Description
The goal of the Emergency Medicine rotation is to provide learning opportunities that will enable residents to develop skills required for emergency diagnosis and care.
Objectives
By the completion of this rotation, residents will be able to:
Family Medicine Expert
FAM2. Perform a patient-centered clinical assessment with the goal of establishing a management plan
 2.1
Prioritizing: Effectively and selectively identify, assess and prioritize main presenting symptom(s)in a patient encounter
 2.2 Establishing urgency: Recognize a patient with a serious acute, urgent, emergent, potentially life threatening condition and act promptly
 2.3
Assessment: Elicit a history, perform a physical exam, select appropriate investigations and interpret results for the purpose of diagnosis
 2.4
Patient perspective: Solicit the patient's perspective and establish goals of care in collaboration with patients and their families
 2.5
Management Plan: Establish a patient-centered management plan
ADU3. Recognize and respond appropriately to urgent and emergent conditions in adults.
 3.1 Cardiac arrest/ACLS: Demonstrate skills and awareness of current resuscitation recommendations. Using current protocols, promptly manage a compromised airway, serious arrhythmias and other acute cardiovascular compromise, and participate in, and be prepared to lead a patient's resuscitation.
 3.2
Acute coronary syndromes: Recognize typical and atypical presentations of acute coronary syndromes (ACS), interpret electrocardiograms and other investigations appropriately (with understanding of the limitations of various tests), display knowledge of various treatments for ACS, manage the conditions acutely and in a timely fashion while watching for and responding to complications of the condition and the treatment.
 3.3 Respiratory failure: Recognize, assess and manage promptly patients presenting with respiratory failure
 3.4 Anaphylaxis and Allergic Reactions : Recognize and manage promptly an allergic reaction, including anaphylaxis
 3.5 Major burns: Describe the initial approach to the patient presenting with major burns
 3.6 Seizures and status epilepticus: Recognize, assess and manage promptly the patient presenting with seizures, including status epilepticus.
 3.7 Dehydration and electrolyte disturbances: Recognize the signs and symptoms of dehydration, and be able to assess the degree of dehydration and manage appropriately. Manage associated electrolyte and acid-base disorders.
 3.8 Shock: Recognize the signs and symptoms of shock and initiate management.
 3.9 Limb threatening injuries: Diagnose a fracture or joint dislocation by examination and appropriate use of diagnostic imaging, ruling out life-threatening or limb-threatening complications, providing adequate analgesia, and appropriately immobilize and/or reduce the fracture/dislocation in a timely manner.
 3.10 Altered mental status: Investigate loss of consciousness to exclude serious and potentially lethal causes by interviewing the patient and witnesses, performing an appropriate physical examination and laboratory/ diagnostic imaging tests. Demonstrate approach to loss of consciousness that considers disorders of vascular tone or blood volume, cardiovascular disorders, and cerebrovascular disorders. Manage life-threatening causes and complications when appropriate, and arrange for appropriate follow-up.
 3.11 Poisoning and toxin exposure: Recognize cases of intentional and unintentional poisoning caused by medication toxicity, chemical exposure (including household and agricultural chemicals), heavy metal poisoning, alcohol poisoning, common herbal ingestions and carbon monoxide toxicity.
Arrange appropriate investigations and monitoring, and poison/toxicology treatment and utilize resources available (eg poison control centre, toxicology management supports) and collaborate with others (including dialysis teams, pharmacists) when appropriate

