Department of Emergency Medicine Wayne State University School of Medicine 2007-2008
GUIDELINES FOR SENIOR MEDICAL STUDENTS Emergency Medicine Rotation Wayne State University Department of Emergency Medicine Welcome to your senior rotation in Emergency Medicine! The faculty and staff from the various departments of Emergency Medicine assure you that this will be an exciting educational experience. You will have the unique opportunity of being exposed to many different acute care situations and will be actively involved in the clinical care of patients. Below you will find a list of the site coordinators and their email addresses. They are to be contacted for any problems you may encounter during the rotation and will be responsible for coordinating your clinical experience. Detroit Receiving Hospital 313-993-2530 Lawrence Schwartz, MD Sarkis Kouyoumjian, MD Chandra Carter lschwart@med.wayne.edu skouyoum@hotmail.com chandracarter@med.wayne.edu Children's Hospital of Michigan 313-745-5260 Usha Sethuraman, MD Chandra Carter usethu@dmc.org chandracarter@med.wayne.edu Grace Hospital 313-966-1020 William Lusk, DO Gretchen Brownlow (administrator) docdbl@comcast.net gbrownlo@dmc.org St. John Hospital 313-343-8797 Curt Wimmer, MD Lisa Ware (Secretary) curt.wimmer@stjohn.org lisa.ware@stjohn.org Beaumont Hospital 248-898-2015 Colette Wyte, MD Doreen Marquis (Secretary) cjwyte@aol.com dmarquis@beaumont.edu
Emergency Medicine Clerkship Objectives of the Rotation: 1) The student will become familiar with the initial evaluation, assessment and stabilization of patients who present with urgent and emergent medical and traumatic conditions. 2) The student will play an active role in managing acutely ill patients in a timely manner, following the emergency department course, and deciding on an appropriate disposition. 3) Students will become exposed to and expected to perform a variety of invasive and noninvasive procedures that are done in the emergency department. Examples include but are not limited to arterial lines, arterial punctures, central lines, suturing, chest tubes, resuscitation skills, lumbar punctures, IV lines, nasogastric tubes, Foley catheters, airway management, and medical and trauma resuscitation codes. 4) The senior student will practice his/her history and physical exam skills, the formulation of a differential diagnosis, work up and treatment plan 5) Students will become familiar with the overall organization of the emergency department and work closely with ancillary personnel. 6) By attending the weekly didactic sessions, the student will enhance his/her medical knowledge base on specific topics that will be discussed during the rotation and apply this knowledge to actual patient care. 7) The student will finish the rotation a more competent, confident student physician, prepared for his/her internship. Methods of Achieving the Objective Goals: 1) The senior student will function as a sub-intern in the Emergency Department with responsibility for the initial evaluation of assigned patients, history and physical exam, formulating a differential diagnosis, treatment plan, and disposition. The student will perform these duties under the direct supervision of either the attending physician or the senior emergency medicine resident. 2) Students must attend the orientation session at the beginning of the rotation to gain the basic information needed to begin the rotation and function properly in their assigned areas. 3) All students will be expected to perform the following procedures on their patients: a) radial artery puncture for blood gases (2) b) IV line/saline lock (5) c) Foley catheter insertion (2) d) laceration repair (5) There will be a review of these procedures during orientation. If these procedures and numbers are not completed during the clerkship, the student will meet with the clerkship director and schedule time to do those missing procedures on a mannequin. A procedure day, if needed, can be done during a shift. 4) Students must attend the senior medical student facilitated discussion series that is held each Thursday afternoon usually in the Crockett Center at Detroit Receiving Hospital/University Health Center. Students are strongly encouraged to attend the scheduled departmental Grand Rounds at their assigned hospital site. Detroit Receiving Hospital and Sinai-Grace Hospital Department of Emergency Medicine Conference Series are held on Thursdays, 7 am 12:00 noon. Beaumont Hospital has its departmental conferences on Thursdays from 9A-12N. St. John Hospital has its conference series scheduled on Wednesdays, 12N-5P. There will be a sign-in sheet. Attendance at the Thursday afternoon student conferences is mandatory for the student to receive a passing grade
