Ethics Code - LSUHSC Emergency Medicine Residency
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LSU Emergency Medicine Residency Handbook 2013-14 Revised April 2014, M. Haydel, MD LOUISIANA STATE UNIVERSITY HEALTH SCIENCE CENTER – NEW ORLEANS EMERGENCY MEDICINE RESIDENCY PROGRAM POLICIES TO SUPPLEMENT LSUHSC HOUSE OFFICER MANUAL & ROTATION GUIDE Contents INTRODUCTION ..................................................................................................................................................... 4 POLICIES – ACGME ................................................................................................................................................. 5 ACGME CORE COMPETENCIES ........................................................................................................................................5 MILESTONES .............................................................................................................................................................7 PGY1 YEAR ............................................................................................................................................................7 PGY2 YEAR ............................................................................................................................................................8 PGY3 YEAR ............................................................................................................................................................9 PGY4 YEAR ..........................................................................................................................................................10 RESIDENT DUTY HOURS AND THE WORKING ENVIRONMENT.................................................................................................12 DUTY HOURS - EMERGENCY MEDICINE ...........................................................................................................................14 POLICIES - LSUHSC ............................................................................................................................................... 15 ETHICS CODE - LSUHSC EMERGENCY MEDICINE RESIDENCY ................................................................................................15 Code Of Professional Conduct ............................................................................................................................17 Honor Code.........................................................................................................................................................17 Grievance Policy - Academic ..............................................................................................................................18 LSU QUALITY OF CARE STATEMENT ...................................................................................................................23 JOB DESCRIPTION - EM HOUSE OFFICER .........................................................................................................................24 House Officer I ....................................................................................................................................................24 House Officer II ...................................................................................................................................................24 House Officer III ..................................................................................................................................................25 House Officer IV..................................................................................................................................................26 RESIDENT SUPERVISION.................................................................................................................................................27 HOUSE OFFICER CONTRACT ....................................................................................................................................28 LSU Emergency Medicine Residency Handbook 2013-14 COMPENSATION .....................................................................................................................................................29 INSURANCE .............................................................................................................................................................30 Health Plans .......................................................................................................................................................30 Disability Insurance ............................................................................................................................................30 Medical Practice Liability Coverage ...................................................................................................................30 LEAVE: .....................................................................................................................................................................30 Vacation Leave ...................................................................................................................................................30 Sick Leave ...........................................................................................................................................................30 Maternity/Paternity Leave .................................................................................................................................30 Educational Leave ..............................................................................................................................................31 Military Leave .....................................................................................................................................................31 Leave of Absence ................................................................................................................................................31 Family Leave .......................................................................................................................................................31 PAY SCALES - LSUHSC HOUSE OFFICER ...........................................................................................................................35 EMERGENCY FUND FOR RESIDENTS..................................................................................................................................36 CAMPUS ASSISTANCE PROGRAM.....................................................................................................................................37 FITNESS FOR DUTY AND SUBSTANCE ABUSE POLICY ...........................................................................................................39 FATIGUE AND FITNESS