Welcome
Dear Student Doctor,
Welcome to the Emergency Medicine Senior Clerkship Rotation.
Emergency medicine is the medical specialty dedicated to the diagnosis and
treatment of unforeseen illness or injury. The practice of emergency medicine
includes the initial evaluation, diagnosis, treatment, and disposition of any patient
requiring expeditious medical, surgical, or psychiatric care.
There is a critical and growing need for emergency physicians and emergency
medicine resources. To meet this need, physicians must be trained to deliver timesensitive interventions and life-saving emergency care.
The goal of this rotation is to train you as a generalist who is competent in managing
common emergencies without direct supervision either in the community or in an
emergency room.
The team has prepared a very structured and stimulating educational program for
you for the next 4 weeks. We promise to provide you with the best teaching, but
would like you to do your best to learn!
Prepare well, actively interact and participate in all educational activities,
communicate and behave professionally and within your team, show interest and
enthusiasm and we will promise you a great rotation!
We are all here to help you LEARN emergency medicine.
Good Luck.
The Emergency Medicine Senior Clerkship Team
1
Emergency Medicine Rotation: Learning Contract
At the end of the Emergency Medicine Rotation, I will achieve the following
objectives:
1.
Describe the function and structure of Emergency Medical Services in Oman
2.
Describe the important role of emergency departments and the triage system
3.
Obtain and document focused history, perform focused physical examination
and generate a prioritized differential diagnosis of the common presentation
of adults and children to the ED.
4.
Recognize and apply principles of management to common emergencies in
the ED .
5.
Apply the standard principles of resuscitation, wound management, and
trauma life support in a simulated environment.
6.
Conceptualize the general principles of ED approach to clinical presentations.
7.
Demonstrate a professional attitude to learning and practicing emergency
medicine.
8.
Appreciate the need to manage common emergencies independently and
under the pressure of time.
9.
Learn about emergency medicine as a future career choice.
To achieve these objectives, my responsibilities will be to:
1- Attend and actively participate in all clinical shifts ,seminars, workshops, and
visits
2- Study the topics discussed in the clinical shifts, seminars and workshops
3- Read the handouts before coming to the workshops and be prepared for
pre-tests
2
4- Consent to be observed, evaluated, and assessed in the domains of clinical
knowledge and skills, professional attitude, communication skills and team
work skills on frequent basis and to be counseled whenever needed.
5- Complete all educational activities requested including portfolio
6- Give constructive feedback about the rotation during and after the rotation.
7- Abide by Sultan Qaboos University and College of Medicine and Health
Sciences codes of conduct and attendance policy.
8- Attend to measures of patient safety at all times
9- Behave and communicate professionally in any activity related to the rotation
10- Accept to be assessed and graded based on my clinical knowledge and skills,
professional attitude, communication skills and team work skills.
11- Communicate in writing any requests, suggestions, feedback, doubts,
questions or queries to the Rotation Coordinator at weshahi@squ.edu.om
The Rotation Team responsibilities are to:
1- Deliver the educational program of clinical shifts, seminars, workshops and
visits in a sound manner within the prescribed framework
2- Observe, evaluate and assess your performance in clinical knowledge and
skills, professional attitude, communication skills and team work skills in
sound and fair ways.
3- Give you constructive feedback on your performance frequently
4- Present themselves as positive role models
5- Teach you about the Emergency Medicine as a future specialty
6- Provide you with a conducive learning environment
Student's Name: ………………………………………………… Date: ………………. Signature: ………
Coordinator's Name: ………………………………………… Date: ………………… Signature: ……..
