Curriculum

Emergency Medicine Clerkship

Director: Stacey Poznanski, D.O., Instructor, Emergency Medicine

Clerkship Description: The Emergency Medicine Clerkship provides the medical student with an in-depth exposure to Emergency Medicine as a specialty and career choice. They will interact with a wide variety of undifferentiated patients and problems, with a goal of improving the students’ skill in acute care decision-making, a beneficial skill for all physicians. In addition to clinical duties, there is a reading and didactic component. Simulation exercises and small-group discussions/didactics comprise the majority of the educational curriculum, while reading assignments from supplemental materials complete the educational experience. The rotation responsibilities include participation in 130 hours of clinical encounters during the four-week rotation, attendance at four teaching/simulation sessions, attendance at one Resident Didactic Conference, and completion of a written examination and feedback instrument. 

Topics covered in the curriculum each month include but are not limited to:

  • Orientation
  • Introduction to Emergency Medicine, including the Approach to the Undifferentiated Patient Basic Airway techniques
  • Advanced airway techniques
  • Dysrhythmia recognition and management
  • Procedural instruction on thoracostomy, lumbar puncture, central line placement, and suturing.
  • Approach to a patient with Dyspnea, Chest Pain, Abdominal Pain, Altered Mental Status, Trauma, Shock, and Toxic Exposure. 

Students will also be exposed to topics of discussion that are within the core curriculum for emergency medicine residents. One-on-one preceptorship is provided by clinical faculty, emergency medicine residents and academic faculty, each uniquely suited to introduce the broad domain of emergency medicine. This guided activity provides experience with a wide variety of clinical problems and their management. There is active participation in patient care through preliminary workup and presentation to the preceptor, after the student has had the opportunity to formulate their provisional diagnosis and plan.

Boonshoft SOM Educational Objectives/Competencies

Code

What competencies / milestones will this unit address?  

Foundational Knowledge – Medical Knowledge: Master fundamental biomedical concepts, terms, processes, and system interactions

1.1A

Integrate knowledge of the expected changes in organ function in the care of critically ill patients as well as normal physiologic changes across the lifespan

1.1B

Explain the pathogenesis of major conditions related to area(s) of specialty/disciplinary interest

1.1C

Integrate knowledge of diagnostic testing into patient care using principles of evidence-based medicine

Foundational Knowledge – Medical Knowledge: Describe the determinants of health

1.2A

Describe the population-level factors related to the spread of disease and interventions to control spread

1.2B

Develop a treatment plan that considers the determinates, risk factors and protective factors to improve health

Foundational Knowledge – Medical Knowledge: Utilize evidence in making clinical decisions

1.3A 

Appraise and synthesize literature-based biomedical information to address diagnostic, prognostic and/or treatment questions in the clinical care setting

1.3B

Effectively explain to patients how the relevant medical literature applies to their care

1.3C

Determine applicability of literature findings to clinical scenarios by interpreting statistical analysis

Application – Patient Care (Clinical Skills): Conduct patient interviews and physical examinations

2.1A

Independently conduct a reliable history and physical and detect subtle physical exam findings

2.1B

Demonstrate the ability to interview challenging patients

Application – Patient Care (Clinical Skills): Diagnose patient health problems

2.2A

After considering the differential diagnosis, make an informed diagnosis, in a variety of patient settings (emergent, urgent and routine health care)

2.2B

Interpret results and prioritize next steps for appropriate diagnostic evaluation

Application – Patient Care (Clinical Skills): Propose evidence-based health maintenance and therapeutic treatments

2.3A

Apply knowledge of indications, contraindications and potential adverse reactions for a given therapeutic intervention, with attention to cost and quality for patient encounters in a variety of settings

2.3B

Provide patient education regarding prevention, diagnosis, treatment plan, informed consents, and health promotion

2.3C

Demonstrate the ability to perform basic medical procedures independently

Integration – System-Based Practice: Connect knowledge of patient populations and health delivery processes in making diagnoses and therapeutic recommendations

3.1A

Demonstrate an understanding of the clinical role of physicians in community level preparedness

3.1B

Evaluate population-based initiatives that can influence the health of patients and populations, reduce disparities, and/or increase equity 

3.1C

Refer patients to appropriate community resources as part of the treatment plan

Integration – System-Based Practice: Advocate for the humane, just, safe and prudent care of persons

3.2A

Discern when patient care is affected by ethical considerations and interact with the patient and health care team appropriately

