This elective is by far our most popular course offering and is mandatory for all students considering a career in emergency medicine.
Our department is dedicated to providing a quality medical student education to all interested fourth-year students. This is accomplished by providing a specifically designed 4-week didactic curriculum, which includes weekly lectures, small group discussions, case presentations, medical simulation and a procedural skills lab.
Most importantly, students in our department are treated as acting interns. While students interact with, work with and learn from multiple residents, they primarily work with our attendings. As a department, we feel that fourth-year medical students have gained the requisite experience and posses the maturity to be treated as interns. We also feel that it is impossible to choose a specialty for the rest of your life without actively participating in that specialty. Clearly, there is close faculty supervision and support, but students are encouraged to be the primary caregivers for their patients.
Over the course of the rotation, students spend approximately 120 hours in direct patient care activities in the Emergency Department. Shifts are either 8 or 10 hours in length, scheduled approximately 2 weeks prior to the start of the rotation. There is some flexibility in scheduling as long as changes are communicated and approved well in advance.
Students act as interns during the month - engaged stakeholders in all patient care decision making to include but not limited to the following: obtaining the H&P, reviewing diagnostic studies, performing procedures, interacting with family members, calling consultants and patient disposition. As with trainees on every level, faculty directly evaluate all patients, and all decisions regarding patient care are discussed with faculty, thus ensuring that all faculty members are actively engaged in student education.
Students are encouraged to see a wide variety of patients with varied complaints. While not given the primary responsibility of patient care for critically ill or injured patients, student learners are actively involved in the treatment process.
Typical procedures performed by students during the month include: incision & drainage of abscesses, laceration repair, venipuncture and peripheral IV placement, central line placement, arterial puncture (ABG sampling) and arterial line placement, arthrocentesis, lumbar puncture, endotracheal intubation, and needle and tube thoracostomy. The exact procedures and number of procedures is dependent on patient presentations. Not all students perform all of the above procedures, but many do.
Student didactics are held the first two Tuesdays and Thursdays of the month with approximately 4 hours each day. The didactic sessions are composed of a mixture of small group discussions, lectures, student case presentations, and test reviews. Two sessions during each month are dedicated to advanced medical simulation and procedural skills practice. Multiple faculty members and chief residents are involved in each didactic session. Conference topics span the breadth of Emergency Medicine to include topics such as: Chest Pain, Toxicology and Airway Management. Attendance at all sessions is required to receive a passing grade for the course.
Additionally, there are resident conferences held every Thursday from 7:00-11:00 a.m. These conferences are attended by all Emergency Medicine residents. Attendance at these conferences is expected for students.
Students are assigned selected readings from the CDEM Clerkship Primer as well as a few from Rosen’s Emergency Medicine. Access to Rosen’s Emergency Medicine is provided for all students. The CDEM Clerkship Primer is available as a free download.
The final course grade will be calculated based on the score allocations below. The majority of the grade is based on individual faculty evaluation of students while working a clinical shift. Shift evaluation cards are used for this purpose. The mid-term covers the first half of the readings from the CDEM Clerkship primer and the lectures.
The post-test is a written exam covering all of the readings from the clerkship primer. All students receive a mid-month interim evaluation highlighted their strength and areas of possible improvement.
A thorough orientation session is held the first day of each month (and as needed for any off-cycle students). The session will include a tour of the department as well as information on the more technical aspects of the rotation (such as relevant UMMC policies, computer charting, phone numbers needed, etc).
The Emergency Medicine rotation differs from other rotations with regard to several important aspects. First, health care providers are able to participate in all aspects of adult emergency care since the department is not subdivided by medical specialty. In addition to managing the full range of medical problems, health care providers are exposed to patients with a wide variety of other diseases, which are surgical, gynecologic, obstetric, psychiatric, ophthalmologic, orthopedic, traumatic, and toxicologic. The patient population in the Emergency Department is quite diverse and includes all individuals aged 16 and older. All ethnic groups and socioeconomic levels are included. Patients are seen regardless of payment status.
Second, unlike inpatient settings, most patients in the ED have not been previously evaluated or stabilized. As a result, when a seriously ill patient presents, he or she must be evaluated and treated simultaneously.
Third, the 24-hour a day operation of the ED and the relatively short time frame in which decisions must be made precludes the use of prolonged observation and many diagnostic tests, forcing providers to sharpen their skills in making clinical decisions with limited data.
Fourth, despite economic and social pressures, the ED is neither a primary care facility nor a consulting service for previously identified problems. Rather than addressing each of the patient's medical problems, the role of the care provider in the ED is to identify emergency conditions and prioritize care to those problems.
Finally, the often simultaneous arrival of multiple patients to the ED necessitates concomitant care and will force everyone to provide quality, time-efficient medical care to each of several patients at once.
These differences result in a work environment that some will find challenging and exhilarating, but which others find stressful. The key to how individuals respond to this environment is in large part dependent on how comfortable they are seeing patients with problems outside of their prior experience, their ability to make prompt appropriate decisions based on limited data, and their ability to prioritize and organize multiple tasks simultaneously.
While effective decision-making, prioritization, organization, and realization of one's limitations are the keys to the successful practice of Emergency Medicine, these skills are applicable to all areas of medicine. Therefore, enhancing these skills during the ED rotation will be of general benefit to ALL students.