3
Emergency Medicine Rotation Master Timetable
Day & Site
Sunday
One
ED SQUH
Time
Two
Three
Thursday
Skills Lab
Sunday –
Thursday
Hospitals
Four
Tuesday
Skills Lab
Wednesday
ED, SQUH
Sunday –
Thursday
Hospitals
Group Y
0800-0945
Introduction to emergency medicine
1000-1100
Coordinators' monthly meeting
1030-1230
Introduction to EMS in Oman and site visit
1230-1300
The emergency medicine rotation
MondayThursday
Hospitals
Sunday
Skills Lab
Monday
ED, SQUH
Group X
0800-1600
SQUH Hospital
Three mornings:800- 1600
One evening: 1400-2200
Fri evening: 1400-2200
Resuscitation Workshop
Group Z
Royal Hospital
Khoula Hospital
Mon - Thu:
Mo-Thu: 0800-1400
0800-1400
0800-1000
1015-1215
1230-1430
0800-1600
Emergency Approach to Chest Pain Seminar ( Group Z)
Emergency Approach to Poisoning Seminar ( Group Z)
Emergency Approach to Altered Mental Status Seminar ( Group X )
Trauma Management Workshop
0800-1000
1015-1215
1230-1430
Emergency Approach to Anaphylaxis, Stings and Bites Seminar ( Group Y)
Emergency Approach to Shortness of Breath Seminar ( Group Y)
Emergency Approach to Environmental Emergencies Seminar ( Group X)
0800-1400
Wound Management Workshop
Khoula Hospital
SQUH Hospital
Four mornings:800- 1600
One evening: 1400-2200
Fri evening: 1400-2200
Royal Hospital
Royal Hospital
Khoula Hospital
Su - Th:
Su- Thu: 0800-1400
SQUH Hospital
Four mornings: 800- 1200
One evening: 1400-2200
Fri evening: 1400-2200
Su- Thu: 0800-1400
0800-1400
Su - Th:
0800-1400
4
General Objectives
At the end of the rotation the student should be able to:
10. Describe the function and structure of Emergency Medical Services in Oman
11. Describe the important role of emergency departments and the triage system
12. Obtain and document focused history, perform focused physical examination
and generate a prioritized differential diagnosis of the common presentation
of adults and children to the ED.
13. Recognize and apply principles of management to common emergencies in
the ED .
14. Apply the standard principles of resuscitation, wound management, and
trauma life support in a simulated environment.
15. Conceptualize the general principles of ED approach to clinical presentations.
16. Demonstrate a professional attitude to learning and practicing emergency
medicine.
17. Appreciate the need to manage common emergencies independently and
under the pressure of time.
18. Learn about emergency medicine as a future career choice.
5
Specific Objectives
Introduction to EMS in Oman:
1. Describe the structure and function of emergency medical services in Oman
2. Identify different levels of EMS providers
3. Recognize the different equipment of an ambulance unit and their utility.
4. Outline principles of pre-hospital triage and EMS care delivery.
Emergency Approach to a Sick Child Day:
1. Differentiate between sick and ill child presenting to ED.
2. Identify common presentations of sick children in ED.
3. Demonstrate the use of the Pediatric Assessment Triangle ( PAT) for the
initial assessment of children in ED, based on common cause scenario.
4. Outline the key features in history suggestive of a sick child.
5. Disuses the changes of vital signs in different pediatric age groups.
6. Identify the common signs of a sick child.
7. Recognize children at increased risk of illness
8. Apply the basic approach to identifying sick children in a simulated
environment.
Resuscitation Workshop:
Trauma Evaluation and Management Workshop:
1- Define the primary and secondary surveys of multiple trauma patients.
2- Describe the correct sequence of priorities used in assessing the multiply
injured patient.
3- Define airway patency
4- Define tension pneumothorax, flail chest, massive hemothorax and open
pneumothorax
5- Define shock and list the causes of shock in trauma
6- Define Glasgow coma scale (GCS)
7- List the components of GCS
8- Demonstrate on a mannequin how to perform log roll while maintaining
cervical spine immobilization using c-collar and inline stabilization of the neck
9- Demonstrate on a mannequin the application of immobilization splint for the
fractured femur
10- Assess the airway patency while maintaining the cervical spine
immobilization on a mannequin
6
11- Identify the different airway adjuncts used in a trauma patient.
