LONGITUDINAL EM CURRICULUM - LSU
Emergency Medicine (EM) as a discipline is a critical component of a well-rounded undergraduate
medical education. The LCME recognizes that "educational opportunities must be available in
multidisciplinary content areas, such as emergency medicine ..." (ED-17) Furthermore, EM provides a
unique and broad setting in which to develop and evaluate the core competencies set forth by the
ACGME as central to the proper education and training of physicians.
Recognizing that EM is best conceptualized and taught as a longitudinal curriculum throughout all years
of undergraduate medical school, other academicians have proposed goals of EM student education:
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acquisition of basic life support (BLS) skills and basic procedural skills
differentiation and treatment of common acute problems
assessment of the undifferentiated patient
(Burdick et al., Acad Emerg Med 1998)
These core tenets can be taught beginning in the first year of medical school, and proceeding in depth
and breadth throughout the student's career. In detail,
Acquisition of BLS skills and basic procedure skills:
Undergraduate learners should
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be able to recognize the patient with a serious, life-threatening condition that requires
immediate attention
understand how to prioritize attention to and care of those patients with the most serious
conditions (triage)
take the first steps necessary to stabilize a patient or save a life, specifically
 non-invasive airway techiniques (opening maneuvers)
 respiratory support (BVM)
 circulatory assistance (external hemorrhage control, fluids)
recognize serious neurologic insults and poisonings
Differentiation and treatment of common acute problems:
Undergraduate learners should
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have basic knowledge of conditions that commonly affect the general public, by organ system
and disease process, their diagnosis and management, to include:
 chest pain
 respiratory infections/colds
 headache
 minor trauma
 basic orthopedic complaints (back pain, fractures, sprains)
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abdominal pain/nausea & vomiting
common infections (absesses,cellulitis, UTI, pharyngitis, otitis media, etc)
dermatologic complaints (rashes/burns)
eye complaints
gynecologic conditions
Assessment of the undifferentiated patient:
Undergraduate learners should:
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be able to provide a broad differential of an acutely ill patient, with appropriate focus on the
most common diagnoses given the particular clinical situation
appropriately target testing, treatment & management of the undifferentiated patient and
follow the case to resolution and disposition
Suggested methodologies and content areas by year of training have been proposed and are detailed
below.
First Year Medical Students
Focus: first aid/BLS
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exposure to/first aid training in:
 airway obstruction, altered mental status, shock, simple burns/lacerations, extremity
injuries
introduction to history taking/physical exam, counseling & communication skills
Objectives:
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perform mouth-to-mouth/mask ventilation/chest compressions on mannequin
understand how/when to activate 911/emergency response system
provide first aid for choking
perform simple airway opening maneuvers (chin lift/jaw thrust)
take a pulse and blood pressure correctly
understand & apply initial pain control measures, dressings and splints for simple burns &
extremity injuries
Means of Implementation:
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ED/EMS observation period
BLS instruction, reading materials & certification
DxR cases (many ED-based) for introduction to history taking/physical exam
cadaver/simulation labs for basic and advanced procedural techniques
Second Year Medical Students
Focus: basic concepts of emergency care
exposure to toxicology, pharmacology, physiology and pathology
ED-set case-based learning to demonstrate practical applications of preclinical tenets
instruction in simple procedural skills (IV, venipuncture, Foley catheters, etc)
increase proficiency in history taking and physical exam skills
Objectives:
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be able to perform a basic, focused history and physical exam on an undifferentiated patient
be able to perform simple airway techniques (BVM, oxygen application) and basic procedures
(IV, venipuncture)
Means of Implementation:
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students will be exposed to basic history & physical exam skills through DxR cases and the SPM
course, during which the interviewing of patients in the ED is encouraged
ACLS lectures and simulation labs
basic skills labs for simple techniques
Third Year Medical Students
Focus: become familiar with the course of disease from ED through inpatient wards/outpatient clinics
become competent with basic clinical procedures
become competent with basic history taking/physical exam
Objectives:
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perform a targeted history & physical of the undifferentiated patient, and generate a differential
diagnosis addressing possible urgent and emergent conditions
understand the usual course of care/disposition for patients presenting with common medical
conditions
perform common procedures and techniques:
 airway (including endotracheal intubation)
 oxygenation (nasal cannula, mask, BVM, pulse oximetry, ABG)
 venipuncture/IV access/fluid administration
 NG tube, Foley catheterization
 wound care
Means of Implementation:
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dedicated experience in the ED (3 week elective or 2-4 days while on ambulatory clinics)
simulation labs/didactic lectures dealing with emergency patients
exposure to the ED on consulting services (Medicine, Surgery, OB)
Fourth Year Medical Students
Focus: evaluation of undifferentiated patients in the ED setting
apply clinical knowledge to "hands-on," real-time patient settings
emphasis on clinical reasoning skills/application of textbook learning
advanced cardiac life support and resuscitation skills
elective opportunities: toxicology, ultrasound, pediatrics, critical care, research
understand the roles of the members of the health care team and how to function within the team
Objectives:
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perform a focused history and physical exam, develop a broad differential diagnosis, provide a
treatment and management plan for undifferentiated patients in the ED
demonstrate competence in basic resuscitation skills as well as more advanced techniques
(endotracheal intubation, central venous access, defibrillation, administration of advanced life
support medications, trauma resuscitations, ultrasonography)
understand the impact of health care systems, resource allocation, cultural differences and
access to care for patients presenting to the ED
understand situations that are unique to EM: acute critical illness; acute intoxications;
relationships with pre-hospital providers; disaster medicine/mass casualty events; death
notifications for sudden unexplained death; environmental exposures; time-constrained patient
care and decision making
Means of Implementation:
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four-week clinical rotation in the University Hospital ED
observed standardized clinical examinations to assess history and physical skills and patient
management
complementary didactic lectures, online modules, simulation and procedure labs
learn time management/efficiency skills to improve ability to manage multiple patients at once
formal examination to assess acquisition of knowledge of emergency care and disease processes
Sources: Burdick WP et al, Acad Emerg Med 1998; Manthey DE et al, Annals Emerg Med 2006; DeBehnke
DJ et al, Acad Emerg Med 1998; Hobgood C Isr J Emerg Med 2009.
