Emergency Medicine, PGY2
I.
Rationale
Many family practitioners need emergency skills for use in small emergency rooms or for patient
management in their office. The emergency department allows access to a higher acuity of patient
problem in a more intensive setting to focus on acute assessment and management of the patient.
This rotation is aimed to the unique and critical elements that might not be adequately addressed in
other curricular areas (e.g., medicine, pediatrics, surgery, obstetrics, orthopedics, ophthalmology).
It is assumed that management of acute emergent conditions in each required specialty rotation is
adequately addressed within those curricula.
II.
Goals
Patient Care / Medical Knowledge
A. Develop a broad knowledge base of symptoms and diagnoses that present in the
emergency department in all ages of patients.
B. The resident will learn to independently assess patients who present to the Emergency
room
Interpersonal Skills and Communication Skills
A. The resident should develop strong interpersonal and communication skills, to enable
efficient and accurate gathering of patient histories and effective explanation/discussion of
treatment options and plans.
B. The resident should develop effective communication skills in interaction with other
members of the healthcare team in order to effectively in order to facilitate optimal patient
care.
Practice Based Learning
A. The encounter with the patient and the parents will trigger the graduates’ lifelong interest
in maintaining and updating skills and knowledge as essential for delivering safe and high
quality patient care.
B. Residents must be able to investigate and evaluate their patient care practices, appraise
and assimilate scientific evidence, and improve their patient care practices.
C. Residents must be proactive in obtaining the skills and knowledge needed to effectively
treat patients with urgent and/or emergent medical problems.
Systems Based Practice
A. Recognize personal practice limitations and understand the role of other health care
providers and resources in providing optimal care to patients with urgent and/or emergent
medical problems.
B. Understand the role of various health care providers and disciplines in the transition of care
from ambulatory to Emergency care, and emergency care to inpatient care and vice versa.
Professionalism
A. The resident must show a commitment to carrying out professional duties, in a responsible
manner, and adhering to ethical principles in order to deliver optimal patient care at all
times.
Last Updated April 19, 2013
III. Objectives:
Patient Care / Medical Knowledge
A. Develop a broad knowledge and demonstrate the ability to apply knowledge in the following
areas
1. Injuries - Major trauma (blunt and penetrating), lacerations, common fractures, open
fractures, soft tissue injuries, joint injuries, foreign bodies, burns
2. Hemodynamic- hypertensive crisis, hypotension, acute bleeds, shock
3. Poisonings, overdoses, and intoxication
4. Abdominal, chest, and pelvic pain
5. Neurologic- Headache, numbness, vertigo, loss of consciousness, change in mental
status, seizures, CVA
6. Pulmonary and Cardiac problems including PEs, arrhythmias, asthma, CHF, shortness of
breath, acute MI, arrests, chest pain, pneumonia, sepsis
7. Psychiatric- Delirium, Psychoses, Suicide, Depression, Anxiety,
8. Gynecologic/Urologic- Vaginal bleeding, ectopic pregnancy, miscarriage, rape,
hematuria, pyelonephritis, nephrolithiasis
9. Pediatric- similar areas plus fever work-ups, child abuse, and foreign body ingestion and
aspiration
10. Diabetic complications
11. Metabolic disorders including hyper and hypokalemia, hyper and hyponatremia, hyper
and hypocalcemia, renal failure, and acidosis/alkalosis.
B. By the end of the EM PGY2 rotation, the resident should show proficiency in collecting
information in a focused manner to quickly analyze and initially manage the patient's condition.
The resident should be able to make a tentative assessment and plan in a timely fashion. The
resident should be able to present and discuss his/her cases and initial A&P in a concise manner
with the ER attending physician. The resident should be able to complete the care track of the
emergency room patient with guidance and directions from the ER attending as appropriate.
C. Learn patient and apply education skills appropriate for emergency room patient needs.
1. Learn use of prewritten instructional materials for common problems.
2. Learn to use simple instructions appropriate to the receptiveness of a patient in the
emergency setting.
3. Learn to assess patient understanding after providing patient education. Develop
awareness of literacy and fluency.
D. Learn a set of procedural skills essential to the practice of family medicine and select advanced
procedural skills appropriate to anticipated future practice needs.
1. Code Management-Adult and Pediatric
2. Laceration Repair-Simple, Layered, Facial, and Extremities Splint Application Digital
blocks
3. Endotracheal intubation
4. Central lines
5. Femoral lines
6. Foley catheter placement
7. Cardioversion
8. Corneal foreign body removals
9. Slit lamp exams
10. Joint aspirations
Family Medicine Practice/Emergency Medicine PGY2 Curriculum
p. 2
11.