in Emergency Medicine. Attendance at all departmental conference series is mandatory for consideration for an Honors grade. Evaluation Process: Clinical Students are evaluated by emergency medicine residents and staff attending physicians with whom they have worked during the month. Criteria utilized to evaluate a student's clinical performance include the following: - Case presentations - Procedural skills - History and physical exam skills - Dependability - Patient interpersonal skills - Professional qualities - Application of knowledge in the clinical setting - Attendance and participation at conferences - Ability to formulate a differential diagnosis - Proper utilization of diagnostic studies - Medical knowledge base - Ability to develop an adequate therapeutic plan Patient Encounter and Procedure Logs Paper, Blackboard, and PDA Students are required to document all patient encounters and procedures. There is a small paper workbook where you can record your patient data that you will need to have signed by the attending physician daily. The total number of patients seen and procedures performed needs to be entered onto the electronic logbook on Blackboard. The electronic logbook, the paper logbook, and the PDA entries must all be completed on the day of the final exam. You need to sync the following cases on your PDA: Abdominal Pain Chest Pain Respiratory Distress Medical Code Trauma Code Any eyes, ears, nose, or throat case Musculoskeletal case Neurological case Pediatric case Traumatic injury case (not a trauma code) Final Examination There will be a final examination. A minimum score of 70% must be obtained to receive a satisfactory grade for the rotation. An unsatisfactory grade will be turned into the medical school for anyone who does not pass the final examination. A student will be allowed to retake the exam one time only, during the following month. The student's grade will be changed to an S with comments, if the final examination is then passed. The comments noting that the student passed after repeating the final exam. A minimum score of 85% on the final examination must be obtained for the student to be considered for an honors grade. OSCE Examination There will be an OSCE on the final exam day. Unsatisfactory performance on the OSCE will require remediation. Attendance Attendance at orientation, assigned shifts and student conferences is mandatory! Students will sign in for all shifts and conferences. Failure to sign in will be interpreted as an absence. Excused absences from assigned shifts and conferences will result in an incomplete grade being sent to the medical school. This will be changed
to a satisfactory or honors grade, if earned, when the missed shifts and/or conferences are made up. Unexcused absences will result in an unsatisfactory grade being sent in to the medical school. The grade will be changed to an S with comments when the deficiencies are made up. The comments will note that the student received a satisfactory grade after making up deficiencies. The following grading guidelines have been established. 1. Honors Final exam score of 85% or higher; clinical evaluation of exceeds expectation in 8 out of 11categories consistent with previous required clerkships. Categories 1-5, noted by the ** must be rated outstanding. There must be 100% attendance at all shifts and conferences, morning and afternoon. All evaluations and the PDA log must be completed and turned in on the day of the final exam. 2. Satisfactory Passing score on final exam (70%); a satisfactory clinical evaluation (meets expectations); 100% attendance at all shifts and Thursday afternoon student conferences. 3. Incomplete Excused absences of clinical shifts or afternoon conferences. These must be made up within 2 months. An Incomplete becomes a Satisfactory or even Honors when the deficiencies are made up. If not made up within 2 months an unsatisfactory (U) grade will be submitted to records and registration at the School of Medicine. 4. Unsatisfactory Failed final exam, excused missed shifts or conferences not made up within 2 months, or unexcused absences from shifts or mandatory conferences. An Unsatisfactory becomes a Satisfactory with comments * upon making up the missing shift(s) or conference(s); or upon passing the final exam, which MUST be done within 2 months. The comment notes that the student passed the course but that there was a deficiency that had to be made up. Failure to complete any outstanding obligations within 2 months of the end of the rotation will result in an Unsatisfactory grade. This includes, but is not limited to, shifts, conferences, evaluations, log completion or a make-up of a failed final exam. Student Evaluation Forms Each student will receive 8 evaluation forms. He/she is responsible for giving 1 form to an EM attending physician and 1 form to an emergency medicine resident each week. There is also a Midclerkship Evaluation Form that needs to be filled out after 2 weeks of the clerkship. Review this evaluation with a faculty member and submit it to your site director after review by placing it the collection box in an envelope along with the regular evaluations. If you wish to review the midterm evaluation with Dr. Schwartz, Kouyoumjian or your site director, email him/her at that time. Course Evaluations There is a site specific evaluation form on Blackboard. We request your feedback and always find it helpful for making improvements in the clerkship. There is a WSUSOM evaluation on the PDA that is required by the School of Medicine prior to graduation. It is strongly suggested that you fill it out both evaluations during the last week of the month.