EMERGENCY MEDICINE ROTATION SYLLABUS

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1 EMERGENCY MEDICINE ROTATION SYLLABUS Level of Training PGY1, PGY2 Length of Training 4 weeks Preceptors /Attendings Name(s) and Titles Bansidas M. Agravat, MD Sarmed Ashoo, MD Murray Baker, MD Stephen Cremin, MD Lonnie Draper, MD Edward Eastman, MD Javier Escobar, MD Eric Forsthoefel, MD Michael Glaze, MD Alex Ho, MD Michael Jurgaitis, MD John Jusino, MD Robert Manausa, MD William Miller, MD L.L. Pararo, MD Natalie Radford, MD Robby Shaw, MD Joshua Simmons, MD Mathew Snyder, MD Marcus Willett, MD Contact s Name B. David Robinson, MD (FMC faculty contact) ER Physician(s) Phone: Location(s) of the Rotation Bixler Emergency Center Unit 1 (Complex emergency care) extension Description of the Rotation Emergency care will be an important part of most Family Physician practices, and much of this care will take place in the Emergency Center. The goal of this phase of care is to stabilize the patient and provide a foundation for further evaluation and treatment. Ideally this care seamlessly meshes with the care the patient has already received, is efficiently and skillfully provided, and bridges the gap between out- and inpatient care or prevents the need for admission. The emergency setting must be able to prioritize patients with life-threatening illnesses or injuries, while not ignoring those whose problems are simply urgent. Patients who use the Emergency Center to provide primary care must be attended to as well, and optimally pointed toward more appropriate sites for their future needs. 1

2 The TMH Emergency Medicine rotation is two four-week required rotations where PGY1 or PGY2 residents work with ER physicians to master skills, which will enable them to provide emergency/urgent care. (Residents may also select ER as an elective rotation of two to four weeks duration.) During the initial contact hours the resident is expected to follow the ER physician as he/she triages, evaluates and treats a wide variety of patients. By the beginning of the second week, the resident is expected to be able to triage, evaluate, and recommend treatment options to the attending physician who will then see the patient. By the end of this rotation, the resident is expected to be able to provide a wide range of emergent and urgent care. Specifically, the resident should be able to provide adult advanced life support including leading a code resuscitation team, performing CPR, and intubating patients. In addition, he or she should be able to perform, under attending supervision, the initial assessment, stabilization, and triaging of trauma victims (e.g., accident victims, lightning/electrocution victims, burn victims), perform laboratory and radiographic evaluations, recommend treatment options, and consult specialists when appropriate. The resident is expected to know the medical and non-medical support services available to ill patients who are to be discharged from the Emergency Center. The resident will be expected to provide appropriate care and with assistance from the ER physician, referral for patients with psychiatric illnesses (e.g., acute substance intoxication, suicide attempt, psychosis) as well. Schedule Emergency Center physicians work the following 9 or 10 hour shifts: 7 a.m. 4 p.m. (9 hours), 11 a.m. 9 p.m. (10 hours), 4 p.m. 2 a.m. (10 hours), and 9 p.m. 7 a.m. (10 hours). The resident must work 3-4 shifts each week and work at least one night shift (4p 2a) and 2 weekend day shifts during this rotation. The required number of hours actually in the ER is 100 per 4 week rotation. You may take up to 1 week of CME or vacation during the ER rotation. Learning Goals By the end of this rotation, the resident will be able to: 1. evaluate and manage common problems in the Emergency Department (Competencies: Patient Care 2, 4). 2. perform routine emergency procedures (Competencies: Patient Care 2, 4, 7b). 3. use Consultants appropriately (Competencies: Systems-Based Practice 3, 4). Learning Objectives By the end of the rotation, residents must demonstrate competence in: 1. diagnosing accurately the following problems (Competencies: Patient Care 2, 7b): a. Multiple trauma (MVA), conscious and unconscious victim b. Abdominal trauma (blunt/penetrating) c. Thoracic trauma (blunt/penetrating) d. Head trauma 2

3 e. Burns f. Acute intracranial pathology (CVA, TIA, Hemorrhage, Mass, Seizure) g. Cardiac disease (CHF, MI, Angina, HTN) h. Pulmonary disease (COPD, asthma, pneumonia, pneumothorax) i. GI bleed j. Other GI pathology (pancreatitis, cholecystitis, liver disease, gastroenteritis, appendicitis) k. Nephrolithiasis l. GYN infections (PID, discharge, Bartholin gland abscess, toxic shock) m. Ectopic pregnancy, miscarriage n. Sexual abuse (rape kit) o. STD p. Acute renal failure q. GU infections, male (prostatitis, urethritis, epididymitis) r. Noxious/toxic substance exposure (fumes, organophosphates, etc.) s. Pediatric acute febrile illnesses t. Child abuse/failure to thrive u. Pediatric poisoning v. Acute psychiatric illness (suicide, depression, anxiety, psychosis) w. Alcoholic withdrawal/intoxication x. Fractures/sprains/dislocations y. Diabetic crises (DKA, hyperosmolar coma) 2. starting initial management of the above problems (Competency: Patient Care 4). 3. performing ACLS (Competencies: Patient Care 4, 7b). 4. performing incision and drainage (Competency: Patient Care 7b). 5. suturing simple and complex lesions (Competency: Patient Care 7b). 6. if required, insertion of chest tube or needle decompression (Competency: Patient Care 7b). 7. consulting others in a timely manner (Competencies: Systems-Based Practice 2, 4). Methodology of Teaching A large part of teaching in the Emergency Center occurs as the attending and residents discuss management of patients. The resident should use the textbooks located in the Emergency Center to supplement their learning. These textbooks and required readings are listed under Recommended and/or Required Readings. Computer based materials such as Up-to-Date may also be used to supplement their learning. 3

4 Evaluation Residents are encouraged to request feedback from the attending while precepting with them. Learning is enhanced if the resident can fully evaluate the patient and formulate a plan prior to precepting. In situations where this is not possible (multiple trauma), the resident is encouraged to discuss the case with the attending as soon afterwards as possible. Emergency Center physicians will be asked to complete an evaluation of the resident at the end of the rotation (see Attachment 1). Residents are expected to complete all required reading! Attendings and FMC faculty may assess through questions a resident s mastery of this reading material. Recommended and/or Required Reading Required Reading: Residents should research the following topics in Up To Date, as well as a selection of those listed in objective 1 above. Week 1 Part 2 Trauma - Week 2 Part 2 Trauma - Section 1 General Concepts Section 2 Spinal Trauma Section 3 Chest Trauma Section 4 Abdominal Trauma Week 3 Part 4 Selected Pediatric Problems Section 1 General Concepts Section 2 Cardiopulmonary Disorders Week 4 Part 4 Selected Pediatric Problems Section 3 Gastrointestinal Disorders Section 4 Neurologic Disorders Optional Reading (available in the Emergency Department): Tintinalli, JE: Emergency Medicine: A Comprehensive Study Guide. 5 th ed., McGraw- Hill, 2000 Remember to fill out those procedure cards and enter into Procedure Logger! REVIEWED: 05/13/05, 03/27/06, 04/07, 05/08, 06/09, 09/10, 08/13, 08/15 REVISED 5/26/04, 05/13/05, 04/07, 09/08, 09/10, 08/11, 08/13 4

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