Rotation Overview
Objective
Requirements
Policies and Procedures
Objective
Following the rotation the student will be able to:
1. Understand the EM-based approach, differential diagnosis, and management of patients presenting with:
a. Acute chest pain
b. Cardiac arrhythmias
c. Shock
d. Altered mental status
e. Syncope
f. Abdominal pain
g. Major trauma to the head, spine, thorax, abdomen, and extremities
h. Overdose
i. Seizure
j. Family violence
k. Environmental exposures
l. Hypertension emergencies vs. urgencies
m. Gastrointestinal bleeding
n. Eye complaints
o. Alcohol related emergencies
p. Diabetic emergencies
q. Asthma exacerbations
r. Acute headaches
s. Vaginal bleeding
t. Acute febrile illness
u. Acute musculoskeletal complaints
v. Psychotic behavior
2. Describe
a. Appropriate wound management, including suturing and tetanus prophylaxis.
c. Indications, complications and techniques of splint application.
Requirements
In order to receive PASS for this elective, the medical student must:
1. Be present for all scheduled emergency department shifts, as documented on the sign in sheets (includes being on time and seeing new patients regularly throughout the shift).
2. See 75% or more of the index cases. This is to be documented on the handout and turned in to Gay at the end of the rotation.
3. Maintain a log of all patients you have managed primarily. Turn this log into Gay at the end of the rotation.
4. Obtain “Satisfactory” or higher on all of your clinical evaluations.
5. Score 70% or more on the written test taken during the last week of the rotation.
6. Attend the suturing workshop.
7. Attend 75% of medical student lectures (weekdays from 8a-9a, except Thursdays)
8. Attend 75% of DEM Grand Rounds (Thursdays 9:00a – 1p).
9. EM applicants: Give a case presentation and critique of an original research article to your faculty mentor. You should prepare a handout to accompany the presentation. You should demonstrate thorough H+P, differential diagnosis, and understanding of your chosen case. A copy of the journal article and handout should be turned into Gay and your DEM faculty mentor in advance (Note: this requirement is only applicable to students applying to EM residency)
10. EM applicants: Attend mentoring sessions with DEM faculty. (Note: this requirement is only applicable to students applying to EM residency)
Failure to complete these requirements will result in an “Incomplete or Fail” grade. Any questions, scheduling problems, or exceptions must be discussed with Dr. Fernandez in advance.
Policies and Procedures
DEM Elective/Selective Policies
1. Students, interns and residents on this elective rotation are to be supervised by Emergency Medicine residents and/or attending physicians only. Elective students, interns and residents are not to be supervised by or follow orders from others. (e.g. interns, non-DEM residents, consultants, PAs).
2. When in doubt ASK! There is almost never such a thing as a “stupid" question. The sign of a mature medical student or resident is to know what you know, know what you don’t, be willing to openly admit that you don’t know, and to improve your knowledge by seeking out appropriate assistance.
3. Good sources of information include: websites (particularly emedicine and UpToDate), major texts, selected journal articles, teaching sessions, mentoring sessions, and Grand Rounds. Other members of the department, including nurses and physician assistants, have a great deal of experience and can be another good source of knowledge and assistance.
4. Medical students should never perform any invasive procedures or exams, e.g., arterial blood gases, LP, pelvic exams, incisions and drainage of abscesses, suturing, etc. unless they have discussed it with a DEM resident or attending and are directly supervised during the procedure.
5. Medical students are expected to master IV insertion during this rotation; therefore, you are encouraged to attempt IV lines on your own patients. You should attempt these procedures regularly during the rotation if you already know how to perform them. If unsuccessful or you have never done this before, ask for help. Ultimately, the responsibility for starting lines is the RNs’; however, they will undoubtedly appreciate your help, particularly during busy times.
6. If you sustain a needlestick while working in the DEM, you must inform your resident or the DEM attending immediately. This is to ensure you receive the proper documentation and management of your needle stick injury.
7. Please be professional and courteous at all times to patients and staff, including nurses, attendants, clerks, and x-ray technicians.
8. Notify the nearest resident or attending physician immediately if you notice that a patient appears acutely ill, in distress, or is worsening.
9. Occasionally you may be asked by a resident to help with tasks or duties on a patient other than your own. This usually occurs only in situations of severe emergencies, in combination with a relative manpower shortage. Please help out whenever asked. Unstable patients transported to CT or XR require a licensed RN, PA, or MD for transport. If your resident places you into an uncomfortable situation regarding these rules, please inform Dr. Fernandez or your attending immediately.
