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Emergency Medicine Rotation

Emergency Medicine

Welcome to your Emergency Medicine (EM) Clerkship. You will gain an appreciation of the many roles the emergency medicine physician serves in the community.  You will feel the dual sensations of excitement and hard work that will draw many of your fellow students into the field of emergency medicine.

Regardless of your intended career path, the pathology of illness encountered and the principles of ambulatory and pre-hospital care encountered during your EM rotation will provide you with a great opportunity to learn.  Enjoy your rotation!

Professional Code of Conduct

Every patient that you encounter in EM should be treated as you would want a family member treated.  You may see attitudes and behaviors that are foreign to your value system, but you should deal with these as a professional.  You should treat all staff members (physicians, nurses, patient care assistants, etc.) with respect, and likewise, you should expect the same in return.  If you are verbally or otherwise harassed, report this to the attending physician on duty and contact the EM clerkship director.

Clinical Expectations

Students will participate in the care of undifferentiated patients presenting to the Emergency Department.  Patient care will be provided under the direct supervision of an attending physician.  Students will be expected to obtain an appropriately directed (focused or complete) history and physical examination, formulate appropriate assessments with appropriate differential diagnoses and discuss the case with their supervising physician.  They will assist in the development and implementation of case specific patient management plans including proper patient disposition. This will be done using a combination of electronic and approved paper records. In the event the E.D. does not assign a paper H & P form, a sample is appended at the end of this form.

As a medical student rotating through emergency medicine you are a member of the healthcare team and the health care system for your patients.  You will provide patient care in a structured environment under direct physician supervision. You will function as the primary care giver of patients presenting with undifferentiated medical complaints. Each patient that you encounter should receive a directed evaluation in a timely fashion.  

Core Diagnoses and Presentations

The student will see patients with a variety of diagnoses. “Core” presentations are those diagnoses that are important to the development of the physician. The student should nevertheless record ALL diagnoses in New Innovations. Should a core presentation NOT be seen, it can be supplemented with online learning modules and through directed reading while on the longitudinal E.M. rotation.

Discipline/ Patient Type Evaluation Method Level of Participation
Emergency Medicine Patient types for 3rd year Students*

O=Observation
S=Simulation

O=observation
P=participate with supervision
I=independent with supervision

•    Resuscitation (2)
•    Trauma (1)
•    Chest pain (2)
•    Systemic Inflammatory Response Syndrome (1)
•    Fracture (1)
•    Nausea/vomiting-adult (1)
•    Shortness of breath (1)

O,S
O
O
O
O
O
O

O,P
P/I
P/I
P/I
P/I
I
P/I

  1.  Procedures: although procedures are a central component of emergency medicine, there are no required procedures for your EM clerkship. You should, however, take full advantage of opportunities to participate in any procedures that may be offered in your clinical training location. Under direct supervision, you should be capable and prepared to participate in such activities as: resuscitation team efforts, suturing of minor wounds, Incision/Drainage of wounds, Swabs of body parts for cultures, Placement of Nasogastric tubes, and others.
  2. All students will document patient encounters/procedures using the New Innovations system.
  3. The clerkship administration will review patient encounter / procedure logs and provide feedback to the students to assure that clinical expectations are being met.
  4. If for some reason, a student does not encounter a patient with one or more of the above clinical complaints / conditions, they are still expected to review the educational material pertaining to the specific clinical presentation / condition.

Don’t Forget…

  • All pelvic examinations must be chaperoned by a physician.  
  • All rectal, male GU examinations, and female breast examinations must be  chaperoned.  This can be performed by any health care worker (medical student, nursing assistant, nurse, physician).
  • If you think your patient is sick (unstable vital signs, SOB, CP, abdominal pain with peritoneal findings, change in mental status, etc.), alert the nurse and the attending physician immediately.
  • Check out with the attending physician before you leave at the conclusion of your shift (this is to insure that all patient related matters have been addressed).