FOR DUTY .............................................................................................................................40 WORK RELATED INJURY/ILLNESS .....................................................................................................................................41 DRESS CODE ...............................................................................................................................................................42 LIBRARY - LSUHSC ....................................................................................................................................................47 WELLNESS CENTER ..................................................................................................................................................48 HOUSE STAFF CLEARANCE FORM ............................................................................................................................49 POLICIES – SECTION OF EM .................................................................................................................................. 51 MISSION STATEMENT ...................................................................................................................................................51 GOALS and OBJECTIVES ......................................................................................................................................51 ROLE OF THE RESIDENCY IN THE EMERGENCY DEPARTMENT .................................................................................................53 EM RESIDENCY APPLICANTS ..........................................................................................................................................54 RESIDENCY PROMOTIONS ..............................................................................................................................................55 SUPERVISION OF RESIDENTS ...........................................................................................................................................56 TRANSITION OF CARE POLICY .........................................................................................................................................57 Hand Off Tool .....................................................................................................................................................58 LIAISON & OVERSIGHT POLICY........................................................................................................................................60 DISMISSAL POLICY........................................................................................................................................................61 OMBUDSMAN ....................................................................................................................................................65 REVIEW OF TRAINING PROGRAMS.....................................................................................................................65 SATISFACTORY ACADEMIC STANDING ...............................................................................................................................66 EVALUATIONS .............................................................................................................................................................67 Monthly evaluation of Residents by Faculty ......................................................................................................68 Annual evaluation of Faculty by Residents .........................................................................................................70 Evaluation of Rotations by Residents .................................................................................................................71 Evaluation of Program by Residents ..................................................................................................................72 6 month Evaluation of each Resident by Advisor ...............................................................................................73 Yearly Eval and Final Exit Evaluation of Resident by Program Director .............................................................74 FACULTY ADVISORS ......................................................................................................................................................81 Evaluation of Resident Documents Policy ..........................................................................................................81 PROCEDURE AND PATIENT EXPERIENCE DOCUMENTATION ...................................................................................................82 Procedures And Resuscitations ..........................................................................................................................82 Ultrasound..........................................................................................................................................................83 NEW INNOVATIONS ......................................................................................................................................................84 EDUCATIONAL STIPEND .................................................................................................................................................85 TRAVEL FORMS ............................................................................................................................................................85 LSU Emergency Medicine Residency Handbook 2013-14 MAILBOXES/ EMAIL .....................................................................................................................................................86 BEEPERS.....................................................................................................................................................................87 VACATION ..................................................................................................................................................................88 YEARLY SCHEDULE REQUESTS .........................................................................................................................................88 ED SCHEDULES ............................................................................................................................................................89 TARDINESS...............................................................................................................................................................90 DISASTER CALL ............................................................................................................................................................91 Disaster Call Scheduling .....................................................................................................................................91 