LSUHSC-New Orleans
School of Medicine
Critical Concepts
Senior Rotation
Student Handbook 2013-2014
CONTACT INFORMATION
Course Director:
Jennifer Avegno, MD
Clerkship Director
Room 543 University Hospital (physical office)
javegn@lsuhsc.edu
(504) 903-3594 (office)
(504) 301-5058 (cell)
Course Coordinator:
Jennifer Jeansonne
2020 Gravier Street Room 615
Jjean2@lsuhsc.edu
(504) 568-4620
Website:
http://www.medschool.lsuhsc.edu/emergency_medicine/critical_concepts_rotation.aspx
Critical Concepts
Rotation Guidelines
Welcome to Critical Concepts! We are excited about the opportunity to introduce you to the
care of the acutely ill patient using a multi-specialty, innovative learning approach. Throughout
the rotation, we will work hard at providing you with an excellent educational experience.
Please read the following information carefully and do not hesitate to contact us at any time
with suggestions or questions.
Course Objectives:
 Provide all senior students with exposure to acute and critical care concepts in a variety
of learning modalities (i.e. direct patient care, case discussions, didactic lectures,
simulation exercises, and procedural skill practice and performance).
 Review and reinforce diagnostic and management skills in common and/or critical
disease entities and procedures encountered in a range of specialties.
 Prepare senior students for their new roles as resident physicians with direct patient
care and health care team responsibilities.
Care of the acutely ill, undifferentiated patient is a challenge encountered by health care
professionals in a wide variety of specialties. The Critical Concepts rotation provides every
senior medical student, regardless of career choice, with a broad and solid foundation in the
principles and skills needed to care for the emergently ill patient.
After completion of core clinical rotations in the junior year, medical students should be
challenged to expand their skills and knowledge base and apply them to more complicated
and/or critically ill patient care situations. Students should also refine and expand their skill set
in terms of commonly performed and/or critical procedures and medical
interventions. Furthermore, as they prepare to enter residency, senior students should also
develop a more sophisticated understanding of the complexity of disease and health system
management.
Structure of the Rotation:
 multispecialty didactic sessions (1 week)
 ICU rotation (1 week)
 Emergency Medicine rotation (2 weeks)
DIDACTIC WEEK INFORMATION
For one week on the rotation, students will attend 8 specialty sessions all focused on the acute
management of critical topics unique to their field. These sessions will blend traditional
lectures with a variety of other learning experiences: small group case discussions; interactive
videos; hands-on simulation cases and skills and procedure labs. Each session has been
designed and will be run by educators from that field, and targets student learning to what they
believe are the most common critical presentations in their field.
Prior to each session, students should read the assigned material in Moodle or on the website
(under "Required Course Reading - Emergencies by Specialty") and come prepared to discuss
and practice the material contained therein.
ICU ROTATION INFORMATION
The ICU affords students the opportunity to care for the sickest patients. Students will
improve their abilities to take a systems- or problem-based approach to ill patients.
Students may also participate in difficult family discussions, such as end of life care or
support withdrawal.
Students will spend one week on service in one of 5 ICUs: MICU (Baton Rouge General);
NICU (Children's); PICU (Children's); MICU (University) or TICU (University). While on the
ICU portion of the rotation, students are expected to participate fully as part of the ICU
team, including taking call as directed by the ICU faculty.
EMERGENCY MEDICINE ROTATION INFORMATION
Students may do their Emergency Medicine (EM) rotation in the Emergency Department (ED) at
University Hospital in New Orleans or Our Lady of the Lake in Baton Rouge. In each location,
you will be supervised by board-certified EM faculty and have the opportunity to work with EM
residents. You will work 6 12-hour shifts during a 2 week period and are expected to attend all
of the required student EM lectures and activities in your particular location.
EM ROTATORS IN BATON ROUGE - information, scheduling and further details will be given on
the first day of your rotation at orientation. For more information, please see the Moodle and
the website under "Baton Rouge Information."
EM ROTATORS IN NEW ORLEANS - please read below for your expected duties and
responsibilities.
You will be working 6 12-hour shifts in the Main ED (MER) - the busiest and largest
section of the ED. YOU ARE CONSIDERED TO BE AN "ACTING INTERN" - that is, you will
have direct patient care responsibilities for your own patients, with significant
supervision and backup from EM residents and staff. You are responsible for full
documentation in the patient record.
After performing an H&P, you may present the patient either to an EM resident or
directly to staff for guidance. All procedures must be directly supervised by an EM
resident or staff, and EM staff must review the case and sign the patient’s chart prior to
discharge. At shift change, you must sign out and provide detailed information on any
active patients to oncoming students or interns.
Major trauma resuscitations will be done by the upper-level EM resident with staff
backup. The EM resident serves as team leader and will assign you a role in the
management and care of trauma patients, and you are expected to observe and
participate in each resuscitation.
