Texas A&M Health Science Center College of Medicine Emergency Medicine Clerkship Scott & White Memorial Hospital Welcome to the Scott & White Memorial Hospital Emergency Department and your fourth-year clerkship in Emergency Medicine. Approximately 60,000 patients per year are seen in our Emergency Department, and Scott & White s role as a tertiary referral center as well as Level 1 Trauma Center provides a higher than average patient acuity than might otherwise be expected based on our volume. Your rotation in the ED should provide ample opportunity to learn basic principles of the diagnosis and stabilization of the acutely ill and injured, which will be applicable to any field of medicine you may wish to pursue. This handout is designed to explain basic components of the rotation and help maximize your learning experience. Orientation Orientation is typically held at 9 a.m. on Mondays, immediately following the computer orientation required for non-a&m medical students. Please meet Carla Owens (clerkship coordinator) in the Ben H. Chlapek Emergency Medicine Suite (S037). This orientation packet, the shift schedule, and a departmental tour will be provided. If you have any questions during your rotation, please contact Carla Owens (cjowens@swmail.sw.org; phone (254) 724-1068) or Dr. Trey Morris (clerkship director; jamorris@swmail.sw.org). Our department is divided into three pods, with varying numbers of rooms. Each pod has two major resuscitation bays (A1, A2, B1, B2, C1, and C2). Rooms 1-8 in each pod are anticipated to be open 24 hours, with additional rooms in each pod opened for the majority of the day contingent on staffing and anticipated patient demand. Upper-level residents work 12 hour shifts, with A and B pod shifts running from 6a-6p and 6p-6a, and C pod shifts beginning at various times. Goals and Objectives At the end of the rotation, the student will: Better appreciate the role of emergency medicine within the healthcare system Acquire basic life support skills, including the recognition of immediately lifethreatening conditions and appropriate interventions Diagnose and treat common acute problems Develop skills to assess the undifferentiated patient, including the performance of a focused history and physical and the development of an appropriate differential diagnosis
The above goals will be accomplished through the performance of the following core competency-based objectives: Patient care Obtain an accurate history and physical Recognize immediately life-threatening illnesses Patient management skills Procedural skills Health promotion Medical knowledge Develop the skills to evaluate an undifferentiated patient Develop a differential diagnosis Develop management plan for common ED complaints Interpret common diagnostic tests and procedures Learn key concepts within the educational core Practice-based learning Effectively use available technology to improve patient care Interpersonal and communication skills Effectively communicate with patients and family members Work in a collegial manner with all members of the health care team Demonstrate competency in presentation skills Complete documentation Professionalism Work ethic Practice ethical decision-making Demonstrate sensitivity to cultural issues Systems-based practice Make an appropriate referral from the ED Describe the role of emergency medicine in the community Demonstrate awareness of medication and treatment costs
Clinical Shifts You are expected to work a total of 16 eight-hour shifts over your four-week rotation. These shifts are distributed across morning, afternoon, evening, and night shifts, and correspond to the senior resident scheduled in each pod. Shift work is an integral and at times unpleasant feature of Emergency Medicine. Every effort has been made to avoid isolated shifts and provide a circadian-friendly schedule progression. You are welcome to trade shifts amongst yourselves, with the caveat that you may not work more than 7 days in a row, you may not work consecutive shifts ( pull a double ), and must be free of clinical/educational duties for at least 8 hours prior to your shift (e.g., you may not work 10p-6a, attend Thursday conference, and then work 2p- 10p). You are excused from your shifts for clerkship labs and lectures and for the weekly resident conference, held on Thursdays from 7a-12p. If you need to reschedule or otherwise change one of your shifts, please let Carla know as soon as possible. Unexcused absence from a clinical shift may result in a failing grade for the rotation. The shift evaluation cards (see below) serve as a simple way to ensure that you receive credit for your clinical shift. Required Reading You will be provided a copy of An Introduction to Clinical Emergency Medicine, by Mahadevan and Garmel. Although the reading requirement may appear daunting at first, it is an average of approximately 10-15 pages per day, and if you stay up on the reading the amount of material is not prohibitive. At least 90% of the exam questions will be taken from the assigned reading. Lectures Lectures on topics relevant to the practice of emergency medicine will be given by the administrative resident or a faculty member weekly (see attached schedule). This is in addition to lectures presented as part of the resident conference on Thursdays. In addition, each week there will be a procedure lab covering important skills (suturing, splinting, resuscitation, etc.). Attendance at lecture and lab sessions is mandatory; however, if you are scheduled to work the night before and after clerkship lectures, you are excused. If you need to miss a lecture or conference for any other reason (illness, residency interviews, etc.) please notify Carla as soon as possible. A suture lab will be held on Mondays at 10 am with the administrative resident; please contact Carla for further details. Exam Either during or immediately after the Thursday resident conference during your last week of the rotation, you are expected to complete a 50-question, multiple-choice exam which will cover material from the assigned readings. The test is closed-book and should take approximately 1 hour to complete. If you are unable to complete the test on the designated day, please notify Carla Owens to reschedule as soon as possible.
