LSUHSC-New Orleans School of Medicine Critical Concepts Senior Rotation Student Handbook 2012-2013
CONTACT INFORMATION Course Director: Jennifer Avegno, MD Clerkship Director Room 543 University Hospital (physical office) javegn@lsuhsc.edu (504) 903-3594 (office) (504) 301-5058 (cell) Course Coordinator: Jennifer Jeansonne 2020 Gravier Street Room 615 Jjean2@lsuhsc.edu (504) 568-4620 Website: http://www.medschool.lsuhsc.edu/emergency_medicine/critical_concepts_rotation.aspx
Critical Concepts Rotation Guidelines Welcome to Critical Concepts! We are excited about the opportunity to introduce you to the care of the acutely ill patient using a multi-specialty, innovative learning approach. Throughout the rotation, we will work hard at providing you with an excellent educational experience. Please read the following information carefully and do not hesitate to contact us at any time with suggestions or questions. Course Objectives: Provide all senior students with exposure to acute and critical care concepts in a variety of learning modalities (i.e. direct patient care, case discussions, didactic lectures, simulation exercises, and procedural skill practice and performance). Review and reinforce diagnostic and management skills in common and/or critical disease entities and procedures encountered in a range of specialties. Prepare senior students for their new roles as resident physicians with direct patient care and health care team responsibilities. Care of the acutely ill, undifferentiated patient is a challenge encountered by health care professionals in a wide variety of specialties. The Critical Concepts rotation provides every senior medical student, regardless of career choice, with a broad and solid foundation in the principles and skills needed to care for the emergently ill patient. After completion of core clinical rotations in the junior year, medical students should be challenged to expand their skills and knowledge base and apply them to more complicated and/or critically ill patient care situations. Students should also refine and expand their skill set in terms of commonly performed and/or critical procedures and medical interventions. Furthermore, as they prepare to enter residency, senior students should also develop a more sophisticated understanding of the complexity of disease and health system management. Structure of the Rotation: multispecialty didactic sessions (1 week) ICU rotation (1 week) Emergency Medicine rotation (2 weeks)
DIDACTIC WEEK INFORMATION For one week on the rotation, students will attend 8 specialty sessions all focused on the acute management of critical topics unique to their field. These sessions will blend traditional lectures with a variety of other learning experiences: small group case discussions; interactive videos; hands-on simulation cases and skills and procedure labs. Each session has been designed and will be run by educators from that field, and targets student learning to what they believe are the most common critical presentations in their field. Prior to each session, students should read the assigned material in Moodle or on the website (under "Required Course Reading - Emergencies by Specialty") and come prepared to discuss and practice the material contained therein. ICU ROTATION INFORMATION The ICU affords students the opportunity to care for the sickest patients. Students will improve their abilities to take a systems- or problem-based approach to ill patients. Students may also participate in difficult family discussions, such as end of life care or support withdrawal. Students will spend one week on service in one of 5 ICUs: MICU (Earl K. Long); NICU (Children's); PICU (Children's); MICU (University) or TICU (University). While on the ICU portion of the rotation, students are expected to participate fully as part of the ICU team, including taking call as directed by the ICU faculty. EMERGENCY MEDICINE ROTATION INFORMATION Students may do their Emergency Medicine (EM) rotation in the Emergency Department (ED) at University Hospital in New Orleans or Earl K. Long in Baton Rouge. In each location, you will be supervised by board-certified EM faculty and have the opportunity to work with EM residents. You will work 6 12-hour shifts during a 2 week period and are expected to attend all of the required student EM lectures and activities in your particular location. EM ROTATORS IN BATON ROUGE - information, scheduling and further details will be given on the first day of your rotation at orientation. For more information, please see the Moodle and the website under "Baton Rouge Information." EM ROTATORS IN NEW ORLEANS - please read below for your expected duties and responsibilities. You will be working 6 12-hour shifts in the Main ED (MER) - the busiest and largest section of the ED. YOU ARE CONSIDERED TO BE AN "ACTING INTERN" - that is, you will
have direct patient care responsibilities for your own patients, with significant supervision and backup from EM residents and staff. You are responsible for full documentation in the patient record. After performing an H&P, you may present the patient either to an EM resident or directly to staff for guidance. All procedures must be directly supervised by an EM resident or staff, and EM staff must review the case and sign the patient s chart prior to discharge. At shift change, you must sign out and provide detailed information on any active patients to oncoming students or interns. Major trauma resuscitations will be done by the upper-level EM resident with staff backup. The EM resident serves as team leader and will assign you a role in the management and care of trauma patients, and you are expected to observe and participate in each resuscitation. On most shifts, there will be a dedicated EM teaching resident. This resident will