Emergency Medicine (VS)

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

Accept Visiting Students: yes (4 week only)

Note to US Visiting Students: The Yale Emergency Medicine Residency Program strives for excellence in all areas. Continuing this year, we will be offering a scholarship to underrepresented minorities accepted for a subinternship or ultrasound rotation. This scholarship will pay up to $1500 to assist in travel and lodging while rotating at Yale New Haven Hospital. If interested, applicants should email their CV and a statement explaining their interests in leadership and academics at the time of their VSAS submission to Lisa Courtney at lisa.courtney@yale.edu. For questions, please also contact lisa.courtney@yale.edu.

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).

At Yale-New Haven Hospital emergency medicine subinterns complete a 4-week rotation comprised of clinical shifts and didactic activities. Students complete 16 shifts of 8 hours’ duration, a clinical schedule similar to that of our residents. Students are expected to function as interns, evaluating patients primarily, managing multiple patients simultaneously, and presenting directly to the senior resident and attending. Students see a broad case mix in the emergency department and are expected to generate coherent, problem-focused differential diagnoses. They are involved in all aspects of patient care including updating patients and families, calling consultants, and performing procedures. They rotate with a variety of attendings and are exposed to faculty from the sections of education, ultrasound, critical care, global health, administration, and EMS. Didactic activities for sub-interns include resident educational conference, ultrasound image review and simulation.

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. 
Note to US Visiting Students: The Yale Emergency Medicine Residency Program strives for excellence in all areas.  Continuing this year, we will be offering a scholarship to underrepresented minorities accepted for a subinternship or ultrasound rotation.  This scholarship will pay up to $1500 to assist in travel and lodging while rotating at Yale New Haven Hospital.  If interested, applicants should email their CV and a statement explaining their interests in leadership and academics at the time of their VSAS submission to Lisa Courtney at lisa.courtney@yale.edu.  For questions, please also contact lisa.courtney@yale.edu.

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.

At Yale-New Haven Hospital combined emergency medicine/ultrasound sub-interns complete a 4-week rotation comprised of 12 clinical shifts, 4 scanning shifts dedicated to bedside ultrasound, and didactic activities. On clinical shifts, subinterns are expected to function as interns, evaluating patients primarily, managing multiple patients simultaneously, and presenting directly to the senior resident and attending. Students see a broad case mix in the emergency department and are expected to generate coherent, problem-focused differential diagnoses. They are involved in all aspects of patient care including updating patients and families, calling consultants, and performing procedures. They rotate with a variety of attendings and are exposed to faculty from all sections of the emergency department but they spend a majority of their shifts with ultrasound-trained faculty to maximize their ability to incorporate bedside ultrasound into clinical evaluation. Scanning shifts are dedicated to the skills of performing and interpreting bedside ultrasounds and are typically supervised by a senior resident or ultrasound fellow, which is the standard for our interns on their ultrasound rotation. Attention is paid to image acquisition, machine optimization, and image interpretation. Diagnostic pelvic, vascular, cardiac, pulmonary, biliary, trauma and soft tissue sonography are introduced. In addition, there are opportunities for the student to participate in supervised ultrasound guided procedures (central and peripheral vascular access, abscess drainage, paracentesis). Didactic activities for EM/US subinterns include resident educational conference and ultrasound image review.

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. 
Note to US Visiting Students: The Yale Emergency Medicine Residency Program strives for excellence in all areas.  Continuing this year, we will be offering a scholarship to underrepresented minorities accepted for a subinternship or ultrasound rotation.  This scholarship will pay up to $1500 to assist in travel and lodging while rotating at Yale New Haven Hospital.  If interested, applicants should email their CV and a statement explaining their interests in leadership and academics at the time of their VSAS submission to Lisa Courtney at lisa.courtney@yale.edu.  For questions, please also contact lisa.courtney@yale.edu.


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 considering this specialty should consider the following electives or subinternships:

Dermatology

  • EL Dermatology Electives

Emergency Medicine

  • EL Emergency Medicine Electives

Frontiers in Medicine

  • EL Frontiers in Medicine Elective

Internal Medicine

  • EL Internal Medicine Analytical Clinical Cardiology Elective
  • EL Internal Medicine Cardiology Elective (VAMC)
  • EL Internal Medicine Cardiology Elective (YNHH)
  • EL Internal Medicine Geriatric Medicine Elective
  • EL Internal Medicine Geriatric Medicine Elective (YNHH/SRC)
  • EL Internal Medicine Palliative/Hospice Medicine Elective (Branford, CT)

Obstetrics & Gynecology

  • EL Obstetrics & Gynecology Outpatient Elective

Orthopaedics and Rehabilitation

  • SI Orthopaedics and Rehabilitation Subinternship

Pediatrics

  • EL Pediatrics Electives
  • EL Pediatrics Cardiology Elective

Surgery

  • SI Surgery Plastic and Reconstructive Surgery Subinternship