12- Assess the breathing using the techniques of chest palpation, auscultation,
vital signs and oxygen saturation on a mannequin
13- Differentiate between tension pneumothorax, open pneumothorax, and
massive hemothorax using the physical examination findings on a mannequin
14- Perform resuscitative measures to restore adequate ventilation which
includes oxygen administration, occlusive dressing for open pneumothorax
and needle decompression for tension pneumothorax on a mannequin
15- Assess for signs of shock using symptoms and signs of organ hypo-perfusion
on a mannequin
16- Manage hypovolemic shock using direct external pressure to control
hemorrhage, establishing iv access and rapid fluid administration on a
mannequin
17- Assess the neurological disability using GCS and pupillary reaction during the
primary survey on a mannequin
18- Demonstrate how to undress the patient to ensure adequate exposure while
maintaining patient privacy and preventing hypothermia on a mannequin
19- Perform a complete thorough physical examination to identify injuries which
does not poses and immediate threat to the patient life on a mannequin
20- Identify the disposition plan, which includes transfer, and urgent consultation
utilizing written case scenarios.
21- Summarize the injuries and critical procedures performed during the
management of trauma patients.
22- Evaluate the performance of the team leader and recommend the correct
sequence of action to be followed in the management of multiple trauma
patients using a standardized checklist.
Wound Management Workshop:
1- Identify wounds and their presentations.
2- Compare the different types of wounds and the prognostic implications of
each type.
3- Describe different classes of local anesthesia, their indications,
contraindications and complications.
4- Identify the important steps in the preoperative wound assessment
including ABC and detailed wound assessment
5- Identify the different methods used for wound closure including: Tissue
glue, skin tapes, staples and suturing
6- Identify different types of suture material.
7- Identify the different type of dressing material and their use.
8- Explain the need for tetanus toxoid and rabies prophylaxis
7
9- Demonstrate cleaning and irrigation of a wound on mannequin
10- Demonstrate giving local anesthesia in preparation for wound closure on
a mannequin
11- Demonstrate the technique for closing a wound including: choosing the
right material, holding needle and other suturing material in a simulated
environment
12- Demonstrate the appropriate closing methods of different wound in a
simulated environment.
13- Demonstrate the various basic suturing techniques including: simple
interrupted, simple continues, vertical mattress, horizontal mattress in a
simulated environment.
14- Explain the disposition and follow-up of wounds.
Emergency Approach to Chest Pain Seminar:
1. Define acute coronary syndrome
2. List the 3 most common causes of chest pain in ED: Stemi, Aortic
dissection, Pericarditis
3. Describe the pathophysiology of chest pain for most common causes
presenting to ED.
4. Describe the principles of initial approach and management of chest pain
in ED.
5. Outline the important investigations for patients with chest pain.
6. Formulate a differential diagnosis of various chest pain syndromes.
7. Identify basic interpretation of EKGs of acute coronary syndrome (STEMI).
8. Identify definite management of STEMI.
9. Recall the indication and contradictions of Thrombolysis.
10. Explain the disposition of chest pain patients presenting to ED
Emergency Approach to Shortness of Breath Seminar:
1. Outline the primary functions of the respiratory system.
2. Describe the pathophysiology of altered lung function.
3. Define the following terms: Shortness of breath, hypoxia, hypoxemia,
asphyxia, anoxia, respiratory distress, and respiratory failure.
4. List 10 most common causes of acute SOB presentation to the emergency
department.
5. Describe the general initial approach to SOB in ED
8
6. Describe the role of the following tests in diagnosing acute respiratory illnesses:
PEFR, ABG, CXR, D-DIMER, CT CHEST,
7. List the available non-invasive oxygen delivery devises and their use in the ED.
8. Outline briefly the specific management of the following causes of SOB: asthma,
pulmonary edema, pneumothorax, pulmonary embolism,
9. Outline the disposition of patients presenting with SOB.
Emergency Approach to Altered Mental Status Seminar:
1. define altered mental status
2. List the 10 most common causes of altered mental status in the ED.
3. Describe the pathophysiology that lead to altered mental status in the
most common causes of altered mental status presenting to ED.
