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4 week block rotation PGY3 under the supervision of Dr. Bradley Weir in emergency medical care, including Level 1 Trauma.
Demonstrate rapid assessment and initial management of medical and surgical emergencies. Demonstrate procedures for treatment of major and minor trauma. Diagnose and treat minor acute illnesses on first-contact, improving competency in an ambulatory setting. Carle ED Rotation Rules are required reading for the rotation.
II. OBJECTIVES
A. PATIENT CARE
Objective 1: Classify and prioritize patients according to severity and emergent nature of illness.
Objective 2: Demonstrate appropriate emergency medical evaluation in the performance of a comprehensive interview and physical examination, including functional assessment and mental status as needed, and initiation of patient care.
Objective 3: Demonstrate principles of pain management, including proactive treatment.
Objective 4: Perform and record procedures
Procedure Skills : The resident is expected to perform and become adept at the following procedural skills including understanding of indications, contraindications and techniques
Objective 5: Observe Universal Precautions at all times.
Objective 1: Demonstrate principles of pain management, including proactive treatment.
Objective 2: Demonstrate and evaluate a pharmacotherapeutic approach, including objectives and options, selection of dose and parameters, and measurement of response and outcome.
Objective 3: Triage medical emergencies and assimilate knowledge of patient condition to initiate patient care and consultation as indicated.
Objective 4: Recognize and manage the following medical emergencies
C. PRACTICE-BASED LEARNING AND IMPROVEMENT
Objective 1: Evaluate patients with medical emergencies and formulate an appropriate, cost-effective diagnostic and therapeutic plan.
Objective 2: Demonstrate ability in medical decision making, which incorporates medical assessment and patient values and preferences.
Objective 3: Demonstrate evidence-based practice through appraisal and assimilation of scientific information, e.g. scientific journals, related to patient care.
D. INTERPERSONAL AND COMMUNICATION SKILLS
Objective 1: Create an atmosphere of positive regard for the patient and family to promote the best medical outcome through accessibility, affability and assurance of care continuity.
Objective 2: Incorporate psychosocial and ethical concerns of the patient and family in the development of the care management plan.
Objective 3: Dictate timely, comprehensive patient care notes, including admission summaries, and write thorough, succinct progress notes in accepted format.
Objective 1: Demonstrate humane and compassionate use of medical skills to include high-quality care and technology, and an awareness of the limits of medical intervention.
Objective 2: Actively participate in the multidisciplinary approach to caring for patients, including appropriate recognition of other health professional and paraprofessionals’ roles and demonstrate competence in team interactions, i.e. paramedics, pharmacists, physician’s assistant, advanced practice nurses, nurses, social workers, and chaplains.
Objective 3: Recognize the documentation and legal requirements of informed consent, and advanced directives with understanding of the process of assessing patients’ advance directives, including the patient’s perspective.
Objective 4: Model appropriate professional attitudes and behaviors of time management and punctuality, reliability, peer support, objective peer evaluation, community teaching, and ethical behavior.
Objective 1: Evaluate patients with medical emergencies and formulate an appropriate, cost-effective diagnostic and therapeutic plan.
Objective 2: Demonstrate knowledge of emergency medicine delivery systems within the department, the hospital, and in the community.
Objective 3: Facilitate continuity of care of patients admitted to the hospital, including communication and collaboration with patients’ families, attending and consulting physicians, paramedics, pharmacists, physician’s assistants, advanced practice nurses, nurses, hospital support staff, technicians, social workers and chaplains.
Objective 4: Recognize financial issues of health care, with consideration of cost containment and emphasis on understanding acute and chronic care, and medication coverage and the role of the Center for Medicare and Medicaid Services (CMS), and other third party payers.
Objective 5: Demonstrate understanding of special needs, e.g. athletic injuries and workers compensation.
III. METHODS
The Emergency Medicine rotation is a PGY 3 four-week training experience in the Emergency Department, Carle Foundation Hospital. Responsibilities are to the education rotation, excluding one half day per week at Continuity Clinic, and one half day per week at core conference. Refer to Carle Emergency Department Rules for specifics.
Residents train with direct supervision by a number of emergency medicine physicians. The residents perform the initial history and physical examination, and present findings and available laboratory data. After review of patient data and pertinent teaching points, the resident and attending complete the patient encounter together. Selected components of the examination may be repeated and demonstrated to the resident. Residents are responsible for documenting the patient encounter with a written or dictated note.
