Emergency Medicine Clerkship MDCN PDF

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Emergency Medicine Clerkship MDCN 522 UNDERGRADUATE MEDICAL EDUCATION CORE DOCUMENT (Year 3) Class f Academic Year 2016 EMERGENCY MEDICINE CLERKSHIP CLERKSHIP DIRECTOR Dr. Trevr Langhan EVALUATION COORDINATOR Dr. Jasn Fedwick PROGRAM COORDINATOR Kerri Martin Tel: Each f these key peple is very apprachable and cncerned abut individual students having a psitive experience during their medicine clerkship rtatin. If prblems arise during the rtatin, please cntact the apprpriate persn listed abve as sn as pssible. Cntents ORIENTATION... 2 INTRODUCTION... 2 I. PRECEPTORS and SCHEDULING... 3 II. MONITORING ACADEMIC AND CLINICAL WORK HOURS... 3 Illness... 3 Vacatin... 4 Nn-vacatin time ff requests... 4 Absenteeism/ missed shifts withut ntificatin... 4 Attendance... 4 III. SUPERVISION... 4 IV. EDUCATION... 5 V. EVALUATION... 6 Clinical Perfrmance... 6 MCQ Exams... 6 Lgbks... 7 VI. TEAM RELATIONS... 7 VII. PATIENT/FAMILY RELATIONS... 7 VIII. EMERGENCY DEPARTMENT STRUCTURE... 7 Triage... 7 Telephnes... 7 Charting... 8 Discharge Instructins... 8 Fllw-Up Care... 8 Release f Infrmatin... 8 IX. DIAGNOSTIC IMAGING (RADIOLOGY)... 8 X. LABORATORY... 8 XI. PHARMACEUTICALS... 9 XII. CRISIS TEAM... 9 XIII. SOCIAL WORK/HOMECARE... 9 XIV. BED DISTRIBUTION IN DEPARTMENT... 9 Resuscitatin/Trauma Rm... 9 Treatment Area, Minr Emergency, Fast Track... 9 Remaining Beds... 9 XV. OBJECTIVES XVI. LOGBOOKS... 12 ORIENTATION Welcme t the Emergency Medicine Clerkship prgram at the University f Calgary. This is a multi-center clinical clerkship based in the Adult Emergency Departments f the Fthills Medical Center (FMC), Peter Lugheed Center (PLC), Suth Health Campus (SHC) and the Rckyview General Hspital (RGH). We hpe that yu will find it t be bth interesting and educatinal. Please take a few minutes t review the fllwing guidelines, which will utline yur rle and respnsibilities, thus enabling yu t fit int ur team as smthly and quickly as pssible. The wide variety f prblems seen in the Emergency Department, frm trivial t life threatening, prvide a challenge fr any physician. Emergency Medicine differs frm yur ther clinical experiences insfar as yu will be asked t make timely decisins regarding patient management. Decisins based upn limited clinical infrmatin, labratry results and/r radilgical investigatins. Shuld yu have any questins abut any f this material, please feel free t ask any f the emergency physicians. INTRODUCTION The gal f an Emergency Medicine clinical clerkship is t prvide the fundatin fr future physicians t be able t recgnize and initiate first line medical treatment f the acutely ill r injured patient. This gal will be accmplished by: Students building their fund f knwledge thrugh independent study. Applicatin f knwledge in a variety f situatins. Use f infrmatin in a realistic and dynamic setting. There is a scietal expectatin f all physicians t have basic knwledge in emergency care. During their pst-graduate training, residents regardless f future career specialty will manage patients with acute illness. It is inevitable that emergencies unrelated t that practitiner s specialty will arise at sme pint. All physicians shuld have the skills t recgnize illness and initiate treatment until help arrives. Once a patient has a diagnsis, a health care prvider can turn t reference material fr guidance. The greater challenge lies in the undifferentiated patient. Basic skills in recgnitin and evaluatin are critical elements f an Emergency Medicine experience. It is expected that the student begin t cultivate the skill f data interpretatin and wrk tward the frmulatin f a management plan. Mst Emergency Medicine experiences are enjyable fr students it is ften their first pprtunity t feel primarily respnsible fr patient care. 2 I. PRECEPTORS and SCHEDULING Clinical clerks n rtatin in the Emergency Department (ED) in the Alberta Health Services will be assigned t wrk 6-10 shifts in the ED during a 2 week blck. These shifts will be assigned t be wrked at any f the fur adult ED sites in the regin. Shifts can be expected t include day, evening and night shifts bth during the week and n weekends. Shift scheduling will be in accrdance with UME recmmendatins. There is n n-call expectatin fr clerks wrking in the ED; night shifts are nt cnsidered shifts n call. Clinical clerks may NOT trade shifts with ther students at any time during the emergency rtatin. Once the learner schedule is published, it is final and may nt be changed withut discussin with the scheduling crdinatr. This rule is in place due t infectin cntrl plicies as set ut by the UME ffice and the AHS. II. MONITORING ACADEMIC AND CLINICAL WORK HOURS Students hurs shuld be set by taking int accunt the effects f fatigue and sleep deprivatin n learning, clinical activities, and student health and safety. Students may be required t wrk evening shifts prir t summative examinatins. There will be a minimum eight (8) hurs between the end f