1. Mission and Introduction
The Emergency Medicine rotation provides students with the knowledge, clinical skills, and professional behaviors necessary to care for patients presenting with a broad range of undifferentiated urgent and emergent conditions. The rotation enables students to develop and demonstrate the core competencies required to function effectively as members of the emergency department healthcare team.
The objectives may be taught and evaluated through clinical bedside teaching, observed structured clinical evaluation, lectures, problem-based learning, self-directed study, and simulation.
2. Guidelines
- Length: 4–6 weeks
- Site: Emergency Department
- At the beginning of the rotation, the clerkship director provides an orientation addressing the expectations and responsibilities of students, the general organization of the department, and student schedule and assignments to residency teams and preceptors.
- Before beginning the rotation, students must access the corresponding online Emergency Medicine course in the learning management system. This course includes an introduction by the SOM Chair of Emergency Medicine, the rotation curriculum, and required web-based assignments.
- Students should be exposed to undifferentiated patient complaints across all age groups, including pediatric, adult, and elderly patients.
- Teaching rounds for house staff and students should be conducted at least once daily.
- A full schedule of teaching conferences should be available, including grand rounds, residency conferences, and scheduled didactic sessions specific to the needs of students.
- Clinical faculty must provide direct supervision of students during physical examinations, case presentations, and clinical procedures.
- All clinical write-ups or formal presentations must include a focused history and physical examination, a problem list with assessment, and a diagnostic and therapeutic plan.
- Clinical faculty evaluate oral presentation skills, including transitions of care, and provide an objective assessment of competency in communication.
3. Educational Objectives
- Identify the acutely ill patient
- Suggest the appropriate interpretation of tests and imaging data
- Develop a differential diagnosis, which includes possible life- or limb-threatening conditions, along with the most probable diagnoses
- Describe an initial approach to patients with the following ED presentations: 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
- Perform assessment of the undifferentiated patient
- Gather a history and perform a physical examination (EPA 1)
- Recognize a patient requiring urgent or emergent care and initiate evaluation and management (EPA 10)
- Prioritize a differential diagnosis following a clinical encounter (EPA 2)
- Recommend and interpret common diagnostic and screening tests (EPA 3)
- Perform general procedures of a physician (EPA 12)
- Correctly perform the following procedural techniques: CPR, intravenous line and phlebotomy, ECG, Foley catheter, splint sprain or fracture, suture laceration. Enter procedures in the Patient Encounter Log (under Procedures)
- Provide an oral presentation of a clinical encounter (EPA 6)
- Develop skills in disposition and follow-up of patients
- Demonstrate accessibility to patients, families, and colleagues
- Communicate effectively and sensitively with patients, families, and healthcare teams in verbal and written presentations
- Acquire skills in breaking bad news and end-of-life care
- Develop skills in giving and receiving safe patient handoffs and transition of care (EPA 8)
- Form clinical questions and use information technology to advance patient care (EPA 7)
- Critically appraise medical literature and apply it to patient care
Professional Behavior
- Demonstrate dependability and responsibility
- Demonstrate compassion, empathy, and respect toward patients and families, including respect for the patient’s modesty, privacy, confidentiality, and cultural beliefs
- Demonstrate an evidence-based approach to patient care based on current practice-based data
- Demonstrate professional and ethical behavior
- Collaborate as a member of an interprofessional team (EPA 9)
- Evaluate own performance through reflective learning
- Incorporate feedback into improvement activities
- Be aware of their own limitations and seek supervision and/or consultation when appropriate
4. Core Topics
The educational core identifies the basic set of clinical presentations, procedures, and educational topics that should 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 principal teaching materials are consistent across all training sites. The various educational venues used to teach these topics and procedures should be complementary and may include lectures, bedside teaching, self-study materials, medical student presentations, simulated encounters, direct observation, and laboratory workshops.
The Department of Emergency Medicine provides 12 “Essential Topic” PowerPoint Presentations to serve as the foundation for a didactic lecture series. These lectures are not meant to be the only didactic presentations students encounter or to negate the importance of other educational presentations.
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. The clinical experience should provide the student with the opportunity to evaluate patients across the age and gender spectrum.
Because of multiple factors, including the unpredictable nature of emergency medicine, clinical experience may vary considerably, even within a single clerkship rotation. Certain ED patient presentations are common. Based on a national curriculum, all medical students should have exposure to the following during their clinical rotations:
- Abdominal/pelvic pain
- Altered mental status/loss of consciousness
- Back pain
- CVA/stroke
- Chest pain
- Fever/SIRS/sepsis
- Gastrointestinal bleeding
- Geriatric emergencies
- Headache
- Respiratory distress
- Shock/resuscitation
- Obstetric and gynecological emergencies
- Trauma/musculoskeletal/limb injuries
- Wound care
This list is not meant to identify the only types of patients a student will encounter or to negate the importance of many other patient presentations.
Procedures
Procedures that should 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.
- Pulse oximetry and arterial blood gas interpretation
- ECG
- Foley catheter placement
- Interpretation of cardiac monitoring/rhythm strip
- Nasogastric tube placement
- Peripheral intravenous access
- Splint application
- Wound Care: simple laceration repair and incision and drainage of an abscess
- Venipuncture
The procedures listed here are derived from previous curricula, consensus opinion, and an informal evaluation of procedures currently performed during rotations. In recognition of the variation in the procedures available during clinical shifts, the use of laboratories, mannequins, direct observation, video presentations, and simulators is encouraged.
5.WEB-BASED EDUCATIONAL ASSIGNMENTS FOR INDEPENDENT LEARNING
- Clerkship Directors in Emergency Medicine (CDEM) Course
- Communication Modules
- Ethics Modules
Clinical experience cannot expose every student to all aspects of the Emergency Medicine curriculum or ensure that each student encounters the same clinical presentations. Therefore, the clinical experience is supplemented by a core knowledge curriculum addressing essential emergency medicine topics. These topics are based on published curricula, the model curriculum for emergency medicine residency training, and expert consensus.
To promote consistency in learning objectives and required content, the Department of Emergency Medicine has established minimum self-study requirements. The web-based curriculum uses online reading assignments, simulated patient encounters, and assessments of medical knowledge in a self-directed learning environment. Students must complete all required lesson modules in the CDEM Course in the learning management system.
| Module | Topic | Content sections: |
|---|---|---|
| 1 | Introduction | Orientation Presentation The Approach to the Undifferentiated Patient |
| 2 | Cardiac Arrest | Assigned Reading Examination |
| 3 | Chest Pain | Assigned Reading Simulated Patient Encounter Examination |
| 4 | Pulmonary Emergencies and Respiratory Distress | Assigned Reading Simulated Patient Encounter Examination |
| 5 | Abdominal & GU Emergencies | Assigned Reading Simulated Patient Encounter Examination |
| 6 | Neurologic Emergencies | Assigned Reading Simulated Patient Encounter Examination |
| 7 | Critical Care | Assigned Reading Simulated Patient Encounter Examination |
| 8 | Poisoning and Environmental Emergencies | Assigned Reading Simulated Patient Encounter Examination |
| 9 | Trauma | Assigned Reading Simulated Patient Encounter Examination |
| 10 | Emergency Care of the Elderly | Assigned Reading Simulated Patient Encounter Examination |
Each lesson module includes a multiple-choice quiz that assesses students' understanding of the assigned readings and simulated patient encounters. Students must earn a score of 100% to pass the lesson module. Ethics and Communication Skills modules are evaluated independently. Students must complete the required Communication Skills modules and associated quizzes in the learning management system.