4. Apply Glasgow coma scale to case scenarios of patients with altered
mental status.
5. Describe the general initial approach to altered mental status in ED.
6. Outline the important investigations for most common causes of altered
mental status in ED.
7. Identify the definitive management for the most common causes of
altered mental status in ED.
8. Identify the disposition of altered mental status patients presenting to
ED.
Emergency Approach to Anaphylaxis, Stings and Bites:
12345678-
Define anaphylaxis using patient case scenarios
Describe the four diagnostic criteria for anaphylaxis
Outline the pathophysiology of anaphylaxis
Describe angioedema in terms of pathophysiology and clinical
presentation
Differentiate between anaphylaxis, angioedema and anaphylactoid
reaction
Define the basic management of anaphylaxis
Prioritize the management of anaphylaxis in terms of attention to lifethreatening issues first
List the medications used to treat anaphylaxis and relate the mechanism
of action to the pathophysiology
9- Identify the disposition of patents of anaphylaxis, stings and bites presenting to
ED
9
Emergency Approach to Poisoning Seminar:
1- Define poisoning
2- Describe epidemiology of poisoning
3- List the groups at risk of poisoning and situations in which poisoning
should be suspected.
4- Discuss the challenges in diagnosing poisoning.
5- Discuss the five principles of management of poisoning.
6- Identify general principles in the disposition of a poisoning case from the
ED.
Environmental Emergencies:
1.
2.
3.
4.
Differentiate venomous from non-venomous snakes.
Describe the clinical presentations of snake bites.
Outline the prehospital care of snake bite victims.
List the important investigations for identifying occurrence of systemic
envenomation.
5. Describe the principles of management of snake bite patients and
disposition criteria.
6. Differentiate between different mechanisms of electrical injuries (AC, DC,
lightening)
7. Describe the basic principles of management and disposition of electrical
injury patients
8. Outline the principles of prehospital and ED management and disposition
of submersion injury patients.
9. Differentiate between major and minor heat illnesses.
10. Describe the pathophysiology and complications of heat illnesses.
11. Discuss the differential diagnoses of hyperthermia and altered mental
status.
12. Outline principles of management and disposition of patients with heat
illnesses.
10
List of Cases and Procedures
1.
Bedside Procedures:
Performance of basic emergency room procedures by the students under
supervision and guidance depending on the nature of the practice at each
training site, the students are expected to perform the following procedures –
1234-
Establishment of I.V. access
Extraction of venous blood sample.
Extraction of arterial blood sample for ABG
Oxygen administration with various delivery devices –
a. Nasal cannula
b. Simple face-mask
c. Non-rebreather mask
d. Venturi mask
ECG monitoring and performance of 12 or 15 lead and right-sided ECG
Wound care - suturing and dressing
Urinary bladder catheterization
Application of cervical collar and preformed, commercial or cast splints to
limbs.
9- Attachment of patients to bedside monitors e.g. pulse oximeters, automatic
blood pressure measuring devices and cardiac monitors.
5678-

Suggested Procedures to be observed:
1- Central line insertion
2- CPR
3- Reduction and immobilization of fractures and dislocations
4- Care of large or complicated wounds.

Types of Cases :
Although each training site has no control over the types of cases which will
attend the emergency department during the periods of rotation, the nature of
the practice at each site gives a rough idea of the types of life threatening,
serious or common emergency cases which are very likely to be seen at each
training site as shown below –
11
At SQUH:
1- Pediatric cases (fever, abdominal pain, dehydration, and respiratory
complaints)
2- Environmental emergencies
3- Seizures
4- Abdominal pain
5- Acute headache
6- Multiple Trauma
7- Cardiac Arrest
8- Acute coronary syndromes (Chest pain)
9- Acute bronchial asthma
10- COPD
11- Congestive cardiac failure
12- Sickle Cell Disease crises
13- Stroke
14- Drug overdose / poisoning
At Khoula Hospital:
1- Multiple Trauma
2- Wounds of various types
3- Common musculo-skeletal injuries
4- Common musculo-skeletal infections
5- Burns
At Royal Hospital:
1- Cardiac Arrest
2- Chest pain – Acute Coronary Syndromes
3- Acute bronchial asthma
4- COPD
5- Congestive Heart failure
6- Drug Overdose / Poisoning
7- Stroke
8- Diabetic ketoacidosis and hypoglycemic crisis.