 3.12 Stabilizing ill patients: Stabilize and appropriately immobilize a victim of trauma and prevent decline in a pro-active way.
 3.13 Prepare for transport: Recognize signs or symptoms when a patient should be transported to another facility (by land, or air), manage patients with advice from specialists at a distance, and where appropriate coordinate transfer and adequately stabilize and prepare the patient for transport.
ADU4.
Perform patient-centered clinical assessment and manage adults presenting with common
(key) conditions.
 4.1 Fever and infectious conditions: Describe an approach to fever and diagnose and manage key infectious conditions. fever of unknown origin pneumonia upper respiratory tract infections tuberculosis appendicitis cholecystitis diverticulitis infectious diarrhea cystitis and pyelonephritis sexually transmitted infections prostatitis epidymiditis soft tissue infections meningitis
 4.2 Allergic conditions: Diagnose and manage key adult allergy conditions. angioedema allergic rash urticaria
 4.3 Skin conditions: Diagnose and manage key adult skin conditions. cellulitis purpura contact dermatitis urticaria erythema multiforme petechiae erythema nodosum erythema migrans burns skin ulcers
 4.4 Head and neck conditions: Diagnose and manage appropriately key adult head and neck in conditions. acute dental pain acute hearing loss otitis externa otitis media serous otitis media sinusitis stomatitis pharyngitis epistaxis eye trauma vertigo
 4.5 Eye conditions: Diagnose and manage key adult eye conditions. conjunctivitis acute glaucoma decreased visual acuity strabismus preorbital and orbital cellulitis
 4.6 Endocrine conditions: Diagnose and manage key pediatric endocrine conditions. type 1 diabetes hypothyroidism early Type 2 diabetes diabetic ketoacidosis upper respiratory tract infections
COPD and COPD exacerbations post viral cough adrenal insufficiency
 4.7 Respiratory conditions: Diagnose and manage key respiratory conditions pneumonia asthma

 4.8 Cardiovascular conditions: Diagnose and manage key cardiac conditions. hypertensive emergencies ischemic heart disease
PVT/PE congestive heart failure acute coronary syndrome arrhythmia aortic aneurysm and dissection
 4.9 Gastrointestinal conditions: Diagnose and manage key gastrointestinal conditions. acute abdominal pain peptic ulcer disease vomiting gastroenteritis gastrointestinal bleeding jaundice volvulus obstruction appendicitis biliary colic bowel perforation hernias constipation inflammatory bowel disease pancreatitis gastroesophageal reflux diverticulitis hepatitis
 4.10 Renal, urologic, genitourinary conditions: Diagnose and manage key renal, urologic and genitourinary conditions. urinary tract infections sexually transmitted infections vulvo-vaginitis vaginal bleeding hematuria testicular torsion renal colic acute renal failure urinary retention
 4.11 Neurologic conditions: Diagnose and manage key neurologic conditions. headaches syncope
CVA/TIA meningitis epilepsy intra-cranial hemorrhage
 4.12 Hematological conditions: Diagnose and manage key hematological conditions. anemia neutropenia (febrile neutropenia)
ITP acute leukemia/lymphoma bleeding disorders
 4.13 Musculoskeletal conditions: Diagnose and manage key pediatric musculoskeletal conditions. septic arthritis fractures dislocations ligamentous tears sprains back pain/sciatica
 4.14 Oncology conditions: Diagnose and manage key oncology conditions. lung cancer breast cancer liver cancer pancreatic cancer bowel cancer prostate cancer gynecologic cancers (ovary, uterus, cervix, vagina) urologic cancer (kidney, bladder) bone metastases hypercalcemia
 4.15 Emergency contraception issues: Develop an approach to emergency contraception.