12.
13.
14.
15.
16.
joint relocations
Lumbar puncture
Nasogastric tube insertion/aspiration
Paracentesis
Slit lamp exam
Tonometry
Advanced Procedures
17.
18.
19.
20.
21.
22.
23.
24.
25.
Arterial line, percutaneous
Arterial puncture, adult
Chest tube insertion
Cricothyroidotomy
Suprapubic aspiration
Temporary Pacemaker
Thoracentesis
Venous cutdown
Ventilator management, initial
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty
Conference
Morning Report
X
Didactics
X
BLS, ACLS course
Evaluation Methods
X
Attending Evaluation
X
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
X
X
X
Program Director
X
Review
360 ᵒ evaluation
Other: BLS, ACLS exam
Faculty Supervision
Procedures
Directly Supervised
Procedures
In-Training Exam
Videotape Review
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
X
Faculty Supervision
and Feedback
Quarterly Review
Interpersonal Skills and Communication Skills
A. Develop skills for interviewing that allow rapid collection of information that impacts on
immediate management of the patient.
B. Develop skills in communicating effectively with patient and family members in the emergency
setting.
C. Rapidly develops trust and rapport with a patient needing urgent care.
D. Directs the emergency patient care personnel in handling patient care urgently and
expediently.
E. Assists other members of the patient care team in accomplishing their tasks for urgent
care of the patient.
F. Communicates and documents clearly and completely by written and verbal methods.
G. Learns to document patient instructions and follow-up thoroughly.
Family Medicine Practice/Emergency Medicine PGY2 Curriculum
p. 3
H. Documents patient assessment and management compulsively including history taken,
time of orders, response to therapy, and results of tests ordered.
I. Notifies the emergency room of patients prior to arrival and communicates significant
information relevant to patient care.
J. Utilizes pre-ordering of tests to expedite patient care.
K. Learns to prioritize urgency of numerous patients and their needs.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty
Conference
Morning Report
Didactics
BLS, ACLS course
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
X
Evaluation Methods
X
Attending Evaluation
Faculty Supervision
Procedures
Directly Supervised
Procedures
In-Training Exam
Program Director
Review
360 ᵒ evaluation
BLS, ACLS exam
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
X
Videotape Review
Faculty Supervision
and Feedback
Quarterly Review
Practice Based Learning
A. Residents must be able to investigate and evaluate their patient care practices, appraise and
assimilate scientific evidence, and improve their patient care practices. Residents must be
proactive in obtaining the skills and knowledge needed to effectively treat urgent and/or
emergent medical conditions.
B. Learns to identify resources for personal education and develops a plan for ongoing education.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty
Conference
Morning Report
X
Didactics
BLS, ACLS course
Evaluation Methods
X
Attending Evaluation
Program Director
Review
360 ᵒ evaluation
BLS, ACLS exam
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
X
X
X
Faculty Supervision
Procedures
Directly Supervised
Procedures
In-Training Exam
Videotape Review
Family Medicine Practice/Emergency Medicine PGY2 Curriculum
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
X
Faculty Supervision
and Feedback
Quarterly Review
p. 4
Systems Based Practice
A. Promotes family practice through encouragement of ongoing continuity of care for emergency
room patients.
B. Understands appropriate utilization of Emergency Room care, in the larger setting of the US
healthcare system.
C. Demonstrate understanding of the continuum of ambulatory, ER and inpatient care, and the
physician’s role in facilitating smooth care transition from one level to the other.
D. The resident should demonstrate understanding of their personal limitations, and appropriately
consult with the ED physician and make appropriate use of specialty consultation.
E. Learn about the importance of coding and billing, as appropriate for patient care services in the
emergency department.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty
Conference
Morning Report
X
Didactics
BLS, ACLS course
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
X
Evaluation Methods
X
Attending Evaluation
Program Director
X
Review
360 ᵒ evaluation
BLS, ACLS exam
Faculty Supervision
Procedures
Directly Supervised
Procedures
In-Training Exam
Videotape Review
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
X
Faculty Supervision
and Feedback
Quarterly Review
Professionalism
Residents must demonstrate a commitment to carrying out professional responsibilities, adherence
to ethical principles, and sensitivity to a diverse patient population. Residents are expected to:
A. Demonstrate respect, compassion, and integrity; a responsiveness to the needs of patients and
society that supersedes self-interest; accountability to patients, society, and the profession; and
a commitment to excellence and on-going professional development.