9- Environmental emergencies
10- Seizures
11- Acute headache
Efforts should be made by the tutors at each training site to ensure that students
see as many cases as possible with emphasis on the listed types of cases.
12
General Regulations
1- At the beginning:
-
Read carefully and sign your learning contract
-
Complete the information form
-
Note all important numbers and emails
2- The Shifts:
-
Be on time.
-
Missing 4 day or shifts without proper justification will result in failing the
rotation
-
Being late for more than 30 minutes at the beginning of the shift without
calling beforehand or providing a valid reason with evidence may result in
considering you missing the entire shift.
-
Daily feedback at the end of the shift is COMPLUSARY and must remain in the
portfolio
-
Daily feedback to be done by the designated supervisor of the week at
Khoula and SQUH. It must be countersigned by a CONSULTANT or A SENIOR
SPECIALIST at Royal. ALL information should be completed STAMPED by the
supervisor.
-
Please wear your surgical scrubs with proper footwear at all times including
seminars and workshops.
13
-
You can do extra 2 shifts provided that you arrange it with a senior doctor
beforehand, he/she will then complete your daily feedback at the end of the
shift.
-
Attend ALL your pre-scheduled shifts. Doing an extra "non-scheduled" shift to
compensate for missing a "pre-scheduled" one is NOT ACCEPTABLE without a
written permission form the Coordinator.
3. Summative Assessment: ( out of 50 marks)
-
20 % :MiniCEX : the student should complete 2 during his\her rotation in the
3rd and 4th weeks, ONLY one with the highest grade will be included in the
final mark.
-
10 % :
 4 % :Tutorial presentation: each student must present once during the 2nd
week
 2 % : Three case summaries
 4 %: Procedures
-
20 % : Workshops
4. Workshops and Seminars:
-
All students should prepare for ALL SEMINARS and actively participate in
them even if they are not presenting.
-
During the first clinical week, approach the your seminar leader, he/she will
guide you to choose a case, follow seminar objectives to prepare a very
interactive and stimulating presentation and prepare a summary flowchart if
possible. The whole presentation should be discussed with the seminar
leader (or a senior doctor) beforehand.
-
Prepare for the workshops beforehand, there is a pre-test for each
workshops.
14
5. Contact:
-
Document all communication with your tutors or coordinator by emailing any
requests or questions.
-
The clerkship coordinator's email is weshahi@squ.edu.om , in case of urgent
issue, text to 99201789. Office number 2206, 2nd floor, Annex Building,
College of Medicine. Extension 3496.
-
The site coordinator at Khoula Hospital is Dr. Khalifa Al-Yousfi , his email is
Kk33alyousefi@yahoo.com
-
The site coordinator at Royal is Dr. Mahmoud Al-Jufaili, his email is
Docmaj08@gmail.com
-
The Head of Department of Emergency Medicine at SQUH is Dr. Nabil Al
Zadjali
who
is
overseeing
the
whole
rotation.
His
email
is
dr.nabilzadjali@gmail.com
-
The Rotation Administrators are Ms. Afrah Al Abri at SQUH Department of
Emergency Medicine, her email is adm2013.business@gmail.com ,the
extension is 4623 (24144623).
15
Emergency Medicine Rotation: Daily Feedback
Section A: ( to be completed by the student)
Student's name:
Hospital:
Date:
Shift: Time in:
Time out:
Supervisor's name:
1- Cases:
2- Procedures:
Section B : ( to be completed by the supervisor)
3- Professional attitude:
4- Communication:
5- Strengths:
6- Areas for improvement and future plan:
Student's signature:
Supervisor's signature:
16
17