Course Structure

  1. Orientation – You must know where to go and which attending physician you are working with before you arrive on your first day. Read the sections in Tintinelli (see mandatory reading assignments below) on Airways Management, CPR, Shock, Chest Pain, Anaphylaxis, and Stroke BEFORE you step foot into the Emergency Department. Read the remaining mandatory sections as soon as you can. You want to be competent and you want to be part of the care team.
  2. Scheduling of Rotations- You will be scheduled 6 shifts per academic year. You will be given your schedule for three shifts in advance of beginning your 6 month block. At that time the Block Coordinator will give you an allotted period of time to make any changes needed. On the date specified, all changes to your EM schedule will need to be submitted to the corresponding facilities. Moving forward from that date, changes will only be made for emergency situations. If a change needs to be made, please contact the block coordinator and block director immediately. Any change to your schedule must be approved by the coordinator and block director. Student will not be given credit for any previously unapproved shift and will then need an additional approved shift to meet block requirements to pass. You will be required to submit at least one evaluation that is dated and signed by the attending for each shift.
  3. Clinical schedule – Your clinical schedule may vary from one site to another but generally entails 6-12 hour shifts.  Hours will vary.  Please be respectful and adapt to the schedule of your clinical site.
  4. Attendance policy – If you must be absent, immediately notify the clinical site director and the clerkship coordinator. Please also send an email to the clerkship director to notify them of your absence.  The UCR SOM attendance policy that allows up to 2 excused absences per block does not apply.  ALL Emergency Medicine shifts must be made up. The attendance policy is strictly enforced. Unexcused absence or lateness is unprofessional, and will affect your final clerkship grade. You will be required to submit at least one evaluation that is dated and signed by the preceptor for each shift. Failure to submit an evaluation from a shift will result in the assumption that this shift was not completed and student will be required to do an additional shift and submit an evaluation from that shift.  Any exceptions can be made on a case by case basis by the clerkship director.  
  5. Patient / procedure logs – All 3rd and 4th year students are required to document patient encounters / procedures using the New Innovations system in a timely manner.  This is mandatory for successfully completion of the rotation.  The New Innovations website can be accessed at www.new-innov.com.  To access the system, you will need your username and password.  Medical students should keep track of patients encounters and procedures for future needs.
  6. Evaluations – All students must submit an end of rotation course and supervisor evaluation using the New Innovations system. Additionally, you will be required to submit at least one evaluation that is dated and signed by the preceptor for each shift. Failure to submit an evaluation from a shift will result in the assumption that this shift was not completed and student will be required to do an additional shift and submit an evaluation from that shift.
  7. Dress code –Please be respectful of the professional attire request of your individual sites. You are a guest in their house, so to speak. Depending upon your department’s rules, hospital scrubs may be acceptable for this rotation. Tee shirts, blue jeans, open-toed shoes, sweat shirts or other “street clothes” are not acceptable as they do not adhere to professional standards. You must wear your student identification.

Emergency Medicine Textbooks/Resources and Required Readings

The Sanford Guide to Antibiotic Therapy. Buy the book, or Download the app to your phone:
Cost: $29.99 yearly for the app.

Tintinelli’s Emergency Medicine: A Comprehensive Study Guide, 8e.  This is available free on “Access Medicine” via the UCR SOM VPN site. Reading and comprehension of the following diagnoses are mandatory. The earlier you read these, the more valuable you will be to your patients and your attending faculty:

Airway Management: chapters 28, 29
Cardiopulmonary Resuscitation: chapters 11, 22, 23, 24
Shock: Chapters 12, 13, 50
Acute Abdominal Pain: chapter 71
GI Bleeding: chapters 75, 76, 77, 78
Chest Pain: chapter 48, 49, 51
Syncope: chapter 52
Anaphylaxis: chapter 14
Poisoning: chapters 177, 182, 185, 186, 187, 190, 201     
Diabetic Ketoacidosis: chapter 225
Acute Metabolic Acidosis and Metabolic Alkalosis: 15, 16, 17,
The red painful eye: chapter 241
Febrile Infants: chapter 116, 117
Stridor: chapters 123, 124, 125
Dehydration: chapters 128, 129
Acute Low Back Pain: chapter 279
Headache: chapter 165
Seizures: chapter 171
Stroke: chapters 166,167
Domestic Violence: chapters 293, 294, 295
Acute Dyspnea: chapter 62
Wheezing: chapter 69
Acute Pelvic Pain: chapter 98 (subsect on ectopic pregnancy)
Abdominal Trauma: chapter 263
Chest Trauma: chapters 261,262
Head and Neck Trauma: chapters 257, 258
Abdominal Trauma: chapter 263
Wound Care: chapters 39, 40, 41
Pulmonary Embolism: chapter 56

TIPS for a Successful ER Rotation

  1. Read your required chapters early on. You will impress your attendings and you will get wonderful evaluations
  2. Know your limitations; this cannot be over emphasized
  3. Have your H & P templates printed out and ready to use on a clipboard
  4. Demonstrate an eagerness to learn
  5. Call for help early

Grading/Feedback

The Emergency Medicine grade will be assigned by the Block C Clerkship Director in concert with the Emergency Medicine Clerkship Content Specialist. It is based upon Professionalism, ward/unit feedback, and faculty feedback events (FE’s) with written evaluations. You will be required to submit at least one evaluation that is dated and signed by the preceptor for each shift. 6 shifts with corresponding evaluations must be completed prior to the end of week 20 in order to receive a grade of pass or higher. Coordinator and Director will then review the evaluations and drop the lowest score. If a student opts to get 8 evaluations, the lowest two scores will be dropped. No grade of Honors will be given if ANY shelf exams are failed (also true of Family Medicine Grading).

  1. Faculty evaluation will be multiplied by (100/maximum points attainable) x 0.625 to allow the maximum score to reach 62.5% of the final grade.
  2. The Final OSCE score shall be multiplied by (100/maximum points attainable) x 0.375 to allow the maximum score to reach 37.5% of the final grade.
    • The scores of the faculty evaluations and the OSCE shall be summed. An average of 20% of the class shall receive the grade of honors and an average of 30% shall receive High Pass each block. Grades are based upon the above parameters and the application of indices of professionalism and timely completion of weekly Themes Topics. No student who has failed any of the shelf exams for the entirety of the 3rd year will be eligible for honors in either Family or Emergency Medicine.