EMEU-4208 - Emergency Medicine Selective-Clear Lake

EMEU-4208 - Emergency Medicine Selective-Clear Lake

Elective Title: Emergency Medicine Selective-Clear Lake
Course Number: EMEU-4208
Elective Type: clinical Duration/Weeks: 4 Max Enrollment: 4
Prerequisites: Successful completion of Year 2
Additional Requirements: Successful completion of Internal Medicine or Surgery Clerkship
Responsible Faculty Director: Paul Koscumb, MD Periods Offered: 1-13 including holiday period 8 
Coordinator: Vanessa Phillips, valphill@utmb.edu Other Faculty: Gregory Rumph, MD; Robert Kaale, MD; Luke Murphy, MD
Location to Report on First Day:
UTMB Clear Lake, 200 Blossom Street, Webster, TX

The selective in Emergency Medicine is designed to provide exposure to medical students to the field of Emergency Medicine. Students will work within the General Competencies and Medical Education Program Objectives outlined by the John Sealy School of Medicine.

1. Provide a comprehensive view of Emergency Medicine ranging from the minute-to-minute care of the acutely ill or injured patient to high volume - low acuity ambulatory medicine.
2. Students will be included, as possible, in the diagnosis, treatment, and disposition of patients.
3. Students will gain experience in the initial assessment and management of emergency medicine problems.
4. Students will learn to prioritize and rapidly obtain a pertinent history and perform a directed exam appropriate for emergency situations.
5. Students are encouraged to ASSESS and REASSESS their patients until final disposition.
6. Students will obtain experience on differentiating patients requiring hospitalization from patients which can be managed as outpatients.
7. Students will learn short term management of outpatient illnesses.
8. Students will be encouraged to formulate clinically relevant evidence-based medicine questions appropriate for the case, and seek answers using a variety of resources including textbooks, online references, etc.
9. Students will be asked to contemplate on death and dying issues which arise in the ED.
10. Students will learn to work effectively as a member of a health care team. This includes the physicians in the emergency department, the nursing staff, ancillary support staff, as well as consulting physicians. Effective communication and interaction are valuable skills in any field, but perhaps none more so than in the emergency department.

1. Be able to understand and utilize the principles involved in emergency care.
2. Understand concept of Emergency ABC’s.
3. Learn the basics involved in the evaluation and stabilization of the acutely ill patient.
4. Learn how to perform the initial evaluation of the undifferentiated Emergency Medicine patient.
5. Be versed and experienced in those diagnostic and therapeutic procedures utilized in the evaluation and care of the emergency patient.
6. Be thoroughly familiar with the diagnostic and therapeutic maneuvers utilized in the care of the non-emergent patient in the Emergency Department.
7. Understand structure and functions of EMS systems.
8. Understand the management of patients with toxic exposures in general, along with specific, common overdoses in lecture and reading assignments.
9. Understand management of common environmental illnesses.
10. Sharpen procedure skills including phlebotomy, catheterization, suturing, splinting, etc.
11. Understand the indications for emergent/urgent consults and learn to establish appropriate referral relationships.
12. Recognize limitations of the Emergency Department.

Description of course activities
Students will be providing or supporting emergency care for acutely injured or ill patients in the emergency department (EDs). Under the direct supervision of faculty members, students will assess patients, formulate and implement patient care plans. In addition, they will observe, assist, and/or perform procedures as needed to care for their patients. Students will attend approximately 120 hours of clinical shift time in the Emergency Department, attend weekly didactics sessions/grand rounds (UTMB campuses), and other learning seminars/labs as scheduled. Depending on availability and offerings during that month, didactics and learning opportunities may supplement clinical shift time.

Type of students who would benefit from the course
Students seeking credit for their Emergency Medicine selective requirement. 3rd year students who have successfully completed the Internal Medicine or Surgery Clerkship, 4th year students seeking exposure and experience in the practice of Emergency Medicine.