On most shifts, there will be a dedicated EM teaching resident. This resident will
conduct regular student and intern-only rounds, guide you through patient cases, and
instruct and supervise your procedures.
MER shifts are from 7 am – 7 pm ("MD") and 7 pm – 7 am ("MN"). You should have
received your schedule in advance. Students are allowed to make schedule switches as
long as they inform the course director. However, if you make a switch with another
student, and that student fails to show up for the shift, it is the original student’s
responsibility. Repeated problems with switching must be brought to the course
director’s attention.
ATTENDANCE AT YOUR SHIFTS IS MANDATORY. If you are ill or have an emergency, you
must either call the course director or the ED and let the attending staff know you will
not be there. Students who fail to show up for a scheduled shift will be assigned an
extra penalty shift. NO EXCEPTIONS!
Much thought has gone into the scheduling process. To optimize patient and ED flow,
the level of student staffing is as consistent as possible. Any special circumstances
regarding shift scheduling must be discussed with the course director as far in advance
as possible.
The master schedule will be available online under "Current Student Schedule" from the
"Students" group on the top toolbar of the website.
Faculty lectures. On Thursdays from 7:30-9:30 am in the UH Basement room 103 you
will receive lectures from EM faculty and residents on a variety of core EM topics. These
lectures are informal and frequently interactive, and have been very popular in the past.
These are mandatory lectures; if you foresee any problems with attending a certain
lecture, please let Dr. Avegno know ahead of time. If you miss a lecture, you will be
expected to read a selection of core articles on the topics missed and answer questions
about the material.
The schedule of EM lecturers and topics is posted on a Yahoo! calendar. You will be able
to access this calendar at any time to view the student schedule by going to the website:
http://calendar.yahoo.com/lsuemclerkship/5810fa9f62d95156d1f23fa64bd2f25f?od=131
READING MATERIAL AND CURRICULUM
The required EM reading for both BR and NO is available on Moodle and the website
(under "Required Course Reading - Emergency Medicine"). These brief articles should
serve as a starting point for your study of management of the acutely ill and/or
undifferentiated patient. Evidence-based medicine is as important in EM as it is in other
disciplines and should serve as the basis for evaluating, diagnosing, and managing
patients in the ED.
CASE LOG
While on the EM rotation, a daily log of patient encounters and procedures is also
required. All patient encounters and procedures observed, assisted with, or performed
should be logged into the case log on Moodle. This must be completed by the end of
the rotation in order to process your grade.
EXPECTATIONS FOR ALL STUDENTS
Students are expected to attend all ER shifts and ICU activities to which they are assigned. They
are also expected to attend all didactics sessions and will sign in to document their attendance
at these sessions. In addition to the above, students may be required to complete several online modules on core critical topics written specifically at the senior student level. Interactive
cases may be included.
All students are expected to adhere to the same degree of professionalism as in any other
clinical setting. Towards that end, students are expected to be on time for every didactics
session, ED shift, and ICU rounds. Any student arriving more than 10 minutes late on any
occasion without good reason will be given a warning. As stated above, failure to show up for
an assigned ED shift will result in an extra penalty shift.
Students are expected to adhere to the school honesty policy at all times in the didactics,
clinical, and test-taking portions of the course.
Students will be supervised by faculty and senior residents during their EM shifts. They will be
supervised by attending faculty during their week in the ICU. For the didactic sessions, they will
be supervised by the instructors for each session.
EVALUATION METHODS AND GRADING CRITERIA
The evaluation of students will be based on 2 components: an on-line examination
administered through Moodle during the last week of the rotation and a professionalism
assessment during the clinical rotations. Remediation will be based on what is failed – students
will either retake the examination or repeat the week of ICU or ER until they pass it
successfully. The course will be graded on a system for Honors, High Pass, Pass, Fail (based on
the exam) with a Pass/Fail component to the clinical professionalism portion. The students
must pass the professionalism assessment to earn their grade. If a student has to remediate
either component, the highest grade that student may receive after remediation is a Pass. The
end-of-rotation exam will be derived from EM and subspecialty readings, lectures, and didactic
sessions.
ABSENCE POLICY
In accordance with 4th year student attendance policies, students may miss 2 days of the
rotation for interviews. These 2 days may be one ER shift (and one subsequent day off), or 2
days in the ICU. If 2 days in the ICU are missed, those 2 days will be remediated the weekend
before or the weekend after the ICU week to ensure optimal clinical experience. Students may
not miss didactics days for interviews. Students anticipating a competitive match with few
interview days should schedule this course either early or late in the year to avoid interview
conflicts.
Any questions regarding attendance should be directed to Dr. Avegno and/or Ms. Jeansonne.
Please do not hesitate to contact us at any time during your rotation.
Thank you,
Jennifer Avegno MD
LSUHSC - New Orleans Section of Emergency Medicine
javegn@lsuhsc.edu
(504) 301-5058 (cell)
(504) 903-3594 (EM office)