evening clinical duties and the summative exam the fllwing mrning. Students are reminded that EM shifts are eight (8) hurs in duratin, freeing up the daytime hurs prir t the evening shift fr exam preparatin. Illness Students wh are ill and unable t attend a scheduled shift must speak with the preceptr directly as early as pssible during the scheduled shift. Students will call the department during the scheduled shift and speak directly t the physician preceptr in rder t call in sick fr each shift missed due t illness. It is NOT acceptable t speak with a unit clerk r nurse and ask the message t be passed n. EM Department phne numbers are: RGH ER: FMC ER: PLC ER: SHC ER: Students must als submit the nline absence frm n OSLER. Students wh d nt ntify the preceptr and clerkship directrs f illness n the day in questin will be cnsidered absent withut explanatin. Shifts missed due t illness may have t be made up, and will be reviewed in a case by case manner. Please refer t the Student Handbk in regards t UME standards fr illness. 3 Vacatin Vacatin days may nt be taken during the Emergency Department clerkship rtatin. Persnal days may be taken if requested in a timely manner. Requests fr a persnal day ff must be submitted 2 mnths ahead f the blck. While we make every effrt t hnr such requests, requests fr persnal days cannt be guaranteed. Please frward day ff requests t Dr. Trevr Langhan at Nn-vacatin time ff requests Students may nt request that all f their ED shifts be clustered tgether. Such requests will NOT be entertained. When planning scial and ther events during the rtatin, students must cnsider that the published rtatin schedule is final and nn-alterable. Requests fr three r fur day weekends will nt be entertained. Absenteeism/ missed shifts withut ntificatin Unexplained absenteeism is unprfessinal and unacceptable in the University Of Calgary, Cumming Schl f Medicine. The Office f Undergraduate Medical Educatin will be ntified immediately f any unscheduled absences n the FIRST and any subsequent absences. The student will be required t make up such missed shifts during the rtatin, regardless f the subsequent reasn fr the absence. Students with any unexplained absences are at risk f a failing evaluatin f their prfessinal cnduct during the emergency rtatin, resulting in a failing evaluatin fr the blck. Students with a passing academic standing but a failed attendance recrd will thus fail the rtatin. Again, the nline absence frm n OSLER must be cmpleted. Attendance Attendance fr yur clinical shifts is an essential part f the rtatin. Absenteeism will nt be allwed. Attendance will be cnfirmed by assessing the daily ITER frms cmpleted by yur attending physicians (see 4.1 ITER belw). The nus t have the frms cmpleted daily (and prve attendance) is n the clinical clerk. III. SUPERVISION As with all clinical services in a teaching hspital, the attending emergency physician is respnsible fr the care given by the huse staff wrking under his/her supervisin. The Canadian Triage Acuity Scre is a marker f patient acuity used t priritize patients t be seen in the ED (See belw). Clerks shuld nt see CTAS 1 and 2 patients withut the patient first being assessed by their attending physician. Yu shuld discuss each patient with yur preceptr prir t rdering any investigatins and prir t discharging the patient r requesting a cnsultatin. Remember that the Emergency Department is a high risk envirnment fr bth medical and legal liability. All charts, lab results, ECG s and x-rays are t be reviewed with yur preceptr. Please infrm yur preceptr as sn as pssible abut any patient 4 that yu are seeing that appears acutely ill. It is imprtant t review each patient with yur preceptr prir t signing up fr the next patient. As junir learners, clinical clerks shuld fcus n the educatinal value f each patient seen in the Emergency Department, and nt be influenced by departmental flw. Each patient chart will include detailed nursing ntes as well as EMS ntes if they came by ambulance. Please review all f these dcuments. IV. EDUCATION Learning bjectives prvided t yu shuld frm the fundatin f yur independent study. The end f rtatin MCQ examinatin will be based n the learning bjectives. A curriculum blueprint will be prvided t further guide independent study. It is recmmended that after each clinical shift, the clerk pursue independent study related t the patients seen that day. This merger f practical and theretical medicine will help cnslidate learning. Mst f yur educatinal experience will be during yur clinical duties when interacting ne n ne with yur preceptr. This direct attending physician cntact is unlike any ther specialty in undergraduate training, and prvides an excellent pprtunity t learn frm experienced clinicians. Emergency Department patient visits are unscheduled and highly unpredictable. It is therefre difficult t standardize the clinical experience fr each clerk. There are up t eight emergency physicians n at ne time s yu may nt always be directly invlved in the mst critical