Emergency Medicine Clerkship Curriculum

Emergency Medicine Clerkship Curriculum

 

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

 

Attention preceptors: If you are wanting to access the uploaded articles linked below then you must be logged into portal (link here). Please email at travis.smith@lecom.edu for your username and password

 

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

 

1  Table of contents

  1. Table of Contents
  2. Description
  3. Requirements
  4. Materials
  5. Evaluation & Grading
  6. Milestones
  7. 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
  1. Required Reading
    1. Rotation 1
      1. Week 1 Readings
      2. Week 2 Readings
      3. Week 3 Readings
      4. Week 4 Readings
    2. Rotation 2 
      1. Week 1 Readings
      2. Week 2 Readings
      3. Week 3 Readings
      4. Week 4 Readings
  1. EM Match Advice
  2. Emergency Medicine Journals
  3. Emergency Medicine Organizations
  4. 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

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

 

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.

      • 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
  • 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:
    • 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

 

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.)

 

8    Required Reading

8.1    Rotation 1: Week 1 Readings:

Please following the below CDEM Topics during each week of your rotation as it will guide you through your rotation. In addition you will be tested on the following articles:

CDEM Topics

 

8.2    Rotation 1: Week 2 Readings:

Please following the below CDEM Topics during each week of your rotation as it will guide you through your rotation. In addition you will be tested on the following articles:

CDEM Topics

 

8.3    Rotation 1: Week 3 Readings:

Please following the below CDEM Topics during each week of your rotation as it will guide you through your rotation. In addition you will be tested on the following articles:

CDEM Topics

8.4    Rotation 1: Week 4 Readings:

Please following the below CDEM Topics during each week of your rotation as it will guide you through your rotation. In addition you will be tested on the following articles:

 

CDEM Topics

8.5    Rotation 2: Week 1 Readings:

Please following the below CDEM Topics during each week of your rotation as it will guide you through your rotation. In addition you will be tested on the following articles:

 

CDEM Topics

 

8.6    Rotation 2: Week 2 Readings:

Please following the below CDEM Topics during each week of your rotation as it will guide you through your rotation. In addition you will be tested on the following articles:

 

CDEM Topics

8.7    Rotation 2: Week 3 Readings:

Please following the below CDEM Topics during each week of your rotation as it will guide you through your rotation. In addition you will be tested on the following articles:

CDEM Topics

 

8.8    Rotation 2: Week 4 Readings:

Please following the below CDEM Topics during each week of your rotation as it will guide you through your rotation. In addition you will be tested on the following articles:

 

CDEM Topics

9    EM Match Advice

 

10   Emergency Medicine Journals

 

11   Emergency Medicine Organizations

12   Emergency Medicine Educational Links

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