    Weekly Schedule
          Estimated Course Activities (Start-Time/Finish-Time):
Day of Week   AM   PM
Monday Days vary, 5 12-hour shifts, 7a-7p Nights vary 4 12-hour shifts, 7p-7a
Tuesday Weekly Didactics at 7:30 am

 Average number of patients seen per week: 25
 Call Schedule: No

Research / Other Course Activities
(estimated schedule)
Activity Hours per Week
Faculty Contact-Time
Self-Directed Study

Method of Student Evaluation
1.  Clinical Observation
  A. Where are students observed on this elective?
    Inpatient Service   Ambulatory   Surgery   Standardized patients
Patients simulators   Other
  B. Frequency - How often are students observed clinically?
    Observed by the attendings throughout each shift
  C. Format - What method(s) are used to document the student's clinical performance?
    Daily oral feedback   End of period oral feedback   Written feedback

2.  Oral Presentation
  A. Audience - To whom does the student present?
  B. Frequency / Duration of Presentation(s)?
  C. Format - What guidelines are set for the student's presentation?
  D. Assessment - Who assesses the student's presentation performance?
    Self-assessment   Peer assessment   Faculty assessment
  E. Method of content selection
    Current cases  Student-selected topic   Assigned topic

3.  Written Assignment (H&P's, notes, papers, abstracts, etc.)
  A. Frequency of written assignment(s)?
    H&P observed and signed by faculty
  B. Format - What guidelines are set for the student's written work?
  C. Length of written assignment(s)?
    Abstract   Annotated bibliography   1 - 2 page paper   3+ page paper
  D. Are recent references required?   No    If yes, how are they selected?
  E. Method of content selection - e.g. student-selected, relate to cases, etc.?
  F. Audience - Who assesses the student's written performance?
    Peer Assessment     Faculty Assessment     Other

4.  Examination
    Oral   Written multiple choice   Written essay / short answer   OSCE

5.  Extra Course Activities
  What expectations do you have for the student to demonstrate participation in the elective (e.g. small group activities, seminars, thoughtful questions, providing resources, journal club, resident lecture attendance)?

6.  Additional Costs
  Please list any additional costs and/or purchases (books, materials, movies to watch, etc.) that are required for this course. Include an estimated total cost. If there are no additional costs, please enter "None".

7.  Other Modes of Evaluation
  Please explain below.

8.  If this course is an Acting Internship, please complete the following:
  A. Objectives for the AI should relate directly to the Entrustable Professional Activities (EPAs). Each AI should describe how the four key Year-4 EPAs that our school has identified as being Year-4 skills are assessed. The Year-4 objectives are:
1. Entering and discussing orders/prescriptions.
2. Give or receive patient handover to transition care responsibility.
3. Recognizing a patient requiring urgent or emergent care and initiating management.
4. Obtaining informed consent for tests and procedures.
Specify how the student will be given formative feedback on their clinical skills.

Year-4 students should demonstrate mastery of EPAs they developed in the clerkship year, including recommending and interpreting common diagnostic and screening tests, and performing general procedures of a physician. They should be able to demonstrate masterfully and independently skills they mastered in Years 2-3, including efficiently performing comprehensive admission-notes and succinct daily progress notes and perform accurate, concise, and hypothesis-driven clinical presentations, form clinical questions and retrieve evidence to advance patient care. They should be able to demonstrate basic understanding of and beginning mastery of collaborate as a member of the interprofessional team and identify system failures and contribute to a culture of safety improvement.

List advanced clinical skills that a student will be assured an opportunity to practice.

How specifically will this AI build on developing skills from the clerkship year to prepare students for internship?

What opportunities will typically be available to all students who take this AI (procedures, required presentations, etc.)? What opportunities may be available based on patient load/presentation or student initiative (ie. Writing a case report)?

An AI should have expectation of a minimum of 32 hours per week of clinical responsibilities. Duty hours should be capped at ACGME limits for an intern, thus up to 24 hours followed by 4 hours of activities related to patient safety, education, and handoff. Students cannot work more than 80 hours per week averaged over 4 weeks. They can only have 1 day off in a 7-day work week with 8 hours off between shifts.

Clinical responsibilities will vary depending on specialty, but how is the student functioning with work commensurate to a PGY1 with an appropriate level of training?

How is the student demonstrating drawing clinical conclusions and/or developing a management plan and documentation as an intern would do?

How and by whom will midpoint feedback be provided to the student? How will you remediate deficiencies identified at midpoint?

Acting Internship students often seek letters of recommendation following their experience. How many different Faculty will work directly with the student and have knowledge of the student's abilities to detail in a written evaluation? Describe the degree of supervision and interaction with faculty vs. residents or other providers and how feedback will be obtained if more direct work is with residents or other providers.