SLIDELL ED
Dr._________________,
You are assigned to Slidell Memorial Hospital for the month _____________.
Orientation: Dr. Robert Mercadel is the Director of the Emergency Department
at SMH. Please contact him one week before starting your rotation:
rmerca1@yahoo.com or his cell 228-547-2307
Scheduling: Two residents are scheduled each month so every day must be
covered by a resident, except when one resident is assigned to Vacation. Each resident
must have 1 day in 7 free from all duties and each resident must have 10 hours free
from duties after each shift. Each shift is 10 hours from 12p to 10pm. On journal club
(2nd Thursday of each month) the shift will be 8am to 6pm. The schedule must be
approved at least two weeks in advance by Dr. Mercadel and Kathy must receive a copy
at the beginning of the month.
Responsibilities: the daily management of all patients in the ED while on shift.
Directions: Take I-10 East towards Slidell and exit at Gause Blvd (exit #266), the
third Slidell exit. Turn left at the light on Gause Blvd. and go approximately 2 miles. The
entrance to the ED will be on the left after you pass the red light at the end of the
hospital.
Conference: you must attend ED conference and Journal Club.
Extras: All procedures must be recorded in New Innovations.
Supervision: you will work with board certified Emergency Physicians.
Evaluations: Pooled and compiled by ED faculty.
Meals: Provided by SMH.
Slidell Memorial Hospital Emergency Department Rotation
GOALS and OBJECTIVES
The Slidell ED rotation ranges from a 2 week to 1 month rotation, as assigned by the
Program Director. The rotation will take place at the Slidell ED. The year of training may
include PGY 2-5.
The educational goals and objectives for the Slidell ED rotation are to provide residents
with an opportunity to experience and learn about the initial evaluation and
management of emergency patients in the community setting as well as the following:
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) 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.
5) Demonstrate basic understanding of the principles of ACLS resuscitation as
applied to persons in cardio-respiratory arrest.
6) 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.
7) 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.
8) 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.
9) Learn to evaluate and appropriately manage a variety of patient complaints such
as chest pain, abdominal pain, dizziness, headache, syncope, etc.
10) 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.
11) Learn appropriate use of diagnostic lab and imaging studies for emergency
patients and to have basic competence in their interpretations.
12) Learn to use the following diagnostic aids: central venous pressures, pulse
oximetry, arterial blood gases, EKG’s.
13) 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.
14) 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.
15) Be able to arrange appropriate follow-up for discharged patients and give
adequate discharge instructions.
16) Learn and use the available contributions of the Social Services Dept. to patient
care in the ED and for discharge planning.
17) Learn appropriate medical evaluation of mentally disturbed patients including
techniques for restraint and control of violent patients.
18) Learn about billing as it pertains to ED patients.
The clinical and didactic experiences used to meet those objectives included daily
patient care in the Slidell ED, along with bedside teaching. This rotation experience is
part of the greater emergency medicine curriculum, also including PALS/ACLS/ATLS
provider and instructor certification and weekly didactics (part of the overall didactic
curriculum).
The feedback mechanisms and methods used to evaluate the performance of the
resident include an end of rotation global evaluation. 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 emergency medicine. The residents will have access to the resources of the
hospital including medical texts, medical records, doctor’s lounge and cafeteria.
The clinical experiences, duties and responsibilities the resident will have on the
rotation: Residents will act as a part of the Emergency Medicine team in a community
hospital under the supervision of a staff physician. The residents will participate in the
initial management of emergency department patients, to include trauma, psychiatric,
obgyn, pediatric and general medical patients.
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 ED faculty prior to patient discharge.
Duty hours for this rotation will not exceed an average of 60hrs/week, and will include 1
in 7 days off.
Community ED: Specific Competency-based Goals & Objectives, based on Level of
Training: Slidell Memorial PGY1-4
1. While in the community ED, the resident will demonstrate 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 community ED, the resident will demonstrate 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 community ED, the resident will demonstrate 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 community ED, the resident will demonstrate 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 community ED, the resident will demonstrate 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 community ED, the resident will demonstrate 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 community 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: Models and teaches leadership skills to lower level residents.
(*ICS, PR)
8. While in the community 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, even under
stressful situations (*PR)
d. PGY4: Models and teaches professionalism skills to lower level residents.
(*PR)
9. While in the community 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, ICS)
b. PGY2: Appropriately documents medical decision making (*PC, ICS)
c. PGY3: Documents ED course including re-evaluation of patient if
applicable (*PC, ICS)
d. PGY4: Models and teaches verbal and written documentation skills to
lower level residents. (*PC, ICS)
10. While in the community 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 in the community setting. (*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 system-based practice skills to lower level
residents. (*SBP)
11. While in the community ED, the resident will demonstrate skills in “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 patient care decisions (*
PBL, PC)
c. PGY3: Facilitates the learning of professional associates (* PBL, MK)
d. PGY4: Models and teaches practice based learning and self-improvement
skills to lower level residents. (*PBL)
(* denotes core competency area: PC-Patient Care, MK-Medical Knowledge, ICSInterpersonal 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.