B. Demonstrate a commitment to ethical principles pertaining to provision or withholding of clinical
care, confidentiality of patient information, informed consent, and business practices.
C. Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities.
D. Arrive at the ED in time, in order to assume their role during the assigned shift.
E. Work effectively as a member of a team.
F. Respect patient privacy by guarding medical records and discussion of personal information
about patients.
G. Demonstrate professional, respectful demeanor when addressing team members, patients,
ancillary staff, and consultants.
H. Appear professionally dressed and well groomed.
I. Complete notes, referrals and other forms of communication and documentation in a timely
fashion.
Family Medicine Practice/Emergency Medicine PGY2 Curriculum
p. 5
J. Attend required didactics, conferences.
K. Respond to pages and clinic messages in a timely fashion.
Learning Activities
Attending Rounds
Multidisciplinary Rounds
Grand Rounds
Sub-Specialty
Conference
Morning Report
Didactics
BLS, ACLS course
Evaluation Methods
X
Attending Evaluation
Research Conference
Ethics/Comm Conference
Specialty Conference
Noon Conference
X
X
X
Program Director
Review
360 ᵒ evaluation
BLS, ACLS exam
IV.
Faculty Supervision
Procedures
Directly Supervised
Procedures
In-Training Exam
Videotape Review
X
X
Outpatient Clinics
Direct Patient care
Resident Seminar
Journal Club
Readings
Morning Report
X
Faculty Supervision
and Feedback
Quarterly Review
Instructional Strategies (see above)
A.
B.
C.
D.
E.
F.
G.
V.
Direct Care of ED patients (first contact)
Case presentation
Procedural learning
Performing of procedures under supervision
Reading of medical literature as pertinent to Emergency Medicine
Interpretation of EKGs as pertinent to ER/urgent care setting
Interpretation of x-rays as pertinent to ER/urgent care setting
Evaluation Methods (see above)
A.
B.
C.
D.
E.
F.
G.
H.
I.
J.
Rotation evaluation by ER attending
Direct patient care observation by ER attending
Evaluation Case presentations
Ongoing review of resident’s documentation
Direct supervision and evaluation of procedural skills
Medical knowledge assessment
Direct observation of Teamwork ability, Communication skills & Professionalism
Direct observation of appropriate use of consulting services
End of rotation paper or electronic evaluation by EM attending
End of rotation paper or electronic evaluation of rotation by resident
VI. Reading
Tintinalli's Emergency Medicine: a Comprehensive Study Guide, 7e ed, edited by J.E. Tintinalli et al,
2012. (available at Emory Health Library, eBooks link – see below)
Family Medicine Practice/Emergency Medicine PGY2 Curriculum
p. 6
Critical Challenges for Family Medicine: Delivering Emergency Medical Care - “Equipping Family
Physicians for the 21st Century” (Position Paper).
http://www.aafp.org/online/en/home/policy/policies/e/emposition.html
Medical Emergency Preparedness in Office Practice. Am Fam Physician. 2007 Jun 1;75(11):16791684.
http://www.aafp.org/afp/2007/0601/p1679.html
Ocular Emergencies. Am Fam Physician. 2007 Sep 15;76(6):829-836
http://www.aafp.org/afp/2007/0915/p829.html
Emory Health Library eBooks on Emergency Medicine:
http://health.library.emory.edu/search/apachesolr_search/emergency%20medicine?filters=tid%3A3
&retain-filters=1
VII.
Implementation Methods
Location: Emory University Hospital Midtown Emergency Room
Contact: EUHM Emergency Room Attending
Melissa White, MD, MPH 404-886-0022 cell#; pic# 15561
Midtown Hospital Resident Rotation Dir.
Department of Emergency Medicine
550 Peachtree Street NE
Atlanta, GA 30338
cell #404-886-0022; pic# 15561
Melissa.white@emoryhealthcare.org
Chief: Steven Lindsey smlinds@emory.edu; 404-616-6389
Lamar Cochran rcochr2@emory.edu
Family Medicine Continuity Clinic: Two ½ day sessions / week
Call: None
Supervision: Emory University Hospital Midtown Emergency Medicine Attending
Family Medicine Practice/Emergency Medicine PGY2 Curriculum
p. 7