Dress Code While on duty, students may wear scrubs or other appropriate professional dress. Name badges should be worn at all times while in the department. Attire for conferences is typically more relaxed; if you have any questions, feel free to ask any of the residents and when in doubt, err on the side of caution. Clinical Duties At the start of each shift, report to the senior resident in your assigned pod. The resident will assign you a patient, whom you should assess. Perform a focused history and physical exam, then discuss your findings and develop a plan with the resident. If at any point you believe the patient s condition is such that immediate intervention is required, alert the resident or attending before proceeding further. After discussing the patient with the resident or staff, it is important to follow up on any labs or diagnostic imaging studies you may obtain as well as to reevaluate your patient frequently. The more pro-active you are in picking up patients, the more learning opportunities you will have, including opportunities to practice various procedural skills. However, your role is not to perform an H&P and then abdicate care of the patient; you should be involved in the patient s care from initial assessment to disposition. Do not attempt to carry more patients than you can comfortably manage (three patients at a time is a maximum, and you should not expect to start out managing three comfortably). Medical students may document on the SmartNote templates only if expressly instructed to do so by their supervising physician. However, you are encouraged to write out a brief H&P for review by your supervising physician. You may complete prescriptions, referrals, and other forms for review and signing by your supervising physician; make sure to sign any documentation you complete and leave a space for your supervisor to co-sign. Procedures You may help with or perform all procedures done on your patients under appropriate supervision. You will receive a procedure list detailing nine procedures you are expected to be able to perform competently by the conclusion of your rotation; other procedures such as thoracostomy, central venous access, abscess I&D, and lumbar puncture may also be performed if indicated. Please have the individual supervising you sign and date that you have observed one and successfully completed two of each procedure prior to completion of the rotation. Evaluation At the conclusion of each shift, please ask the senior resident or faculty with whom you have worked most frequently on that shift to complete a shift evaluation card. The supervising faculty/resident may choose to review your performance with you at this time and return the card or deposit the card in the labeled box themselves. If they choose to return the card to you, please
remember to deposit it in the box before you leave. These shift evaluations will comprise the bulk of your clinical evaluation. It is important that you schedule a time approximately half-way through the rotation to meet with the clerkship director for feedback regarding your performance, and so that you may address any concerns you might have with the rotation. Call the clerkship coordinator (724-0884) or email Dr. Morris (jamorris@swmail.sw.org) to set up a time for this meeting. The final course grade will be composed of the following: Clinical Performance (40%) based on evaluations and comments from faculty and residents Clerkship Exam (40%) based on assigned readings and lectures Procedure log (10%) submission of a completed log demonstrating competency in each procedure as well as the suture lab check-list Attendance (10%) attendance at all clinical shifts, resident conferences, and weekly lab/lectures A grade of Honors will be awarded to students who demonstrate a clearly superior performance reflecting a comprehensive achievement of the knowledge, skills, attitudes, and behaviors outlined in the course goals and competencies. It is anticipated that no more than 5-10% of students will obtain this level of performance. Exit Requirements Please take the opportunity to let us know how this rotation may be improved by completing the course evaluation and returning it to the clerkship coordinator. You will also need to return your textbook and completed procedure log in order to receive credit. If you are interested in learning more about pursuing a career in emergency medicine or our residency program in particular, please let us know. Questions regarding scheduling an interview during your rotation should be addressed to Dr. Stallard (program director) or Cindy Rush (program administrator, crush@swmail.sw.org). Revised: June 18, 2010