Emergency Medicine Clerkship

Director: Brian Springer, M.D., Associate Professor, Emergency Medicine

Clerkship Description: EMD 8400 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 are simulation sessions and procedure skills instruction. The curriculum includes reading assignments and supplemental materials from online sources to complete the educational experience. The rotation responsibilities include eleven 9-hour shifts, five teaching/simulation sessions, attendance at weekly Resident Didactic Conferences and a passing score for the SAEM national exam.

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

Introduction to Emergency Medicine & ACLS Principles
Dysrhythmia recognition and management
Procedural instruction on thoracostomy, central line placement and advanced airway techniques
High-fidelity simulations cases to include approach to the 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 03/30/2020.

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Emergency Medicine Clerkship

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Clerkship-Level Objectives

Required Clinical Experiences

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