r interesting cases. If yu ntice smething exciting r interesting taking place please feel free t bserve, but let yur preceptr knw where yu are. T supplement the clinical experience, a series f small grup lectures are scheduled. These Key Cncept runds are designed t highlight cardinal EM patient presentatins and t wrk n diagnstic and patient management skills. Manuals fr key cncept runds can be fund n the OSLER website. Key cncept runds are educatinal small grup sessins aimed at students at the clinical clerk and junir resident level. Each sessin generally runs frm 60 t 90 minutes depending n the number f students attending and the clinical and educatinal experience f the grup. The sessins prmte active participatin f students. Supplemental reading material n these tpics can be fund via the OSLER website. Abdminal Pain Altered Mental Status Chest Pain Respiratry Distress Shck Suturing and Wund Care Trauma Txiclgy Each student will participate in ONE Bedside teaching runds sessin. Bedside teaching runds will take place Thursday afternns. The EM prgram crdinatr will prvide yu with a schedule detailing which Thursday t attend. Clerks are t meet with attending physicians in the Fthills Hspital ER frm 1 pm t 4 pm t review clinical prblems at the bedside. The fcus f these sessins will be t link pathphysilgy with patient cmplaints and exam findings. Relevant labratry values and diagnstic images will be reviewed. 5 In additin t the dedicated clerkship lecture series, there are EM Grand Runds, presented by ne f the emergency physicians r EM residents, every Thursday at 0900 hurs at either the FMC (Cmbs Theatre) r the Alberta Children s Hspital. V. EVALUATION Yu will be evaluated during yur EM rtatin by three methds: Clinical Perfrmance Yur preceptrs during yur clinical shifts will evaluate yu n the basis f yur attendance and perfrmance in the Emergency Department. They will use the standard In Training Evaluatin Reprt (ITER) used by UME. Evaluatin will be based n prficiency in such areas as academic knwledge, clinical and prcedural skills, clinical judgment and decisin-making ability, apprpriate use and interpretatin f investigative mdalities, wrk ethic, cmmunicatin skills and prfessinal attitudes twards staff and patients. The daily ITERs will be cnslidated int a final ITER, which will be upladed nt the web One45 system. It is the respnsibility f the student t ensure the frms are cmpleted and submitted t the EM prgram crdinatr. The Final ITER will shw a Satisfactry with Perfrmance Deficiencies fr the fllwing three reasns: 1) Previusly unsatisfactry n a cmpnent fllwed by Satisfactry Cmpletin f Remedial Wrk, 2) Prfessinalism Issues, 3) Failure t cmplete a Mandatry Prtin f the Clerkship. MCQ Exams At the end f the 2 week blck, the summative exam will be a 50 questin MCQ examinatin. The summative multiple chice exam fr Emergency Medicine will be written n the final Friday f the 2-week rtatin. A student may have 2-3 clinical shifts that fllw the summative exam. There is n mandatry frmative exam in EM. EM is nly a 2-week rtatin, with n time fr a mandatry frmative exam. In lieu f a frmative exam, students are prvided daily ITERs frm direct supervisin. A practice exam is ffered thrughut yur rtatin. If yu wish t cmplete this exam fr study purpses, please d s. E-Learning will yu the link and yur user name and passwrd at the beginning f yur clerkship year (please be sure t keep track f this ). This exam may als be accessed via the Frmative Exam Schedule tab in OSLER. Yu may cmplete the exam as many times as yu like and review yur results immediately afterwards. Yu will nt be penalized if yu chse nt t cmplete the practice exam. Generally, clerks may request a deferral f any UME exam nly n the grunds f dmestic afflictin, illness r religius hliday. Dcumentatin will be required t supprt the deferral. Student perfrmance will be mnitred by the EM Clerkship Cmmittee. Students are respnsible fr self-reprting any issues directly t the cmmittee. 6 Lgbks Tw nline lgbks are part f yur evaluatin. One is t track yur cmpletin f expected prcedural skills during yur tw week rtatin. The secnd lgbk is t guide yur clinical experience by emphasizing which clinical presentatins are essential t Emergency Medicine. The lgbks can be linked t via the OSLER website and must be cmpleted t pass the rtatin. VI. TEAM RELATIONS Yu are part f a team cnsisting f medical staff, nurses and ther supprt staff, such as radilgy and respiratry therapy. The relatinship with the nursing staff is extremely imprtant. Our nurses have a high level f training and skills and are certified in prcedures such as ECGs, arterial bld gases, rgastric lavage, insertin f nasgastric tubes and urinary catheters, peripheral intravenus lines and defibrillatin. Supprt f, and gd cmmunicatin with the nursing staff is essential t ptimize patient care in the ED. Many f the nurses are excellent teachers f prcedural skills. VII. PATIENT/FAMILY RELATIONS The encunter with the ED is ften very stressful and cnfusing fr the patient