BEH4. Describe specific approaches to screening for, recognizing, diagnosing and managing common (key) mental health conditions. Demonstrate familiarity with the DSM diagnostic criteria for common disorders
 4.2 Mental health conditions in adults . Screen for, diagnose and manage common mental health condition in adults adjustment Disorders alcohol and drug abuse/dependence bi-polar Spectrum Disorders depression and Dysthymia anxiety disorders schizophrenia and psychotic illness
 4.5 Suicide risk.
Assess patient's suicide or homicide risk and determine if patient requires involuntary admission
 4.6 Risk to others: Identify and manage patients at risk to others.
 4.7 Involuntary admission . State criteria for involuntary admission.
PAL2. Demonstrate an effective approach to advance care planning
 2.1 Discussion of Advance care plans: Initiate advance care planning discussions with patients and families and participates in the development of highly specific and detailed advance care plan documents that clearly outline the patient’s wishes that will serve to direct care in the event of certain clinical conditions.
 2.2 Quality of Life:
Identify the elements that define “quality of life” for an individual patient living with advanced disease. Understand that family members may differ in opinion from the patient when prioritizing these elements.
 2.3 Differing opinion: Appreciate that family members may differ in opinion form the patient when prioritizing elements of quality of life
 2.4 Legal definitions: Describe the elements of substitute decision-making, power of attorney, and living wills.
 2.5 Consultation: Refer for consultation (specialty or ethics) those patient with complex issues
FAM 5. Perform family medicine specialty-appropriate procedures to meet the needs of individual patients and demonstrate an understanding of procedures performed by other specialists to guide their patients’ care
 5.1 Selection: Determine the most appropriate procedures or therapies.
 5.2 Consent: Obtain and document informed consent, explaining the risks and benefits of, and the rationale for, a proposed procedure or therapy.
 5.3 Prioritize: Prioritize a procedure or therapy, taking into account clinical urgency and available resources.
 5.4 Performance: Perform the following procedures in a skillful and safe manner, adapting to unanticipated findings of changing clinical circumstances:
Resuscitation oral airway insertion emergency venous access bag-and-mask ventilation endotracheal intubation cardiac defibrillation
Procedural sedation
Venous Access peripheral intravenous line peripheral venous access child
Injections
Intramuscular injection sub-cutaneous injection lumbar puncture
Skin
Abscess, cyst incision & drainage laceration repair (suture and glue) release of sub-ungual hematoma removal of foreign body infiltration of local anesthetic digital block in finger or toe
Eye/Ear/Nose
Slit lamp examination instillation of fluorescein tonometry removal of corneal foreign body removal of foreign body from ear removal of foreign body form nose cautery for anterior epistaxis anterior nasal packing

GI procedures
Nasogastric insertion
Incision and drainage of thrombosed hemorrhoid
Musculoskeletal release of subungual hematoma application of sling splint application of casts (forearm, scaphoid) application cast (below-knee) reduction of dislocated finger reduction of dislocated radial head splinting of injured extremity
 5.5 Aftercare: Develop a plan with the patient for the aftercare and follow-up after completion of a procedure.
 5.6 Complications: Describe the normal post-operative healing course and recognize and manage post-operative complications.
BEH3. Recognize and provide care to patients presenting with a history of abuse.
 3.1 Domestic violence.
Recognize risks of intimate partner violence (e.g. pregnancy) and screen for abuse and domestic violence appropriately. Assess the level of risk for all members of the household, and appropriately refer to child protection services (eg Child and Family Services) as required.
 3.2 Sexual assault and abuse: Identify and develop and approach to patients presenting with sexual assault, sexual abuse, rape or incest.
Communicator
FAM8. Establish effective professional relationships with patients and their families
 8.1 Patient-centered approach: Communicate using a patient-centered approach that encourages patient trust and autonomy and is characterized by empathy, respect, and compassion
 8.2 Environment: Optimize the physical environment for patient comfort, dignity, privacy, engagement, and safety
 8.3 Patient perspective: Recognize when the values, biases, or perspectives of patients, physicians, or other health care professionals may have an impact on the quality of care, and modify the approach to the patient accordingly
 8.4 Non-verbal communication: Respond to a patient’s non-verbal behaviors to enhance communication
 8.5 Disagreements: Manage disagreements and emotionally charged conversations
 8.6 Adapting communication: Adapt to the unique needs and preferences of each patient and to his or her clinical condition and circumstances
FAM9. Elicit and synthesize accurate and relevant information, incorporating the perspectives of patients and their families
 9.1 Patient-centered interviewing: Use patient-centered interviewing skills to effectively gather relevant biomedical and psychosocial information
 9.2 Interview structure: Provide a clear structure for and manage the flow of an entire patient encounter
 9.3 Corroborating information: Seek and synthesize relevant information from other sources, including the patient’s family or caregivers, with the patient’s consent
FAM10. Share health care information and plans with patients and their families
 10.1 Sharing information: Share information and explanations that are clear, accurate, and timely, while checking for patient and family understanding
 10.2 Disclosure: Disclose harmful patient safety incidents to patients and their families accurately and appropriately
FAM11. Engage patients and their families in developing plans that reflect the patient’s health care needs and goals

