LSUHSC EMERGENCY DEPARTMENT
Dr.__________________________,
You are assigned to the ED for the month of__________________.
Orientation: Mandatory for all interns, (day, night or off shift) at 7am on the
first day of the month.
Schedule: A choice of a prearranged schedule will be available on a first come
first serve basis around the middle of the month preceding your schedule rotation in the
emergency medicine office. Please see Kathy or the scheduling chief for schedule
template.
Responsibilities: Interns and Residents are expected to manage their individual
patients as well as assist in other areas as needs arise. It is the expectation that the
intern and resident will work in harmony with the ER RN to accomplish all tasks.
Conference: All resident are expected to attend EM conference and journal
club.
Procedures: All procedures must be recorded in New Innovations.
Supervision: You will be supervised by board certified Emergency Medicine
physicians.
Evaluations: Monthly evaluations via New Innovations.
Meals: Resident Responsbility, although food is available in the hospital’s
Resident Lounge.
What follows are the goals and objectives for the ED rotation, that will range from a 2
week to 1 month rotation, as assigned by the Program Director. The rotation will take
place in the LSU ED. The year of training may include PGY 1-5.
GOALS and OBJECTIVES
At the completion of rotations in the LSU ED, the intern/resident will be able to:
1) Perform basic assessment of patients with a variety of moderate and major
traumatic conditions.
2) Formulate a differential diagnosis for patients with various kinds of traumatic
conditions and mechanisms of injury.
3) Order and interpret appropriate diagnostic laboratory and imaging studies for
trauma patients.
4) Understand the interrelationships of the pre-hospital, emergency department,
and in-house trauma team and perform as a team member of the emergency
department trauma team.
5) Competently perform minor procedures such as suturing of lacerations, incision
and drainage of the abscesses, insertion of nasogastric tubes and urinary
catheters, venipuncture, insertion of peripheral intravenous catheters, lumbar
puncture, splinting of fractures and sprains, spinal immobilization.
6) Demonstrate basic understanding of the principles of ACLS resuscitation as
applied to persons in cardio-respiratory arrest.
7) Achieve ability to perform an adequate history and physical exam, prioritize
conditions, and form a differential diagnosis in adults with acute and chronic
medical problems of varying severity presenting to the ED for care.
8) Learn proper methods for stabilization of patients with life threatening
conditions such as sepsis, respiratory failure, acute MI, CHF, status epilepticus,
status asthmaticus, cardiac arrhythmias, severe GI bleeds, and overdose.
9) Learn to evaluate, diagnose and initiate any needed therapy for a variety of
specific medical problems such as asthma, seizures, anemia, stroke, GI disorders,
urinary tract infections, pneumonias, and other respiratory illness.
10) Learn to evaluate and appropriately manage a variety of patient complaints such
as chest pain, abdominal pain, dizziness, headache, syncope, etc.
11) Learn to perform an adequate history and physical exam in female patients with
gynecologic problems or problems related to early pregnancy including
abdominal bleeding, infection, threatened abortion, and ectopic pregnancy.
12) Learn appropriate use of diagnostic lab and imaging studies for emergency
patients and to have basic competence in their interpretations.
13) Learn to use the following diagnostic aids: central venous pressures, pulse
oximetry, arterial blood gases, EKG’s.
14) Perform the following procedures with basic competency and to know
indications and contraindications: venipuncture, starting an IV or heparin lock,
arterial puncture, insertion of a Foley catheter, placement of a central venous
line, thoracentesis, paracentesis, lumbar puncture, urinalysis with microscopic,
wet prep of vaginal secretions.
15) Become familiar with common medico-legal problems which present in
emergency medical practice such as: consent, desertion, AMA, restraints,
impaired patients, child or adult abuse or neglect.
16) Be able to arrange appropriate follow-up for discharged patients and give
adequate discharge instructions.
17) Learn and use the available contributions of the Social Services Dept. to patient
care in the ED and for discharge planning.
18) Learn appropriate medical evaluation of mentally disturbed patients including
techniques for restraint and control of violent patients.
Residents and interns will participate in the management of all emergency department
patients under the supervision of emergency medicine faculty.
The clinical and didactic experiences used to meet those objectives included daily
patient care of the MCLANO Emergency Department patients, along with bedside
teaching. The rotating resident is to attend lectures as part of the greater emergency
medicine curriculum, as scheduled by the LSU EM residency program.
The feedback mechanisms and methods used to evaluate the performance of the
resident include daily self and faculty evaluations.. Immediate feedback may also be
given to the resident, and any significant problems will be discussed during the rotation
with the LSU EM administration.
The resources and facilities in the institution that will be available to each resident
include computer access to Up To Date and the LSU Library services, including current
texts in surgery and emergency medicine. The residents will have access to the
resources of the hospital including call rooms, the LSU Medical Library, Emergency
medicine texts, medical records and meals.
The clinical experiences, duties and responsibilities the resident will have on the
rotation: Residents will act as a part of the Emergency Medicine team under the
supervision of a staff physician. The residents will participate in the management of
patients in the emergency department.
The relationship that will exist between emergency medicine residents and faculty on
the service: The overall goals of resident education and patient care will govern the
relationship between faculty and residents. Residents will receive 24 hour supervision
while on the rotation. All patient care and medical charts will be reviewed and signed by
the EM faculty prior to patient discharge.
Duty hours for this rotation will not exceed an average of 60hrs/week, call not longer
and will include 1 in 7 days off.
