Rotation: Emergency Medicine
Elective - Northwest
Site:
- Emergency room, Northwest Texas Hospital
Instructors:
- Dr. Steve Neumann and ER physicians
Makeup of team (responsibility of each team member):
- Resident (either PGY-1 or advanced): Will initially evaluate patients as selected by the ER attending. The resident performs a problem-focused exam and develops a differential diagnosis and treatment plan with the attending. Diagnostic testing and further treatment will then be initiated. Unstable patients will be jointly assessed by the resident and attending, at least until the resident has demonstrated skill in managing the unstable patient. The resident will make sure that all diagnostic results and therapeutic trials have been obtained and will then review disposition with the ER attending.
- One attending: supervises the resident, oversees the diagnostic plan, supervises procedures and agrees to final disposition with the resident. The attending instructs the resident in the principles of efficient emergency care, provides instruction and feedback to the resident.
Days per week (night call):
- The rotation consists of 15 twelve hour shifts. Day shifts are from 7 am to 7 pm and night shifts are from 7pm to 7am. A shift that is missed for any reason must be rescheduled.
Usual time of attending rounds:
- Attendings are present at all times during the resident's shift. Interaction will be ongoing throughout the 12 hour shift. Didactic topics will be discussed during the shift as time allows.
Type of patients encountered:
- A wide variety of patients will be seen, but the emphasis will be on acute presentation of illnesses in adult patients. Residents will be exposed to some obstetrical and gynecological emergencies, and the stabilization of trauma patients will also be addressed. Both genders will be seen in approximately equal proportions; a broad range of ethnic groups will be encountered.
Educational goals/competencies:
Patient care:
The resident will learn to develop a differential diagnosis and treatment plan with emphasis on emergency medical and surgical conditions that represent an immediate threat to the life or welfare of the patient.
The resident will gain exposure to w wide range pf patient problems that may not be encountered elsewhere in IM training (pediatrics, trauma, obstetrics, orthopedics).
The resident will learn to stabilize critically ill or injured patients.
The resident will be able to determine which patients can safely be discharged from the emergency department for follow-up care, and which patients require inpatient care.
The resident will gain proficiency at simple laceration repair and the incision and drainage of simple abscesses. The patient will gain exposure to other procedures such as lumbar puncture, central venous access and endotracheal intubation.
Medical knowledge:
Residents will learn to evaluate patients with these problems: chest pain, respiratory distress, abdominal pain, severe headache, alteration in consciousness, stroke, fever, shock and hypotension, fluid and electrolyte abnormalities, skin rash, epistaxis, red eye, drug overdose, vaginal bleeding, acute musculoskeletal pain, and seizures. Residents will learn to identify an acute decompensation in those with chronic illness and will learn to efficiently and effectively use laboratory and imaging procedures in patients with acute medical problems.
Interpersonal/communication skills:
Residents will learn how to quickly obtain pertinent information from the patient, family members, bystanders, or other members of the health care team (i.e. nurses, EMTs). Issues of confidentiality will be emphasized. Residents will develop skills in clear and understandable communication of instructions to patents and family members.
Professionalism:
Residents will learn to function as a team with attendings, nurses, EMTs, respiratory therapists, etc. All members of the team will be accorded respect and their input will be sought.
Patients under the stress of an acute illness can be difficult. Residents will learn to identify the difficult situation and to deal with it effectively. Conflicts between health care givers and the patient will be managed to help the patient learn how best to return to good health.
Practice based learning:
Residents will learn to keep up with current literature and best practice. An open minded ability to critically asses one's habits and practice will be encouraged.
Systems based practice:
A wide variety of patients can be encountered in the emergency department. Some will be indigent or medically underserved; in these patients social workers and discharge planners will be an invaluable asset and will work with the residents in establishing a treatment plan. The resident will learn cost-effective treatments, how to access indigent care systems ( including the Amarillo Hospital District), how to use the Wyatt Care Plan (e.g. in setting up outpatient enoxaparin treatment rather than inpatient admission for the treatment of DVT), how to access alcohol and substance abuse treatment programs, and the differences between various insurance plans (e.g. the drug coverage programs of Medicaid, the absence of same for Medicare).
Text/references to be consulted:
Manual of Emergency Medicine by Jenkins and Brown. The following should be read at a minimum before or during the rotation:
- Trauma
- Epistaxis
- The Red Eye
- Respiratory Disorders
- Cardiovascular Disorders
- Abdominal Pain
- GI Bleeding
- Nausea and Vomiting
- Sexually Transmitted Disorders
- Testicular and Scrotal Problems
- Vaginal Bleeding
- Neurologic Disorders
- Musculoskeletal Disorders
- Evaluation of Psychiatric Patients
- Evaluation of the Suicidal Patient
- Evaluation of Substance Abuse Patients
Methods of evaluation:
The resident's performance will be evaluated by each individual attending and a summary will be completed by the rotation director. A standard departmental evaluation form will be utilized. There is no written exam.