 11.1 Cultural safety: Facilitate discussions with patients and their families in a way that is respectful, non-judgmental, and culturally safe
 11.2 Support decision-making: Assist patients and their families to identify, access, and make use of information and communication technologies to support their care and manage their health
 11.3 Common ground: Use communication skills and strategies that help patients and their families make informed decisions leading to a shared plan of care.
FAM12. Document and share written and electronic information about the medical encounter to optimize clinical decision-making, patient safety, confidentiality, and privacy
 12.1 Documentation requirements: Document clinical encounters in an accurate, complete, timely, and accessible manner, in compliance with regulatory and legal requirements
 12.2 Record format: Communicate effectively using a written health record, electronic medical record, or other digital technology
 12.3 Information sharing: Share information with patients and others in a manner that respects patient privacy and confidentiality and enhances understanding
Collaborator
FAM13. Work effectively with physicians and other colleagues in the health care professions
 13.1 Relationship: Establish and maintain positive relationships with physicians and other colleagues in the health care professions to support relationship-centered collaborative care
 13.2 Team communication: Demonstrate clear and effective communication (both written and verbal) with physicians and other colleagues in the healthcare professions.
 13.3 Shared decision-making: Negotiate overlapping and shared responsibilities with physicians and other colleagues in the health care professions.
 13.4 Positive work environment: Implement strategies to promote understanding, manage differences, and resolve conflicts in a manner that supports a collaborative culture
FAM14. Hand over the care of a patient to another health care professional to facilitate continuity of safe patient care
 14.1
Timing of transfers: Determine when care should be transferred to another physician or health care professional
 14.2
Safe transfers: Demonstrate safe handover of care, using both verbal and written communication, during a patient transition to a different health care professional, setting, or stage of care
Leader/Manager
FAM17. Engage in the stewardship of health care resources
 17.1 Resource allocation: Allocate health care resources for optimal patient care, including referral to other health care professionals and community resources
 17.2 Cost-appropriate: Apply evidence and management processes to achieve cost-appropriate care
Health Advocate
FAM21. Respond to an individual patient’s health needs by advocating with the patient within and beyond the clinical environment
 21.1
Determinants of health: Work with patients to address determinants of health that affect them and their access to needed health services or resources

Scholar
FAM24. Integrate best available evidence, contextualized to specific situations, into real-time decision-making
 24.1 Identifying knowledge gap: Recognize practice uncertainty and knowledge gaps in clinical encounters and generate focused questions that can address them.
 24.4 Integrating evidence: Integrate evidence into decision-making in their practice by reviewing and appropriately applying guidelines from organizations such as Health Canada, the College of
Family Physicians of Canada, and Canadian Society of Emergency Medicine.
FAM27. Demonstrate a commitment to patients
 27.1 Professional behaviors: Exhibit appropriate professional behaviors and relationship in all aspects of professional practice, reflecting honesty, integrity, commitment, compassion, respect, altruism, respect for diversity, and for maintenance of confidentiality.
 27.2 Excellence: Demonstrate a commitment to excellence in all aspects of practice.
 27.3 Ethical issues: Recognize and respond to ethical issues encountered in practice.
Entrustable Professional Activities

Assess, manage, and follow-up patients presenting with common (key) conditions.

Determine when an adult patient requires admission and inpatient hospital care.

Recognize and provide initial management of common adult emergencies.
Evaluation
End-of-shift feedback notes
In-training Assessment Report (ITAR)