Emergency Medicine Guidelines

The emergency medicine curriculum objectives specify student skills and behaviors that are central to care of an emergency department (ED) patient and are appropriately evaluated in the context of the outcome objectives for the medical program.

The Emergency Medicine objectives can be taught and evaluated in the following various settings to include clinical bedside teaching, observed structured clinical evaluation, lectures, problem-based learning groups, self-directed learning materials, and simulations.

Structure

• Length: four to six weeks

• The clerkship director will provide an orientation at the start of the clerkship. This should include a discussion of the expectations and responsibilities of the clerk, the general department, the student schedule and assignments to residency teams and preceptors. Students should receive log books and the appropriate part of the Clinical Training Manual.

• Site: Emergency Department/Accident & Emergency Department (UK).

• Exposure to Pediatric Emergency Medicine

• Teaching rounds for house staff and students should be done at least once daily.

• A full schedule of teaching conferences including grand rounds, residency conferences, and scheduled didactic sessions specific to the needs of the students.

• The clinical faculty must provide direct supervision of the students for physical examination, case presentations and clinical procedures.

• All clinical write-ups or formal presentations must include a focused history and physical, problem list with its assessment, and a diagnostic and therapeutic plan. Write-ups must include a review of the current literature and explain how this newly acquired knowledge will impact future patient encounters.

• The clinical faculty must meet with each student for a formal one-on-one mid core formative evaluation and complete the University’s form with appropriate comments and suggestion. Both the faculty member and the student must sign the form.

• The clinical faculty must give a final oral examination based principally on the diagnostic entities the student has seen. These diagnoses are entered into a “Patient Log” which each student must keep current. This log is a summation of all the patients with whom the student has had a significant involvement.

Educational Objectives

Medical Knowledge

Students will demonstrate medical knowledge sufficient to:

• Identify the acutely ill patient
• Suggest the appropriate interpretation of tests and imaging data
• Develop a differential diagnosis which includes possible life or limbthreatening conditions along with the most probable diagnoses

• Describe an initial approach to patients with the following ED presentation: chest pain, shortness of breath, abdominal pain, fever, trauma, shock, altered mental status, GI
• bleeding, headache, seizure, overdose (basic toxicology), burns, gynecologic
  emergencies, and orthopedic emergencies

• Actively use practice-based data to improve patient care

Clinical Skills

Students will demonstrate the ability to:

• Perform assessment of the undifferentiated patient
• Efficiently perform a medical interview
• Perform a directed physical examination
• Initiate resuscitation and stabilization measures
• Correctly perform the following procedural techniques: intravenous line, ECG, foley catheter, splint sprain/fracture, suture laceration

• Develop an evaluation plan
• Develop a therapeutic plan
• Develop skills in disposition and follow-up of patients
• Demonstrate an availability to patients, families, and colleagues
• Acquire skills in breaking bad news and end of life care
• Use information technology to improve patient care
• Critically appraise medical literature and apply it to patient care

Professional Behavior

Students will demonstrate the ability to:

• Demonstrate dependability and responsibility
• Treat patients and families with respect and compassion
• Demonstrate an evidence-based approach to patient care based on current practice-based data
• Demonstrate professional and ethical behavior
• Work with other health care professions in a team-oriented approach
• Evaluate own performance through reflective learning
• Incorporate feedback into improvement activities

CORE TOPICS

The educational core identifies the basic set of clinical presentations, procedures, and educational topics that would be covered or experienced during the clerkship. There may be some variability in how this educational core is taught (reflecting the resources of each clinical site). However the principle teaching materials will be consistent across all training site.

Clinical experience.

Clinical experience in the ED is the foundation of all emergency medicine clerkships. The major portion of the clerkship should involve medical students participating in the care of patients in the ED under qualified supervision. Because of multiple factors, including the unpredictable nature of emergency medicine, clinical experience may be quite variable, even within a clerkship rotation. Certain presentations of ED patients that are common and to which all medical students would be uniformly exposed during their clinical experience based on a national curriculum are listed below.

1. Abdominal/pelvic pain
2. Alteration/loss of consciousness
3. Chest pain
4. Musculoskeletal/limb Injuries
5. Gastrointestinal bleeding
6. Headache
7. Pediatric emergencies
8. Respiratory distress
9. Resuscitation
10. Shock
11. Vaginal bleeding
12. Wound care

This list is not meant to identify the only types of patients a student will encounter or negate the importance of many other patient presentations.

Procedures.

Certain procedures to be taught under appropriate supervision during the emergency medicine rotation are listed below. Procedures were selected based on clinical relevance, level of student training, and availability within the ED.

1. Arterial blood gas and interpret pulse oximeter
2. ECG
3. Foley catheter placement
4. Interpretation of cardiac monitoring/rhythm strip
5. Nasogastric tube placement
6. Peripheral intravenous access
7. Splint application
8. Wound Care: laceration repair (simple), incision and drainage (abscess)
9. Venipuncture

The procedures listed here are derived from previous curricula, consensus opinion, and an informal evaluation of procedures currently performed on rotations. In recognition of the variation of what procedures might be available on clinical shifts, the use of labs, mannequins, direct observation, videotape presentations, and simulators is encouraged.