FIRST YEAR MEDICAL STUDENTS
1. Cadaver Labs
Medical students are instructed by EM residents in basic common and life-saving procedures using
their cadavers. Procedures include:
endotracheal intubation
central venous access
tube thoracostomy
Foley catheter insertion
lumbar puncture
2. L1 OBSERVATION
Each first-year medical student will spend a four-hour observation period in the University Hospital
ED. During this period, they will:
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observe EM practice, emergency medical systems (EMS), and the application of basic and
advanced life support skills in a real-time setting.
observe practical history taking and physical exam skills in the acute undifferentiated patient
Opportunities listed above are complementary to the standard first year curriculum, which should
include:
BLS instruction/certification (didactics/simulation lab)
introduction to history & physical exam (SPM/DxR cases)
SECOND YEAR MEDICAL STUDENTS
1. ACLS lectures/simulations
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Students will be taught pharmacologic and physiologic concepts of advanced cardiac life support
by EM faculty
2. ED observation volunteer opportunities
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Through the Emergency Medicine Interest Group (EMIG), students may elect to do brief
observation periods in the ED to further their understanding of the practice of EM as well as
resuscitation techniques, critical illness management, and procedures
Opportunities listed above are complementary to the standard second year curriculum, which should
include:
Instruction in physiology of common disease processes (didactics)
further introduction and practice of history & physical exam (Dxr/SPM)
simulation/procedure labs for basic and advanced resuscitation and procedural skills
THIRD YEAR MEDICAL STUDENTS
1. L3 AMBULATORY EXPERIENCE
During their Internal Medicine core block, students will spend between 2-4 clinical shifts in the ED.
Shifts will take place both in the Main ED and the Urgent Care/Fast Track, so as to expose the student to
the greatest variety of patient presentations. During this rotation, students will:
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work under the supervision of board-certified EM faculty and residents and be responsible for
performing a history and physical exam on ED patients presenting for care
develop a differential diagnosis and participate in the development of treatment and
management plans for the patient
assist with performance of emergent procedures and resuscitation techniques for their patients
2. L3 CLINICAL PLANNING ELECTIVE (CPE)
For the student planning a career in Emergency Medicine, the 3-week CPE is available in the third year in
order to provide sufficient exposure for an informed career decision. During this elective, the student
will:
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meet with Dr. Jennifer Avegno and/or Dr. Micelle Haydel (EM Residency Program Director)
at least once to discuss interest in EM, career goals, objectives for the remainder of medical
school and residency application;
work a total of 10 clinical shifts, divided between the Main ED and Urgent Care/Fast Track,
with patient care responsibilities as befitting a third-year student. When there is a teaching
resident and/or senior EM resident on shift, the CPE student will primarily work with that
resident to coordinate patient care;
attend EM resident conference each Wednesday morning from 7-11 am in order to
understand the EM approach to academics and core knowledge required of an EM
physician.
write a short (500 word) essay at the completion of their CPE detailing their experience in
the ED, and how it has informed their future plans.
Grading for this elective will be P/F only.
Opportunities listed above are complementary to the standard third year curriculum, which should
include:
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exposure to the ED on consulting services
simulation and procedure labs dealing with acute critical illness on other services
FOURTH YEAR MEDICAL STUDENTS
L4 SENIOR ELECTIVE IN EMERGENCY MEDICINE
Students planning to pursue any specialty can benefit from an in-depth exposure to EM, as our specialty
has a broad application to many aspects of medicine. During this rotation, senior students will:
1. work 12 clinical shifts in the ED (Main ED and Urgent Care/Fast Track). Student schedules will
mirror those of rotating interns, as senior students are considered "acting interns" or "subinterns" on their EM rotation. Students will gain experience with managing multiple patient
workups at once, and learn efficiency and appropriate management skills.
2. be responsible for full evaluation and care of patients from start to finish, including: full history
and physical exam; development of treatment and management plans under supervision of EM
residents and faculty; assistance with or supervised performance of any necessary resuscitation
or procedures on their patients.
3. participate in team resuscitation efforts for acute, critically ill trauma and medical patients.
4. be responsible for reading provided material on EM core topics, as well as attending didactic
lectures, simulation and procedure labs, and completing selected online learning modules.
5. perform at least one Observed Structured Clinical Exam and receive feedback on history and
physical exam skills.
6. take an end of rotation exam designed to assess their acquisition and understanding of core EM
topics.
7. participate in a team approach to patient care.
8. develop an understanding of health care system delivery, resource allocation, cultural diversity
and access issues as they pertain to ED patients.
This rotation should provide the student with the exposure to all of the core competencies required of a
medical student rotation, namely:
Patient care:
1,2,3,7
Medical knowledge:
2,4,5,6
Practice-based learning:
4
Interpersonal/communication skills:
Professionalism:
7,8
System-based practice: 8
2,7