Emergency Medicine

Students participating in the four-week combined Emergency Ultrasound and Emergency Medicine Subinternship are immersed in the acute care setting, working under direct faculty supervision in the Yale-New Haven Hospital Emergency Department. Students work a combination of clinical shifts (8 hours long), scan shifts (4 hours long) and participate in weekly resident conference, ultrasound tape review and specialized student case conferences and procedure workshops. Ultrasounds will be performed by students on emergency department patients using Ultrasound equipment in the ED. Attention will be paid to image acquisition, machine optimization, and image interpretation. Diagnostic pelvic, vascular, cardiac, pulmonary, biliary, trauma and soft tissue sonography will be introduced. In addition there will be opportunities for the student to participate in supervised ultrasound guided procedures (central and peripheral vascular access, abscess drainage, paracentesis).

Length of Rotation: 4 weeks (maximum-2 students)

Scheduling Restrictions: N/A

Student's Class Level: 4th, 5th year

Prerequisite(s): Internal Medicine and General Surgery Clerkships

Accept Visiting Students: yes

Learning Objectives:

  1. History skills. Gather the important information that is needed for the Emergency Medicine history and complete a history in the medical record. Obtain a focused developmentally appropriate biomedical and psychosocial story of the patients’ illness in the acute care setting. Know the pertinent history necessary to obtain for acute chest pain, acute abdominal pain, acute shortness of breath, and altered mental status, and gather the important information that is needed for the history of why the patient is getting a point of care ultrasound.
  2. Physical examination skills. Perform a physical exam that is focused on the patients’ acute problem and that examines patients in such a way as to minimize their discomfort and embarrassment.
  3. Knowledge/diagnostic and treatment skills: Organize information gathered from the interview, physical examination, and diagnostic tests and formulate reasonable hypotheses and differential diagnosis appropriate to the acute care setting; formulate management strategies which are consistent with the acuity of the illness as well as patient's interests, needs, and preferences; present clinical information, both in the verbal and written format, in a concise and coherent manner; formulate safe and appropriate dispositions for a wide range in clinical conditions germane to the practice of Emergency Medicine; and become competent/parsimonious in the utilization of professional consultations in the acute care setting; this requires an understanding of which clinical situations demand consultations as well as the ability to present the case to the consulting service. Also know about conditions for which POC US is helpful.
  4. Procedural skills: Perform basic emergency medicine procedures including incision and drainage, arterial blood gas, IV placement and lumbar puncture, and interpret diagnostic tests germane to the acute care setting including, but not limited to, electrocardiogram, chest radiograph and arterial blood gas. Also perform 50 bedside point-of-care ultrasounds on ED patients and 5-10 ultrasound guided procedures (vascular access, paracentesis, thoracentesis, arthrocentesis)
  5. Attitude: Able to utilize a range of communication and interpersonal skills to respond to the patient’s concerns and needs, establish a trusting relationship, and inform, educate, and enlist the patient to participate in his or her health care decision.
  6. Career/context: Know the training/career pathway for Emergency Medicine.

Students participating in the four-week Emergency Medicine Subinternship are immersed in the acute care setting, working under direct faculty supervision in the Yale-New Haven Hospital Emergency Department. Students work ~ 36 clinical hours per week and participate in both the weekly Wednesday morning resident didactic sessions, as well as specialized student case conferences and procedure workshops. Interested students can also do some ultrasound scanning shifts and/or attend ultrasound tape review sessions on Tuesday afternoons. Yale students also have the opportunity to do the EM subinternship in a longitudinal fashion, completing at least 16 shifts over a 6-month period. This is an ideal opportunity for students in the lab or completing a combined degree program to maintain their clinical skills while away from the wards. Yale students who are not planning on a career in EM may also consider applying to do 2 week advanced elective in EM to learn advanced acute patient management, clinical skills, and procedures. Interested students should contact Dr. Hile.

Length of Rotation: 4 weeks (maximum-8 students)

Scheduling Restrictions: N/A

Student's Class Level: 3rd, 4th, 5th year

Prerequisite(s): Internal Medicine and General Surgery Clerkships. May do the subinternship as a third year if student has completed EM clerkship.