3.2B

Incorporate contextual factors into patient treatment or end-of-life plan

3.2C

Implement a root cause analysis and propose steps to improve patient safety

Integration – System-Based Practice: Adapt to the complex economic and social structure of health care delivery

3.3A

Incorporate knowledge of health care systems into patient care

Human Dimension – Personal and Interpersonal Professional Development Goals: Reflect upon one’s personal strengths and weaknesses to make changes in one’s behavior

4.1A

Seek out, learn from and model the attitudes and behaviors of physicians who exemplify professional and ethical behaviors

Human Dimension – Personal and Interpersonal Professional Development Goals: Find one’s own meaning in medicine

4.2A

Identify connections between one’s own meaning in medicine and one’s role in health care 

Human Dimension – Personal and Interpersonal Professional Development Goals: Take care of oneself

4.3B

Model healthy self-care habits

4.3C

Model flexibility within the dynamic medical environment

Human Dimension – Personal and Interpersonal Professional Development Goals: Deliver effective patient presentations and document accurately in the medical record

4.4A

Adapt presentation of patient encounters to appropriate persons (consultants, families, etc.)

4.4B

Expand timely, focused, and prioritized documentation skills (consult reports, admission orders, prescriptions, plans, etc.)

Human Dimension – Personal and Interpersonal Professional Development Goals: Communicate and work effectively with others

4.5A

Model effective and collaborative communication skills

4.5B

Perform appropriate patient handoffs with all members of the health care team

4.5C

Communicate pertinent patient information in a succinct manner

Human Dimension – Personal and Interpersonal Professional Development Goals: Demonstrate leadership skills in a variety of settings

4.6A

Demonstrate a commitment to collaborative skills in a dynamic team-based environment 

Caring/Valuing – Professionalism Goals: Value and behave in a manner consistent with the highest ethical standards of the profession

5.3A

Demonstrate leadership in improving the ethical standards of the profession and the community

5.3B

Demonstrate commitment to human dignity, social justice, and the common good

Learning How to Learn – Practice-Based Learning:Appropriately utilize evidence-based resources to address uncertainty in medicine and gaps in knowledge/skills

6.3A

Utilize appropriate resources to address uncertainty in medicine and gaps in knowledge/skills

Clerkship-Level Objectives

Code

What are the clerkship-level objectives for this course?  

Boonshoft SOM Objectives

LO1

Frame a patient encounter in an organized fashion, reinforcing etiology, pathophysiology, clinical manifestations, diagnostic strategies and therapeutic interventions.

1.1abc, 2.1a

LO2

Explain disease specific treatment strategies and associated prognosis and complications.

1.1abc, 2.1b

LO3

Evaluate and manage patients’ presenting clinical problems, including: (abdominal pain; altered mental Status; chest pain; neurologic complaints (e.g. dizziness, weakness); acute intoxication, overdose or withdrawal; dyspnea; extremity injury; gastrointestinal complaint; headache; obstetric or gynecologic complaint, or major trauma.

1.1ab, 2.1a

LO4

Develop a hierarchy of differential diagnoses based on the initial patient presentation to include the most likely and most threatening.  

1.1ab, 2.1ab, 2.2ab

LO5

Recognize immediate life-threatening illnesses.

1.1ab, 2.1ab, 2.2ab

LO6

Apply the fundamentals of adult care to coordinate the care of acutely ill patients

1.1ab

LO7

Demonstrate a systematic, yet focused, approach to undifferentiated patients utilizing sound skills in gathering and synthesizing components of the history and physical exam.

2.1ab, 4.4a

LO8

Demonstrate appropriate ordering and interpretation of common diagnostic tests and procedures as part of an evaluation and management plan.

2.2b

LO9

Formulate diagnostic reasoning, and justify therapeutic decision-making.

1.3abc, 2.2ab, 2.3ab

LO10

Monitor the response to therapeutic interventions with frequent reassessment of patients.

2.3a

LO11

Develop a disposition plan for patients to include education and ensured comprehension of an outpatient treatment plan.

2.3ab

LO12

Demonstrate clear and concise oral presentations and written documentation reflecting a systematic approach to adult patients.

2.1ab, 4.4ab

LO13

Apply the indications and contraindications for basic procedural skills.

2.3c

LO14

Perform basic procedural skills (e.g. attach a cardiac monitor and pulse oximeter; obtain a 12-lead ECG; basic airway maneuvers; place intravenous line and start IV fluid infusion; suture placement).

