The rotation is designed to expose the student to a wide variety of acute medical and surgical problems and to give students experience in the evaluation and treatment of these illnesses.
Upon completion of the course, students will:
- Acquire first-hand experience in dealing with emergency problems.
- Demonstrate basic knowledge, appropriate to the student's level of training, needed in regards to the evaluation, treatment, and disposition of the most common presentations of patients to emergency departments such as chest pain, abdominal pain, trauma, shock and shortness of breath.
- Gain experience with common emergency department procedures such as IV access, Foley catheterization and wound management.
- Gain insight into pre-hospital care.
- Demonstrate satisfactory performance of selected ED procedures under the supervision of ED faculty or senior residents. Such procedures include arterial blood gas determinations, starting IV lines, inserting Foley catheters, and suturing uncomplicated wounds.
- Have the ability to write a legible, succinct ED record documenting the important elements of the ED encounter - this must be done under the supervision of a resident or faculty team member.
- Accurately interpret common clinical tests (EKGs, serum electrolytes, x-rays), identify abnormalities on these tests, compare abnormalities to previous results (if available), and synthesize information to narrow their differential diagnosis.
- Students will also be expected to apply knowledge of pathophysiology learned in the first two years to explain abnormal physical exam findings or abnormal findings on common clinical tests.
- Attend required ED lectures, conferences and readings as directed by site director.
- Empathize with a variety of patients in the ED, be able to resolve reasonable issues in their health care, and act as patient advocates.
- Be able to list ED indications for admission to inpatient services.
- Arrange or describe appropriate follow-up care and instructions for patients before these patients are discharged from the ED, and become familiar with resources available in the community for patients going home.
- Demonstrate a professional demeanor and a positive attitude toward patient care while in the ED.
Students will be expected to:
- Assess diverse and undifferentiated patients: students are expected to be self-starting and to work with residents to see new patients as they arrive - the student may start by shadowing a resident during several patient encounters to get a sense of how an emergency medicine H&P is performed, but is expected to see his or her own patients and present the patient to the resident and/or attending physician in a timely manner.
- Obtain a careful and concise history and perform a directed physical examination.
- List and discuss an appropriate differential diagnoses emphasizing problems common in Emergency Medicine: students should consider the differential prior to presenting their patients to the attending physician in order to direct their presentation to include only pertinent historical and physical exam items to help assess likelihood of the items on the differential. Emergency medicine physicians typically consider the most serious potential differential items first, and after ruling these out by either H&P or workup, consider the most likely or more benign differential items. Example: for a patient presenting with chest pain, the differential includes life-threatening issues such as acute coronary syndrome, pulmonary embolism, and aortic dissection, but also includes more common and benign pathologies such as costochondritis, GERD, and intercostal muscle strain.
- Develop a plan and establish treatment priorities in consultation with ED faculty or senior residents, follow their patients' progress throughout their stay, perform serial examinations if required, and discuss and document discharge plans and patient follow-up. The medical student should act as the primary provider for the patient whenever possible and ensure they stay abreast of test results, vital sign trends, patient concerns, needs, and questions.
Grading and Evaluation
Students will be graded pass/fail based on their participation in and engagement with the required elements of the rotation. Students will be asked to assign evaluations to faculty and residents whom they worked with during their rotation. These evaluations will be submitted to the course director, Dr. Alison Hayward. In order to help ensure the most detailed and appropriate feedback, we request that students assign the evaluations through MedHub while on their shift, and ask that the residents and/or faculty who they have worked with take a few moments to complete the evaluation with them in real time at the end of the shift. Students may request that feedback be sent via e-mail to the course director and administrator if submitting via MedHub is not feasible. Dr. Alison Hayward will compile all received feedback into the final course evaluation, as well as incorporating feedback based on the simulation writeup and the DIEM cases completed during the course. Due to the limited number of shifts in the rotation, the prevalence of shift swaps, and the large size of our faculty (75 members) and residency program, students may not end up working with the same attending or residents during the ED shifts assigned, although we make efforts to pair attendings with students based on the schedule at the time of the shift assignments. If you would like more detailed feedback and greater breadth and depth of experience in emergency medicine, we encourage you to complete a sub-internship with us, which allows you to work a larger number of shifts and will provide the opportunity for closer evaluation of clinical skills over the duration of the course.
The following are required elements of the Third Year Clerkships:
- On time attendance at all assigned shifts in the emergency department. Lateness is not acceptable on the emergency medicine rotation. If you foresee a problem in attendance for your shift, please notify the course administrator, Jaydale Codrington-Poyotte or course director, Dr. Alison Hayward as soon as the issue arises.
- Completion of 2 out of 3 of the Digital Instruction in Emergency Medicine cases online: Register and enter the site to start the online cases.
- Attendance at simulation sessions on Thursday afternoons, and simulation write-up.
- Attendance at case conference sessions (small group discussions led by emergency medicine faculty and senior residents) on Tuesday mornings, unless just finishing an overnight shift or assigned to an ED shift at that time.
- Attendance at residency lectures on Wednesday mornings, if not just finishing an overnight shift or assigned to an ED shift at that time.
- Attendance at morning report (held biweekly, Tuesdays and Thursdays at 6:35am in the EM administration conference room, next to the CIU) if working the prior night's overnight shift, or if assigned to work the Tues/Thurs day shift.
Medical Student Resources
General Emergency Medicine Resources
The following resources are highly recommended to assist students in excelling in their emergency medicine rotation:
- Clerkship Directors in Emergency Medicine Student Portal : provides overviews on the approach to common emergency medicine presenting complaints, as well as common disease processes. Links to an online question bank to test your knowledge in EM. This site also is the home for the DIEM Cases, completion of 2 out of 3 of the Digital Instruction in Emergency Medicine cases is part of the course requirements.
- Video: How to Think Like an Emergency Physician - from EMUpdates.com - the site also is a resource for algorithms, checklists, and other educational materials related to emergency medicine.
- PDF: The Outstanding Medical Student in EM - provides a brief summary of general expectations of medical student behavior on an emergency medicine rotation and how to perform well on your rotation.
- PDF: The 3 Minute Emergency Medicine Medical Student Presentation - if you have wondered how presentation of patients differs on your emergency medicine rotation, this resource is a great one to review.
- Academic Life in Emergency Medicine (ALiEM) - a blog with a multitude of educational pearls about various topics in emergency medicine and discussions of current hot topics in the specialty.