Daily Management Experience: Residents have first contact patient responsibility for 10 patients of varying acuity. History and physical examinations findings; treatment outlines and patient management plans are immediately reviewed by emergency department attendings. A board-certified emergency medicine attending is always physically present. Residents contact consultants as needed.
Teaching Rounds: Case-oriented teaching rounds are conducted as each case is staffed. Rounds include interesting emergency and/or ambulatory patients. Basic science, pathophysiology, diagnosis, and management, and new advances in emergency medicine are discussed.
Ambulatory Experience: Acute Illness offers a wide range of ambulatory patient problems, generally at a higher acuity than office practice. Each patient is immediately reviewed with a faculty member.
Procedures: Residents participate, based on credentialing status, in endotracheal intubation, central line insertion, defibrillation, suturing, wound management, local and regional anesthesia, incision and drainage techniques, reduction of fractures, casting, splinting, and slit lamp examination. In addition, residents may participate in the care of patients with facial injuries, working with the residents and staff of the Oral and Maxillofacial Surgery Department and Residency.
Radiology: Residents learn to order special views of bones and joints. Residents read and interpret films and learn basic emergency radiology principles, e.g., detection of occult fractures and significant soft tissue changes. When indicated, residents consult radiologists for interpretation of difficult films and special studies e.g., emergency Computed Axial Tomography (CT), Magnetic Resonance Imaging (MRI), isotropic studies, and pulmonary ventilation/perfusion scans.
Advanced Cardiac Life Support (ACLS): All residents must be certified in ACLS and maintain current certification during all three years of residency training. ACLS training is offered at the beginning of PGY1 and recertification is required every two years.
Trauma Management: Residents train with the emergency department and trauma service in the care of all Level I traumas, e.g., resuscitation, management of trauma.
Patient Outcomes: An emergency department logbook is maintained of all patients seen by the residents. Residents are encouraged to follow-up with all hospital admissions for final outcome.
IV. EVALUATION
ACGME Competencies
According to the Accreditation Council of Graduate Medical Education (ACGME), training and evaluation must include the following competencies: Patient Care, Medical Knowledge, Practice-Based Learning and Improvement, Interpersonal and Communication Skills, Professionalism, and System-Based Practice.
Patient Care will be evaluated by assessment of the attending physician and additional information from nursing staff, patients and families. Procedures performed must be documented electronically.
Medical Knowledge will be evaluated by assessment of the attending physician.
Practice-Based Learning and Improvement will be evaluated by assessment of the attending physician.
Interpersonal and Communication Skills will be evaluated by assessment of the attending physician and additional information from nursing staff, patients and families.
Professionalism will be evaluated by assessment of the attending physician and additional information from nursing staff, patients and families.
System-Based Practice will be evaluated by assessment of the attending physician.
The evaluation method is primarily accomplished electronically. Residents’ performance in Emergency Medicine is evaluated by the attending physician. Evaluations are reviewed with the residents for formal feedback. In addition, ongoing feedback is provided related to residents’ patient care responsibilities and activities.
Residents will document the Emergency Medicine rotation in portfolios, e.g. procedures performed. This tool will provide individual learning, reflection and assessment. Additionally, residents will evaluate the Emergency Medicine rotation.
Residents provide input on the Emergency Medicine core lecture series, which is used in scheduling future topics and speakers. Topics include: Abdominal Emergencies, Emergency Flank Pain, Emergency Headache, Patient Safety, Scrotal Emergencies, Emergencies of the Ear, and Toxicological Emergencies.
V. REFERENCES
Required Reading
Ma, O. John, Cline, D., Tintinalli, J. Kelen, G., Emergency Medicine: Just the Facts 2/3(Just the Facts). McGraw-Hill. 2004.
Optional Reading
Rosen's Emergency Medicine: Concepts and Clinical Practice, 3-Volume Set by John A. Marx James Adams Peter Rosen Robert S. Hockberger Ron M. Walls (Hardcover - 2005)
Tintinalli, Judith E., editor in chief; assoc. eds. Ernest Ruiz, Ronald L. Krome, Emergency Medicine: A Comprehensive Study Guide. New York: McGraw-Hill, Health Professions Div, (current edition)
Roberts, James, Hedges Jerris, Clinical Procedures in Emergency Medicine (current edition)
Haywood-Nuss, Ann L., ed.; co-eds. Christopher H. Linden, et al., The Clinical Practice of Emergency Medicine, Philadelphia: Lippincott-Raven, 1996.
Rosen, et al., Textbook of Pediatric Emergency Medicine
Rev. 2/2006, 7/2007, 4/2008.