PACE New Clerkship Proposal: Emergency & Urgent Care Clerkship

1. PACENew Clerkship Proposal:Emergency & Urgent CareClerkship USF Curriculum Committee Retreat December 16, 2004

2. Emergency & Urgent Care Clerkship Clerkship Development Subcommittee Members • Charlotte Derr, MD Emergency Medicine • Jeff Fabri, MD GME/Surgery • Steven Goldin, MD Surgery • Richard Hoffmann, MD Internal Medicine • Chester Kokseng, MD Internal Medicine • Kelly O’Keefe, MD Emergency Medicine • David Orban, MD Emergency Medicine • Marion Ridley, MD Otolaryngology • Damian Caraballo MS-II • Janelle Fauci MS-II • Brooke Shepard MS-IV • Corinne Stobaugh MS-II

3. Emergency & Urgent Care Clerkship Subcommittee Meetings • October 7, 2004 • October 14, 2004 • October 21, 2004 • October 28, 2004 • November 4, 2004

4. Emergency & Urgent Care Clerkship Previous Designations: • Special Sites of Care • Special Sites of Care & Procedures • Sites of Care & Procedures • Sites of Care • Triage & Urgent Care • Triage, Urgent Care & Procedures • Emergency Care & Procedures

5. Emergency & Urgent Care Clerkship Brief Summary: A required four-week clerkship for all third-year medical students based on encounters with patients presenting with emergent and urgent complaints and/or symptoms prior to definitive diagnosis, and the development of competence in basic medical procedures.

6. Emergency & Urgent Care Clerkship Expected Outcomes • Ability to perform a symptom-directed history and physical examination of patients upon initial presentation in emergency and urgent care settings. • Ability to institute appropriate initial management of emergent and urgent medical problems.

7. Emergency & Urgent Care Clerkship Expected Outcomes • Ability to determine indicated additional testing and/or consultation for definitive care of more complex medical problems. • Ability to communicate effectively with the broad spectrum of patients and their families in order to obtain the relevant information necessary to determine an appropriate course of action for the patient’s care.

8. Emergency & Urgent Care Clerkship Expected Outcomes • Ability to perform routine medical procedures: • Venipuncture • Intravenous line placement • Obtaining arterial blood • Bladder catheterization • Endotracheal intubation • Nasogastric intubation • Lumbar puncture • Suturing of simple and deep lacerations

9. Emergency & Urgent Care Clerkship Expected Outcomes • Perform routine procedures (continued) • Fracture splinting • Wound dressing • Chest tube placement • Thoracentesis • Paracentesis • Pericardiocentesis • FAST (focused assessment by sonography in trauma)

10. Emergency & Urgent Care Clerkship Methods for Attaining Competencies • Didactic lectures • Live • Web-based • Skills laboratories • Cadaver • Patient simulator • Vivarium • Portfolio development • Procedures log • Written presentations • Oral presentations • Small group discussions/problem-solving sessions

11. Emergency & Urgent Care Clerkship Portfolio Development • 4 written presentations (1/week) on a patient evaluated by the student (1 patient per group) • Abdominal pain • Chest pain • Musculoskeletal pain/trauma • Dyspnea • Common infections/fever • Change in mental status/coma • Headache • Major trauma

12. Emergency & Urgent Care Clerkship Portfolio Development (cont.) • Presentations to include patient presentation, interpretations of laboratory tests and imaging, differential diagnosis, and evidence based evaluation and treatment. • Maintenance of log of: • Procedures observed • Procedures assisted • Procedures performed • Diagnoses of patients evaluated

13. Emergency & Urgent Care Clerkship Integrated Longitudinal Curriculum Topics • Evidence Based Medicine/Best Practices • End of Life Care • Ethics • Pain Management • Laboratory Medicine • Patient Safety & Medical Errors • Professional Communication • Radiology • System Based Practice

14. Emergency & Urgent Care Clerkship Educational Objectives KNOWLEDGE • To know the appropriate use of methods and procedures for detection, diagnosis, and treatment of disease states at their initial presentation. • To know the theories and principles that govern ethical decision-making in the emergency setting. • To know the components of healthcare that influence the organization, financing, and delivery of health care in hospital emergency departments.

15. Emergency & Urgent Care Clerkship Educational Objectives SKILLS • To perform a directed history and physical examination in the emergency setting. • To identify the indications for and interpret the results of commonly used diagnostic procedures in the emergency setting. • To appropriately document patient encounters in the emergency setting.

16. Emergency & Urgent Care Clerkship Educational Objectives SKILLS (cont.) • To develop an appropriate plan of management and institute therapy in the emergency and urgent care settings. • To communicate effectively in the care of patients. • To assess the level of acuity and initiate appropriate therapy in patients at initial presentation.

17. Emergency & Urgent Care Clerkship Educational Objectives SKILLS (cont.) • To perform routine medical procedures including venipuncture, intravenous line placement, obtaining arterial blood, bladder catheterization, endotracheal intubation, nasogastric intubation, suturing of simple and deep lacerations, fracture splinting, wound dressing, chest tube placement, thoracentesis, paracentesis, pericardiocentesis, and FAST.

18. Emergency & Urgent Care Clerkship Educational Objectives ATTITUDES • To advocate, be compassionate, and ameliorate suffering of patients in emergency and urgent care settings. • To demonstrate honesty, integrity, and sensitivity in all interactions with patients’ families, colleagues and other health care providers.

19. Emergency & Urgent Care Clerkship Educational Objectives ATTITUDES (cont.) • To incorporate the relationships of cost, risk, and benefit in patient evaluation and management. • To demonstrate a commitment to the ethical practice of medicine. • To demonstrate a commitment to collaborate in a team approach for the care of patients.

20. Emergency & Urgent Care Clerkship Educational Objectives ATTITUDES (cont.) • To demonstrate a commitment to the provision of care to all patients including the underserved and to promote the health of the public. • To work with patients and their families in making shared treatment and health care decisions.

21. Emergency & Urgent Care Clerkship Clerkship Components • 120 students = 10 students each rotation • 2 weeks acute care emergency department (TGH) • 5 students • 2 weeks urgent care center (VA, community) • 5 students • ½-day orientation on first day of clerkship • 4 eight-hour shifts/week to include day, evening, night and weekend assignments • 1 day/week (Friday) lecture, skills lab, conference, oral presentations

22. Emergency & Urgent Care Clerkship Major Diagnoses/Encounters Required • Abdominal pain 6 patients • Chest pain 6 patients • Extremity pain/trauma 6 patients • Dyspnea 4 patients • Common infections/fever 4 patients • Change in neurologic status 4 patients • Headache 4 patients • Major trauma 2 patients

23. Emergency & Urgent Care Clerkship Procedural Skills Development • Venipuncture 4 patients • Intravenous line placement 4 patients • Arterial puncture 4 patients • Bladder catheterization 2 ♂, 2 ♀ • Nasogastric intubation 2 patients • Endotracheal intubation Skills lab • Lumbar puncture Skills lab • Suture lacerations 8 patients

24. Emergency & Urgent Care Clerkship Procedural Skills Development (cont.) • Fracture splinting 4 patients • Wound dressing 8 patients • Chest tube placement Skills lab • Thoracentesis Skills lab • Paracentesis Skills lab • Pericardiocentesis Skills lab • FAST 2 patients

25. Emergency & Urgent Care Clerkship Measurement of Student Accomplishment • Direct observation • Patient encounters • Procedures performed • Oral presentations at weekly conference • Preparation and participation in group discussions • Evaluation of portfolio • Written examination