conduct regular student and intern-only rounds, guide you through patient cases, and instruct and supervise your procedures. MER shifts are from 7 am 7 pm ("MD") and 7 pm 7 am ("MN"). You should have received your schedule in advance. Students are allowed to make schedule switches as long as they inform the course director. However, if you make a switch with another student, and that student fails to show up for the shift, it is the original student s responsibility. Repeated problems with switching must be brought to the course director s attention. ATTENDANCE AT YOUR SHIFTS IS MANDATORY. If you are ill or have an emergency, you must either call the course director or the ED and let the attending staff know you will not be there. Students who fail to show up for a scheduled shift will be assigned an extra penalty shift. NO EXCEPTIONS! Much thought has gone into the scheduling process. To optimize patient and ED flow, the level of student staffing is as consistent as possible. Any special circumstances regarding shift scheduling must be discussed with the course director as far in advance as possible. The master schedule will be available online under "Current Student Schedule" from the "Students" group on the top toolbar of the website. Faculty lectures. On Thursdays from 7:30-9:30 am in the UH Basement room 103 you will receive lectures from EM faculty and residents on a variety of core EM topics. These lectures are informal and frequently interactive, and have been very popular in the past. These are mandatory lectures; if you foresee any problems with attending a certain lecture, please let Dr. Avegno know ahead of time. If you miss a lecture, you will be
expected to read a selection of core articles on the topics missed and answer questions about the material. The schedule of EM lecturers and topics is posted on a Yahoo! calendar. You will be able to access this calendar at any time to view the student schedule by going to the website: http://calendar.yahoo.com/lsuemclerkship/5810fa9f62d95156d1f23fa64bd2f25f?od=131 READING MATERIAL AND CURRICULUM CASE LOG The required EM reading for both BR and NO is available on Moodle and the website (under "Required Course Reading - Emergency Medicine"). These brief articles should serve as a starting point for your study of management of the acutely ill and/or undifferentiated patient. Evidence-based medicine is as important in EM as it is in other disciplines and should serve as the basis for evaluating, diagnosing, and managing patients in the ED. While on the EM rotation, a daily log of patient encounters and procedures is also required. All patient encounters and procedures observed, assisted with, or performed should be logged into the case log on Moodle. This must be completed by the end of the rotation in order to process your grade. EXPECTATIONS FOR ALL STUDENTS Students are expected to attend all ER shifts and ICU activities to which they are assigned. They are also expected to attend all didactics sessions and will sign in to document their attendance at these sessions. In addition to the above, students may be required to complete several online modules on core critical topics written specifically at the senior student level. Interactive cases may be included. All students are expected to adhere to the same degree of professionalism as in any other clinical setting. Towards that end, students are expected to be on time for every didactics session, ED shift, and ICU rounds. Any student arriving more than 10 minutes late on any occasion without good reason will be given a warning. As stated above, failure to show up for an assigned ED shift will result in an extra penalty shift. Students are expected to adhere to the school honesty policy at all times in the didactics, clinical, and test-taking portions of the course.
Students will be supervised by faculty and senior residents during their EM shifts. They will be supervised by attending faculty during their week in the ICU. For the didactic sessions, they will be supervised by the instructors for each session. EVALUATION METHODS AND GRADING CRITERIA The evaluation of students will be based on 2 components: an on-line examination administered through Moodle during the last week of the rotation and a professionalism assessment during the clinical rotations. Remediation will be based on what is failed students will either retake the examination or repeat the week of ICU or ER until they pass it successfully. The course will be graded on a system for Honors, High Pass, Pass, Fail (based on the exam) with a Pass/Fail component to the clinical professionalism portion. The students must pass the professionalism assessment to earn their grade. If a student has to remediate either component, the highest grade that student may receive after remediation is a Pass. The end-of-rotation exam will be derived from EM and subspecialty readings, lectures, and didactic sessions. ABSENCE POLICY In accordance with 4 th year student attendance policies, students may miss 2 days of the rotation for interviews. These 2 days may be one ER shift (and one subsequent day off), or 2 days in the ICU. If 2 days in the ICU are missed, those 2 days will be remediated the weekend before or the weekend after the ICU week to ensure optimal clinical experience. Students may not miss didactics days for interviews. Students anticipating a competitive match with few interview days should schedule this course either early or late in the year to avoid interview conflicts. Any questions regarding attendance should be directed to Dr. Avegno and/or Dr. English. Please do not hesitate to contact us at any time during your rotation. Thank you, Jennifer Avegno MD LSUHSC - New Orleans Section of Emergency Medicine javegn@lsuhsc.edu (504) 301-5058 (cell) (504) 903-3594 (EM office)