Essential Topics

Clinical experience cannot provide a student with every aspect of the curriculum, nor can one guarantee what clinical presentations a student will encounter. Therefore, a core knowledge base relevant to emergency medicine topics must also be taught. This list of essential topics is based on previously published curricula, the model curriculum for emergency medicine residencies, and consensus opinion. The topics are primarily organized by symptom complex or presenting complaint and are listed below. Although specific diseases are listed, a symptom-oriented approach to instruction is recommended. The rationale behind this approach is to emphasize the evaluation and treatment of patients with undifferentiated disease processes, which is fundamental to the practice of emergency medicine.

The relevant epidemiology, pathophysiology, medical history and physical examination findings, diagnostic and therapeutic interventions, and disposition should be addressed for each symptom complex or disease process.

The various educational venues used to teach these topics and procedures should ideally be complementary and may include lectures, bedside teaching, self-study materials, medical student-generated presentations, simulated encounters, direct observation, and laboratory workshops. The Department of Emergency Medicine will provide 12 “Essential Topic” PowerPoint Presentations to serve as the foundation for a didactic lecture series. Again, these lectures are not meant to be the only didactic presentations a student will encounter or negate the importance of other educational presentations.

READING

In order to maintain consistency in learning objectives, the Department of Emergency Medicine has developed a minimum standard with respect to student self-study. The following reading list covers many of the main topics of importance in emergency medicine and supplements our Essential Topics Lecture series.

 

Topic	Chapter (in Emergency Medicine: A Comprehensive Study Guide, 5th Ed. Tintinalli, et al.)
Abdominal Pain	68, 69
Airway	14,15
Chest Pain	45,46,47
Endocrine Emergencies	202,203,208
Musculoskeletal Injuries	259
Neurologic Emergencies	220,221
Pain Management	32,33
Pediatric Emergencies	110,120,122
Pregnancy	100,101
Respiratory/Allergy	30,58
Psychiatric Emergencies	280,281, 286, 287
Shock & Sepsis	26,27,28,29
Trauma	243
Toxicology	151

Addendum 1.  - Emergency Medicine Core Educational Topics/Clinical Conditions

 

Presenting Conditions (Approach to …)
Approach to …	Specific Disease Entities
Abdominal/pelvic pain	Aortic aneurysm
	Appendicitis
	Bowel obstruction
	Cholelithiasis/cholecystitis
	Diverticulitis
	Ectopic pregnancy
	Ovarian torsion
	Nephrolithiasis
	Testicular torsion
Alteration/loss of consciousness	Hypoglycemia
	Seizure
	Syncope
Chest pain	Acute coronary syndromes
	Aortic dissection
	Pneumothorax
	Pulmonary embolism
Environmental exposures	Burns (chemical, thermal)
	Envenomations (hymenoptera, Latrodectus, Crotalus)
	Hypothermia/hyperthermia
Eye pain, vision change	Acute angle closure glaucoma
	Trauma
	Retinal detachment
Gastrointestinal bleeding	Upper (peptic ulcer disease, variceal)
	Lower (diverticulosis, hemorrhoids, malignancy)
Headache	Mass lesions
	Meningitis
	Migraine
	Subarachnoid hemorrhage
Pediatric emergencies	Febrile infant
	Respiratory distress
	Abdominal pain
Poisoning/overdose	Anion gap metabolic acidosis
	Decontamination (activated charcoal)
	Specific poisonings/overdoses
	Acetaminophen
	Carbon monoxide
	Opioids
	Salicylates
	Tricyclic antidepressants
	Toxic alcohols (ethylene glycol, methanol)
Psychiatric	Psychosis
	Substance abuse
	Suicidal ideation or attempt
Respiratory distress	Airway obstruction
	Asthma/chronic obstructive pulmonary disease
	Heart failure
	Pneumonia
	Pulmonary embolism
Resuscitation	Basic airway management
	Basic airway maneuvers
	Airway adjuncts
	Bag-valve-mask ventilation
	First minute of a code
	Cardiopulmonary resuscitation
	Dysrhythmia identification/treatment
Shock	Anaphylactic
	Obstructive (pulmonary embolism, pericardial tamponade)
	Cardiogenic
	Hypovolemic
	Septic
Traumatic injuries	Abdomen (bowel, hepatic, splenic injuries)
	Chest (hemothorax, pneumothorax, tension pneumothorax)
	Extremities
	Dislocations
	Fractures
	Immobilization techniques (Splinting/Strapping)
	Head injuries (epi-/subdural hematomas)
	Neck/spine (cervical spine fractures, spinal cord damage)
	Pediatric non-accidental trauma/domestic violence
Vaginal bleeding	Abortion (threatened/ complete/incomplete/inevitable)
	Ectopic pregnancy
	Placenta previa
	Placental abruption
Weakness and dizziness	Cerebrovascular accident (embolic, hemorrhagic, thrombotic)
	Vertigo (benign positional vertigo, cerebellar hemorrhage)
Wound care	Irrigation
	Local anesthesia
	Primary closure
	Tetanus prophylaxis