showing intellectual curiosity, initiative, honesty, integrity, and dedication.

Show intellectual curiosity
Accept responsibility for your patients
Being prepared and on-time
Being dependable
Reliable attendance and participation
Strive for excellence
Not passing others’ work off as your own
Actively seek to broaden education and experience beyond clerkship requirements
Avoid complaining

7.7 Osteopathic Philosophy and Osteopathic Manipulative Medicine

Integrate Osteopathic Concepts and OMT into the medical care provided to patients as appropriate. Understand and integrate Osteopathic Principles and Philosophy into all clinical and patient care activities.

Identify and treat those emergency medical conditions that may be effectively managed by OMT (e.g. spinal muscle strains, tension headaches, upper and lower respiratory tract infections, pre-menstrual syndrome, dysmenorrhea, etc.)