Accept Visiting Students: yes - department approval

Learning Objectives:


  1. History skills. Obtain a focused developmentally appropriate biomedical and psycho social story of the patients’ illness in the acute care setting. Know the pertinent history necessary to obtain for acute chest pain, acute abdominal pain, acute shortness of breath, and altered mental status.
  2. Physical examination skills. Perform a physical exam that is focused on the patients’ acute problem and that examines patients in such a way as to minimize their discomfort and embarrassment.
  3. Knowledge/diagnostic and treatment skills: Organize information gathered from the interview, physical examination, and diagnostic tests and formulate reasonable hypotheses and differential diagnosis appropriate to the acute care setting; formulate management strategies which are consistent with the acuity of the illness as well patient's interests, needs, and preferences; present clinical information, both in the verbal and written format, in a concise and coherent manner; formulate safe and appropriate dispositions for a wide range in clinical conditions germane to the practice of Emergency Medicine; and become competent/parsimonious in the utilization of professional consultations in the acute care setting; this requires an understanding of which clinical situations demand consultations as well as the ability to present the case to the consulting service.
  4. Procedural skills: Perform basic emergency medicine procedures including incision and drainage, Arterial blood gas, IV placement and lumbar puncture, and interpret diagnostic tests germane to the acute care setting including but not limited to electrocardiogram, chest radiograph and arterial blood gas.
  5. Attitude: Able to utilize a range of communication and interpersonal skills to respond to the patient’s concerns and needs and establish a trusting relationship, and inform, educate, and enlist the patient to participate in his or her health care decision.
  6. Career/context: Know the training/career pathway for Emergency Medicine.

This elective is a two- or four-week experience that will introduce the student to the use of diagnostic and procedural ultrasound at the bedside. Educational ultrasounds will be performed by the student on emergency department patients using ultrasound equipment in the ED. Attention will be paid to image acquisition, machine optimization, and image interpretation. Diagnostic pelvic, vascular, cardiac, pulmonary, biliary, trauma and soft tissue sonography will be introduced. In addition there will be opportunities for the student to participate in supervised ultrasound guided procedures (central and peripheral vascular access, abscess drainage, paracentesis). The bulk of time will be spent performing ultrasounds in the emergency department; with one half-day a week spent reviewing recorded examinations. Educational materials will be provided. While the focus of this rotation is the sonographic evaluation of the emergency patient, students considering almost any specialty may benefit as clinician-performed ultrasound continues to expand.
This elective is dedicated solely towards the experience and practice of point-of-care ultrasound in the Emergency Department. Students will be assigned daily scanning shifts which do not carry any clinical responsibility but receive exposure to the clinical environment. It is not the same as the combined Emergency Medicine / Ultrasound Sub-internship, in which the student will be primarily assigned clinical shifts to demonstrate knowledge, proficiency and workflow, and will also receive exposure to ultrasound through a few scan shifts and image review sessions.

Length of Rotation: 2 or 4 weeks (maximum-4 students)
Scheduling Restriction(s): N/A
Student’s Class Level: 3rd, 4th, 5th year
Prerequisite(s): N/A

Learning Objectives:

1.    History skills: Gather the important information that is needed for the history of why the patient is getting a point of care ultrasound. Document the history in the ultrasound log sheet and complete a history for at least 50 (2 weeks)/ 100 (4 weeks) of point of care ultrasound.

2.    Physical examination skills: Complete a pertinent physical examination for the evaluation of a sonographically identifiable illness on at least 10 patients. The student should demonstrate the ability to perform this pertinent physical examination while being observed by at least one attending or resident.

3.    Knowledge/diagnostic and treatment skills: Know about conditions for which POC US is helpful.

4.    Procedural skills: Perform 50-100 bedside point-of-care ultrasounds on ED patients. Perform 5-10 ultrasound guided procedures (vascular access, paracentesis, thoracentesis, arthrocentesis).