2.3c

LO15

Identify the social determinants of health for a specific patient, and develop a plan to coordinate care to include community resources to try to improve the health of the individual.

1.2ab, 3.1abc, 3.2abc

LO16

Consider patient, physician, and system barriers to successfully negotiate treatment plans and patient adherence; and identify strategies that may be used to overcome these barriers.

1.2b, 3.1bc, 3.2abc

LO17

Identify the role of each team member to the care of the patient, and call on interdisciplinary resources to provide optimal and comprehensive care.

3.3a, 4.5bc, 4.6a

LO18

Establish professional relationships and effectively communicate with patients, their families, instructors, colleagues and staff.

4.1a, 4.3c, 4.5abc, 4.6a

LO19

Work effectively with the broad, interdisciplinary team in patient care and appropriately incorporate their unique care skills.

4.1a, 4.3c, 4.5b, 4.6a

LO20

Demonstrate the ability to act with honesty/integrity and compassion while maintaining ethical duties and a nonjudgmental approach to patients and others.

5.3ab

LO21

Demonstrate the ability to act in a manner that is dependable, dedicated and punctual, while maintaining a professional appearance.

5.3a

LO22

Demonstrate the ability to act with patience, altruism and equanimity, with sensitivity to cultural issues.

4.1a, 4.6c

LO23

Recognize when additional information is needed to care for the patient and demonstrate ongoing commitment to self-directed learning.

6.3a

LO24

Demonstrate effective skills in navigating the medical literature and available information technology to answer clinical care questions.

6.3a

LO25

Demonstrate the ability to acquire and soundly manage knowledge, identify knowledge deficiencies and create a plan for knowledge gains

4.2a, 6.3a

LO26

Demonstrate the ability to seek out and listen to feedback on performance, accept it positively, and respond to it constructively by improving performance.

4.5a, 4.3bc, 4.1a

To review all Boonshoft SOM Educational Milestones please visit the Educational Milestones page.

Required Clinical Experiences

Clerkship/Clinical discipline

Patient type/Clinical condition

Procedures/Skills

Clinical setting

Level of student responsibility

Emergency Medicine

Neurocognitive Disorders

 

Emergency Dept. 

Full Participation

Emergency Medicine

Chronic Respiratory Illness

 

Emergency Dept. 

Full

Emergency Medicine

Psychiatric Condition

 

Emergency Dept. 

Full

Emergency Medicine

Diabetes

 

Emergency Dept. 

Full

Emergency Medicine

Cardiovascular disease

 

Emergency Dept. 

Full

Emergency Medicine

Infection

 

Emergency Dept. 

Full

Emergency Medicine

Toxicological Condition (e.g. intentional or unintentional overdose)

 

Emergency Dept. 

Full

Emergency Medicine

Abdominal pain

 

Emergency Dept. 

Full

Emergency Medicine

Acute Neurologic condition

 

Emergency Dept. 

Full

Emergency Medicine

Major Trauma Resuscitation 

 

Emergency Dept. 

Moderate Participation

Emergency Medicine

Headache

 

Emergency Dept. 

Full

Emergency Medicine

Obstetrical or gynecologic condition

 

Emergency Dept. 

Full

Emergency Medicine

Geriatric

 

Emergency Dept. 

Full

Emergency Medicine

Pediatric

 

Emergency Dept. 

Full

Emergency Medicine

Extremity Injury

 

Emergency Dept. 

Full

Emergency Medicine

Critical Care

 

Emergency Dept. 

Moderate

Emergency Medicine

 

Attach cardiac monitor/pulse oximeter

Emergency Dept. 

Fully performed the procedure

Emergency Medicine

 

Obtain 12 lead ECG

Emergency Dept. 

Fully performed 

Emergency Medicine

 

Perform basic airway maneuvers

Emergency Dept. 

Fully performed 

Emergency Medicine

 

Peripheral IV line placement

Emergency Dept. 

Fully performed 

Emergency Medicine

 

Suture placement

Emergency Dept. 

Fully performed 

 

Observation: Student is observing encounter

Moderate Participation: Student completes the History and Physical (either complete or focused) and participates in the differential diagnosis. (*Student directly interacts with the patient)

Full Participation: Student completes History and Physical (either complete or focused), participates in the differential diagnosis, and then completes a therapeutic treatment plan, which can include documentation.

For Procedures:

            Observation

            Assisted in the procedure

            Fully performed the procedure

 

Last edited on 07/12/2018.