and his/her relatives. Please infrm the patient f wh yu are, what yu are ding and why yu are ding it, and t keep the patient s relatives infrmed abut what is happening. It is als necessary t explain t the patients wh they are seeing when a cnsultatin is made. Parents f children under the age f sixteen, if nt present, shuld be cntacted by telephne if pssible, and infrmed f their child s prblems and treatment. Ensure that a patient des nt leave befre being seen persnally by yur preceptr. Family meetings r discussins shuld take place with yur attending physician present. This ensures that families are nt receiving cnflicting messages. VIII. EMERGENCY DEPARTMENT STRUCTURE Triage A triage nurse is always n duty at the frnt t determine the severity f the patient s illness. If the illness is minr, the nurse may elect t have the patient return t the Admitting desk t cmplete a chart. If the patient is acutely ill, the triage nurse will send the patient t a bed immediately. The chart will be cmpleted later. In additin, the nurse may direct a physician t that bed immediately. Telephnes The ambulance and trauma telephnes, alng with STARS dispatch infrmatin are lcated at the frnt f the ED. The nursing staff answers these telephnes and an emergency physician may be requested t prvide telephne cnsultatin r advice. The unit clerks at the frnt desk handle all f the incming and utging telephne calls, as well as the verhead paging. They have a cmplete list f physician s telephne numbers 7 and the cnsultants n call. All pages shuld be dne thrugh the frnt desk and nt via the main switchbard. Charting The ED chart is t be cmpleted in a legible manner and signed. Charting shuld include a relevant histry and physical examinatin. Include a diagnsis and treatment plan/dispsitin. Yu will find the ED chart t have much less space than inpatient recrds. Please leave rm fr yur preceptr t dcument their wn findings n the chart. Discharge Instructins Discharge plans and advice shuld be recrded n the chart in the space prvided. There are sme handuts available t cver certain situatins, e.g. Hme Management Fllwing Head Injury. If a patient is t be seen by anther physician as an utpatient in fllw-up, e.g. Hand Clinic, it is imprtant t give the patient a cpy f the chart t take with them as it cntains the infrmatin necessary fr the secnd physician t deliver the apprpriate fllw-up care. As well, the fllw-up physician s name and telephne number shuld be given t the patient. Fllw-Up Care Fllw-up is an integral part f gd emergency care and patients shuld be referred back t their family dctr unless this is inapprpriate, e.g. certain patients with casts. Patients with n family dctr can be given a phne number t btain ne. There is a list f family dctrs wh are accepting new patients at the frnt desk. Release f Infrmatin Ntes t emplyers shuld nly indicate the date the patient was seen, the anticipated duratin f absence and wrk limitatins. Investigating plice fficers may be tld f the patient s cnditin in general terms nly and n infrmatin shuld be released t the press. Any request fr infrmatin frm lawyers r insurance cmpanies shuld be referred t the emergency physician invlved. IX. DIAGNOSTIC IMAGING (RADIOLOGY) The Department f Diagnstic Imaging (Radilgy) is lcated adjacent t the Emergency Department and all f ur x-rays are dne n a stat basis. Prtable x-rays can als be btained if indicated. X. LABORATORY Lab wrk carried ut n Emergency Department patients shuld be limited t tests required t reslve immediate prblems. All f ur bld and urine samples are prcessed by the lab n a stat basis. Patients shuld nly rarely be tld t call back t the Emergency Department fr results f tests. 8 XI. PHARMACEUTICALS A wide range f drugs are stcked in the Emergency Department fr use in the department. A directry f city pharmacies and their hurs f peratin is available at the frnt desk. There is a CPS lcated in the medicatin rm as well as in the treatment area. Prescriptin pads may be btained at the frnt desk. D nt leave prescriptin pads lying arund carelessly. XII. CRISIS TEAM Patients wh require psychiatric evaluatin, after apprpriate medical clearance, may be referred t the Crisis Team. The Crisis Team is made up f specialized psychiatric nurses wrking under the supervisin f a staff psychiatrist. They may arrange further in r utpatient assessments fr psychiatric patients. XIII. SOCIAL WORK/HOMECARE The department has a cmmunity care crdinatr available frm hurs daily t assist in discharge planning and special fllw-up arrangements. XIV. BED DISTRIBUTION IN DEPARTMENT The ER is a high vlume, rapid turnver assessment and treatment space. Please mnitr where yur patients are mved t during their ED stay. Patient flw thrugh the ED is meant t be fluid and seamless. Try t summarize yur histry and physical and limit the assessment t details relevant t the day s visit. Resuscitatin/Trauma Rm Each adult ED has a large designated Trauma r Cde Rm. These rms are fully eq
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