MCLANO ED: Specific Competency-based Goals & Objectives: PGY1-4/5
1. While in the MCLANO ED, the resident will demonstrates skill in “Data
Gathering” that includes but not limited to:
a. PGY1: Perform an appropriate focused history and physical exam (* PC, MK,
ICS, PR)
b. PGY2: Appropriate ordering and interpretation of ancillary tests (* PC, MK,
SBP)
c. PGY3: Gather essential and accurate information from all available
sources (* PC, SBP)
d. PGY4 Challenges assumptions. Able to establish rapport in order to
obtain historical date in difficult situations. (* PC, IPC & PR)
2. While in the MCLANO ED, the resident will demonstrates skill in “Problem
Solving” that includes but not limited to:
a. PGY1: Generate an appropriate and complete differential diagnosis for an
undifferentiated patient (* PC, MK)
b. PGY2: Appropriate organization of data collection in relation to patient
management decisions (* PC, MK, PBL)
c. PGY3: Generate an expanded differential diagnosis including possible
atypical presentations (* PC, MK, PBL)
d. PGY4: Able to supervise and teach problem-solving skills to lower level
residents. (* PC, MK, PBL)
3. While in the MCLANO ED, the resident will demonstrates skill in “Patient
Management” that includes but not limited to:
a. PGY1: Development of a basic treatment plan (* PC, MK, SBP)
b. PGY2: Prompt recognition and appropriate emergency stabilization of the
unstable patient (*PC, MK, SBP)
c. PGY3: Institutes appropriate advanced treatment plans autonomously (*
PC, MK, ICS, PR, SBP)
d. PGY4 Multitasks, appropriately utilizes resources, facilitates patient flow.
(* PC, MK, ICS, SBP)
4. While in the MCLANO ED, the resident will demonstrates skill in “Medical
Knowledge” appropriate for level of training that includes but not limited to:
a. PGY1: Demonstrates a basic fund of medical knowledge (*MK)
b. PGY2: Understands the scientific basis for their decisions (*MK, PBL)
c. PGY3: Demonstrates an advanced fund of medical knowledge (*MK)
d. PGY4: Demonstrates an advanced fund of knowledge and challenges
assumptions using problem-based learning techniques. (*MK, PBL)
5. While in the MCLANO ED, the resident will demonstrates technical proficiency in
“Procedural Skills” consistent with level of training that includes but not limited
to:
a. PGY1: Suturing, lumbar puncture, splinting, I/D abscess (*PC)
b. PGY2: Endotracheal intubation, central venous access, direction of
medical and trauma resuscitation (*PC)
c. PGY3: Conscious sedation, ultrasound, and direction of medical and
trauma resuscitation (*PC)
d. PGY4: As above, but also skilled in teaching procedures to lower level
residents.
6. While in the MCLANO ED, the resident will demonstrates skill in “Efficiency” of
care that includes but not limited to:
a. PGY1: Effectively manages 1 patients per hour (*PC, MK, SBP)
b. PGY2: Effectively manages 1.5 patients per hour (*PC, MK, SBP)
c. PGY3: Effectively multi-tasks and adjusts to increased patient care
demands as needed, with a goal of 2 patients per hour (*PC, MK, SBP)
d. PGY4 Effectively multi-tasks and adjusts to increased patient care
demands as needed, with a goal of >2 patients per hour (*PC, MK, SBP
7. While in the MCLANO ED, the resident will demonstrate appropriate
“Interpersonal and Communication Skills” that includes but not limited to:
a. PGY1: Demonstrates effective information exchange with patients, their
families, and professional associates (*ICS, PR)
b. PGY2: Demonstrates appropriate conflict resolution skills (*ICS, PR)
c. PGY3: Works effectively with others as a leader (*ICS, PR)
d. PGY4: Teaches leadership skills
8. While in the MCLANO ED, the resident will demonstrate appropriate
“Professionalism” that includes but not limited to:
a. PGY1: Introduces self to patient and/or family (*PR)
b. PGY2: Respectful of patient’s privacy and confidentiality (*PR)
c. PGY3: Demonstrates respect, compassion, and integrity (*PR)
d. PGY4: Models and teaches respect, compassion, and integrity (*PR)
9. While in the MCLANO ED, the resident will demonstrates skills in proper
“Documentation” that includes but not limited to:
a. PGY1: Medical record is accurate, complete, timely, and appropriate (*PC)
b. PGY2: Appropriately documents medical decision making (*PC)
c. PGY3: Documents MCLANO ED course including re-evaluation of patient
if applicable (*PC)
d. PGY4: Models and teaches appropriate and timely documentation in the
ED to lower leve residents. (*PC)
10. While in the MCLANO ED, the resident will demonstrates an understanding of a
“Systems-Based Practice” that includes but not limited to:
a. PGY1: Understands basic resources available for care of the emergency
department patient (*SBP)
b. PGY2: Utilizes the consultation process appropriately (*SBP, PC)
c. PGY3: Provides appropriate medical command to pre-hospital providers
(*SBP, PC)
d. PGY4 : Models and teaches Systems-Based Practice to lower levels. (*SBP,
PC)
11. While in the MCLANO ED, the resident will demonstrate an awareness of the
importance of “Practice Based Learning and Improvement” that includes but
not limited to:
a. PGY1: Uses appropriate information resources (ie, texts, online web sites,
etc.) for care of patient (* PBL, PC)
b. PGY2: Applies knowledge of scientific studies to care (* PBL, PC)
c. PGY3: Facilitates the learning of professional associates (* PBL, MK)
d. PGY4: Models and teaches practice based learning to lower levels. (* PBL,
MK)
(* denotes core competency area: PC-Patient Care, MK-Medical Knowledge, ICS-Interpersonal and Communication
skills, PR-Professionalism, SBP-Systems Based Practice, PBL-Practice Based Learning and Improvement).
This rotation summary has been reviewed and agreed to by the service director and LSU
Program Director.