10. Medical students in the DEM must always wear their nametags, clearly visible.
11. It is acceptable and recommended to wear clean, matching, surgical scrubs (with a white lab coat).
12. DEM Grand Rounds are held each Thursday morning from 9:00am to 1:00pm in GH Room 1645. There are also medical student conferences Monday, Tuesday, Wednesday, and Friday from 8AM to 9AM. In order to pass the rotation, you must attend 75% of both conferences and lectures. Any scheduling exceptions must be discussed with Dr. Fernandez in advance.
13. Your learning experience during your elective centers around you seeing your own patients (assigned and supervised by a resident). Merely watching someone else offers much less return for your time. Consider yourselves as sub-interns who are responsible for the care and well-being of your patients and who are expected to know more about their patients than the resident or attending.
14. There is no quota of patients to be seen during a shift; your rotation is learning oriented, not service oriented. Quality of your care is emphasized over quantity of patient’s seen. However, you should not necessarily have finished with one patient before starting another, particularly if you are waiting for results.
15. Students never take pass-ons at shift change without the direct involvement of the oncoming resident or attending. There are NO exceptions.
16. Trading shifts with other students is not permitted without approval by Gay and Dr. Fernandez in advance. In the case of an unexpected absence from a shift, see the policy stated below.
17. When you leave the clinical area during a shift for any length of time (e.g. for a meal, a conference or lecture, or when finishing a shift), update the DEM resident you are working with or a senior resident as to the progress of your patient’s workup. At the end of a shift, it is your responsibility to pass-on the responsibility of care of each of your patients to a DEM resident. Your supervising resident and attending should always co-sign your charts, and residents must co-sign your orders. Even patients who have been dispositioned and are awaiting transportation home or for a bed should be passed on if they remain in the area after you leave.
18. In general, take your meal breaks at the same time as your supervising resident.
19. If you need to be unexpectedly absent from an assigned shift (acceptable reasons include residency interviews, personal illness, or illness or death in your family) contact Dr. Fernandez or Gay at ext. 6812 or by email. Always call the area to which you are assigned and speak with either your assigned resident, the “two star” resident, or an attending. If they are not available, contact any DEM resident in the area. Please ask them to place a written note of this absence in Gay’s mailbox or to email her.
20. Please attempt to arrange interviews for your future internship or residency on your days off. If you are only able to have an interview on one of your assigned days, then permission to be absent from the DEM for an interview must be obtained from Dr. Fernandez in advance. Be prepared to provide a proof of your interview in writing.
21. If you have prior commitments, which you must keep during the elective (i.e. - tutoring, ongoing medical care), communicate this to Gay prior to your start date, or speak with Dr. Fernandez about this on the first day of your rotation, in order to make accomodations.
22. You must be present on your assigned days, during your assigned hours. A very high degree of responsibility for attendance is required of our residents AND all rotating students. Failure to comply with these expectations will negatively impact your grade on this rotation.
23. Students are not to be in any of the clinical areas at times other than their assigned shifts, unless given permission by Dr. Fernandez or another DEM attending.
24. If you have questions, comments, complaints, suggestions, etc., which cannot be resolved with your supervising resident, please notify Dr. Fernandez IMMEDIATELY! Don’t wait until the rotation is near the end or has ended, so that we can help.
25. All charts of patients worked up by medical students must be co-signed by the assigned DEM Resident and attending staff physician prior to patient disposition.
26. All orders for medications and/or procedures must be co-signed by the assigned DEM Resident or attending staff physician. All prescriptions are to be written and signed by the assigned DEM resident or attending staff physician.
27. When working in the clinical areas, introduce yourself to everyone, including attendings, residents, midlevel providers, and nursing staff. Emergency medicine is a team-sport that is much more enjoyable in a collegial working environment! Furthermore, you will be provided multiple opportunities to perform procedures or to see interesting cases if the staff are aware of your presence and enthusiasm.
28. You must PERSONALLY request evaluations from each of your supervising residents, on the last day that you are assigned to work with that resident. You may also give blank evaluation forms to other faculty members and residents with whom you have worked, at your discretion. If you forget, you must contact Gay immediately, so that you can email your resident with two attachments containing: a) a blank evaluation form and b) a photograph of yourself. If you would like to find out if your evaluation was turned in by a resident or attending, you may call Gay Lewis-Taylor x6812.
Generally, all rotating students have found this elective clerkship to be enormously educational, interesting, stimulating, and enjoyable. We sincerely hope that you find it to be so as well, and we encourage you to provide us with any feedback and suggestions for improvement!