Disaster Call & Duty Hours .................................................................................................................................92 CODE GREY – HURRICANE GUIDELINES ............................................................................................................................93 ADVANCED LIFE SUPPORT PROGRAMS POLICY ...................................................................................................................97 MOONLIGHTING POLICY ................................................................................................................................................99 CALL ROOM ..............................................................................................................................................................101 CONFERENCE ATTENDANCE POLICY ...............................................................................................................................102 JOURNAL CLUB ..........................................................................................................................................................103 Journal Club Literature Critique ........................................................................................................................103 PATIENT SAFETY PRESENTATIONS ..................................................................................................................................105 MEDICAL RECORDS ....................................................................................................................................................108 RESEARCH REQUIREMENT ............................................................................................................................................109 CHIEF RESIDENT RESPONSIBILITIES.................................................................................................................................110 Chief Resident Questionnaire ...........................................................................................................................110 RESIDENCY CURRICULUM ............................................................................................................................................111 Model For Emergency Medicine .......................................................................................................................111 REFERENCE BOOK LOAN-OUT POLICY ............................................................................................................................112 MEDICAL LICENSE ......................................................................................................................................................113 Louisiana License, Training Permit & STEP 3: ...................................................................................................113 State Licensure .................................................................................................................................................114 DEA number .....................................................................................................................................................114 NPI number ......................................................................................................................................................114 Notary ..............................................................................................................................................................115 GUIDELINES TO ROTATIONS/GOALS & OBJECTIVES ...........................................................................................................115 LSU PUBLIC HOSPITAL EMERGENCY DEPARTMENT ...........................................................................................................117 ED: Specific Competency-based Goals & Objectives........................................................................................123 ANESTHESIA & US.............................................................................................................................................126 ANESTHESIA and US at ILH ...............................................................................................................................130 LALLIE KEMP EMERGENCY DEPARTMENT ........................................................................................................134 EMS- New Orleans EMS ....................................................................................................................................138 CHILDREN’S HOSPITAL ED ...............................................................................................................................140 MICU ................................................................................................................................................................143 OB Ochsner .......................................................................................................................................................147 OCHSNER ED.....................................................................................................................................................151 OLOL Pediatric ED.............................................................................................................................................158 OCHSNER ED.....................................................................................................................................................160 OCHSNER ED-Pediatrics ....................................................................................................................................167 SLIDELL ED ........................................................................................................................................................171 PEDIATRIC INTENSIVE CARE UNIT ROTATION ..................................................................................................177 TOXICOLOGY ....................................................................................................................................................180 TRAUMA ICU ....................................................................................................................................................184 VA URGENT CARE CENTER ...............................................................................................................................187 WEST JEFFERSON ED ........................................................................................................................................194 WEST JEFFERSON PEDIATRIC ED & FASTTRACK ...............................................................................................195 ELECTIVE ...........................................................................................................................................................200 LSU Emergency Medicine Residency Handbook 2013-14 INTRODUCTION Welcome to the LSU Emergency Medicine Residency Program. This LSU EM Policies Manual is meant to augment the LSUHSC School of Medicine, Office of Graduate Medical Education, House Officer Manual. The House Officer Manual is updated each year and is available on the LSUSHC website at: http://www.medschool.lsuhsc.edu/medical_education/graduate/HouseOfficerManual.asp A hard copy of the EM Policies manual is available in the emergency medicine offices and online at the LSU EM website. LSU Emergency Medicine Residency Handbook 2013-14 POLICIES – ACGME ACGME Core Competencies The following 6 Core Competencies for ACGME accreditation purposes. The residency program requires that its residents obtain competence in the six areas listed below: 1. Patient Care: Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Among other things, residents are expected to: a. b. c. d. Gather accurate, essential information in a timely manner. Generate an appropriate differential diagnosis. Implement an effective patient management plan. Competently perform the diagnostic and therapeutic procedures and emergency stabilization. e. Prioritize and stabilize multiple patients and perform other responsibilities simultaneously. f. Provide health care services aimed at preventing health problems or maintaining health. g. Work with health care professionals to provide patient-focused care. Residency Experience: each clinical rotation and every off site ED rotation, didactic/lecture sessions, skill labs, simulation labs, US, Tox, all orientations, ACLS/PALS/ATLS and teaching medical student anatomy labs. Residency Assessments: Direct observation and documentation of Monthly and Yearly evaluations, simulation cases, oral board cases, Follow-up cases 360 evaluations. 2. Medical Knowledge: Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. Among other things, residents are expected to: a. Identify life threatening conditions, the most likely diagnosis, synthesize acquired patient data, and identify how and when to access current medical information. b. Properly sequence critical actions for patient care and generate a differential diagnosis for an undifferentiated patient. c. Complete disposition of patients using available resources. LSU Emergency Medicine Residency Handbook 2013-14 Residency Experience: each clinical rotation, every off site ED rotation, didactic/lecture sessions, skill labs, simulation labs, asynchronous learning modules, US, Tox, all orientations, ACLS/PALS/ATLS and teaching medical student anatomy labs. Residency Assessments: National In-service Exam, Monthly and Yearly evaluations, 360 evaluations, oral board cases, simulation cases and journal club. 3. Practice-Based Learning: Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence and improve their patient care practices. Among other things, residents are expected to: a. Analyze and assess their practice experience and perform practice-based improvement. b. Locate, appraise and utilize scientific evidence related to their patient’s health problems. c. Apply knowledge of study design and statistical methods to critically appraise the medical literature. d. Utilize information technology to enhance their education and improve patient care. e. Facilitate the learning of students and other health care professionals. 4. Interpersonal and Communication Skills: Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their families and professional associates. Among other things, residents are expected to: a. Develop an effective therapeutic relationship with patients and their families, with respect for diversity and cultural, ethnic, spiritual, emotional and age-specific differences. b. Demonstrate effective participation in and leadership of the health care team. c. Develop effective written communication skills. d. Demonstrate the ability to handle situations unique to the practice of emergency medicine. e. Effectively communicate with out-of-hospital personnel as well as non-medical personnel. 5. 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 demonstrate a set of model behaviors that include but are not limited to: a. b. c. d. Treats patients/family/staff/paraprofessional personnel with respect. Protects staff/family/patient’s interests/confidentiality. Demonstrates sensitivity to patient’s pain, emotional state and gender/ethnicity issues. Able to discuss death honestly, sensitivity, patiently and compassionately. LSU Emergency Medicine Residency Handbook 2013-14 e. Unconditional positive regard for the patient, family, staff and consultants. f. Accepts responsibility/accountability. g. Openness and responsiveness to the comments of other team members, patients, families and peers. h. Arrives for scheduled shifts on time, fit for duty and appropriate attire. 6. Systems-Based Practice: Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Among other things, residents are expected to: a. Understand access, appropriately utilize and evaluate the effectiveness of the resources, providers and systems necessary to provide optimal emergency care. b. Understand different medical practice models and delivery systems and how to best utilize them to care of the individual patient. c. Practice cost-effective health care and resource allocation that does not compromise quality of care. d. Advocate and facilitate the patients’ advancement through the health care system. MILESTONES It is anticipated that residents will reach certain milestones in their training as remonstrated by the following General Competency Goals and Objectives for level of training. EMERGENCY MEDICINE YEAR END COMPETENCIES-being updated to reflect ACGME and ABEM MILESTONES PGY1 YEAR These objectives are the criteria that are used to determine a resident’s ability to advance to the next year of residency. By the end of the PGY-1 year, EM residents are expected to: Core Competency Objective Assessment Method Competency Complete all clinical rotations with satisfactory evaluations PC, MK, ICS Rotation evals Attend at least 70% of all mandatory EM conferences. PF, MK, PBL Attendance sheets Demonstrate EM knowledge by scoring at least 70th percentile MK, PC ABEM exam on the ABEM In-service examination. Obtain documents required for medical licensure. PC, SBP Resident File Properly assist in trauma or medical resuscitations with Simulations, global MK, PC guidance. evals, oral boards Demonstrate the ability to execute admission and discharge, SDOT, global MK, PC, SBP once the disposition is determined. evaluations Residents are expected to maintain timely documentation of ICS, PC, SBP Procedure logs, LSU Emergency Medicine Residency Handbook 2013-14 charts in the ED, medical records and hospital paperwork. Obtain faculty evaluations and document procedures in New Innovations. Demonstrate adequate documentation of procedures with at least 1/5 of ACGME targeted procedures in the NewInnov. Demonstrate adequate documentation of follow-up diagnoses of patients seen in the ED and complete 10 followup/year Demonstrate adequate progress with all specified academic requirements as judged by the program director. Identify a potential area of need for the residency required administrative project. Identify and choose a potential topic for the residency required academic project. Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population. Demonstrate the ability to interact effectively with nurses, ancillary staff, patients and families. PC med. recs dept. Procedure logs, simulations, SDOT PC Procedure logs PC, MK Follow up logs, resident portfolios PBL, ICS Portfolio, lecture evaluations SBP Semi-Annual eval. PBL Semi-Annual eval. PF Global evaluations, 360 evaluations ICS Global evaluations, 360 evaluations PGY2 YEAR These objectives are the criteria that are used to determine a resident’s ability to advance to the next year of residency. By the end of the PGY-2 year, EM residents are expected to: Core Competency Objective Assessment Method Competency Complete all clinical rotations with satisfactory evaluations PC, MK, ICS Rotation evals Attend at least 70% of all mandatory EM conferences. PF, MK, PL Attendance sheets Demonstrate improvement in EM knowledge by scoring at MK, PC ABEM exam least 75th percentile on the ABEM In-service examination. Pass USMLE Step 3. Louisiana License, Training Permit & STEP 3: MK, PC, SBP Resident File Properly perform a trauma or medical code resuscitation with Simulations, global MK, PC minimal guidance. evals, oral boards Demonstrate the ability to execute admission, discharge, and SDOT, global MK, PC, SBP transfers once the disposition is determined. evaluations Residents are expected to maintain timely documentation of Procedure logs, ICS, PC, SBP charts in the ED, medical records and hospital paperwork. med. recs dept. Completes all procedure-related readings, achieve 80% on all Procedure logs, PC post-tests, obtain faculty evals and documentation in RP. simulations, SDOT Demonstrate adequate documentation of procedures with at PC Procedure logs least ½ ACGME targeted procedures in NewInnov. Demonstrate adequate documentation of 10 follow-up PC, MK Follow up logs, LSU Emergency Medicine Residency Handbook 2013-14 diagnoses of patients seen in the ED. Demonstrate adequate progress with all specified academic requirements as judged by the program director. Complete significant progress on the residency required administrative project. Complete significant progress on the residency required academic project. Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population. Demonstrate the ability to interact effectively with nurses, ancillary staff, patients and families. PL, ICS resident portfolios Portfolio, lecture evaluations SBP Semi-Annual eval. PL Semi-Annual eval. PF Global evaluations, 360 evaluations ICS Global evaluations, 360 evaluations PGY3 YEAR These objectives are the criteria that are used to determine a resident’s ability to advance to the next year of residency. By the end of the PGY-3 year, EM residents are expected to: Core Competency Objective Assessment Method Competency Complete all clinical rotations with satisfactory evaluations PC, MK, ICS Rotation evaluations (meets expectations or above). Attend at least 70% of all mandatory EM conferences. PF, MK, PL Attendance sheets Demonstrate improvement in EM knowledge by scoring at MK, PC ABEM exam least 78th percentile on the ABEM In-service examination. Maintain licensure. PC, SBP Resident File Properly perform a trauma or medical code resuscitation with minimal supervision. Appropriately sequences critical actions Simulations, global MK, PC and identifies interventions required to immediately stabilize evals, oral boards a patient. Manages multiple patients at various, progressive stages of SDOT, global work-up throughout the shift, making appropriate, timely MK, PC, SBP evaluations decisions Residents are expected to maintain timely documentation of Procedure logs, ICS, PC, SBP charts in the ED, medical records and hospital paperwork. med. recs dept. Demonstrate adequate documentation of procedures with at PC Procedure logs least ¾ of ACGME targeted procedures listed in NewInnov. Demonstrate adequate documentation of 10 follow-up Follow up logs, PC, MK diagnoses of patients seen in the ED. resident portfolios Demonstrate adequate progress with all specified academic Portfolio, lecture PL, ICS requirements as judged by the program director. evaluations Complete [significant progress on] the residency required SBP Semi-Annual eval. administrative project. LSU Emergency Medicine Residency Handbook 2013-14 Complete [significant progress on] the residency required academic project. Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population. Demonstrate the ability to interact effectively with nurses, ancillary staff, patients and families. PL Semi-Annual eval. PF Global evaluations, 360 evaluations ICS Global evaluations, 360 evaluations PGY4 YEAR These objectives are the criteria that are used to determine a resident’s ability to advance to the next year of residency. By the end of the PGY-4 year, EM residents are expected to: Core Competency Objective Assessment Method Competency Complete all clinical rotations with satisfactory evaluations PC, MK, ICS Rotation evaluations (meets expectations or above). Attend at least 70% of all mandatory EM conferences. PF, MK, PL Attendance sheets Demonstrate improvement in EM knowledge by scoring at MK, PC ABEM exam least 80th percentile on the ABEM In-service examination. Maintain licensure. PC, SBP Resident File Properly perform a trauma or medical code resuscitation. Simulations, global Appropriately sequences critical actions and identifies MK, PC evaluations, oral interventions required to immediately stabilize a patient. boards Manages multiple patients at various, progressive stages of SDOT, global work-up throughout the shift, making appropriate, timely MK, PC, SBP evaluations decisions. Supervises and facilitates patient flow in ED. Residents are expected to maintain timely documentation of Procedure logs, ICS, PC, SBP charts in the ED, medical records and hospital paperwork. med. recs dept. Demonstrate adequate documentation of procedures with at PC Procedure logs least 100% of ACGME targeted procedures listed in RP. Demonstrate adequate documentation of 10 follow-up Follow up logs, PC, MK diagnoses of patients seen in the ED. resident portfolios Demonstrate adequate progress with all specified academic Portfolio, lecture PL, ICS requirements as judged by the program director. evaluations Complete the residency required administrative project. SBP Semi-Annual eval. Complete the residency required academic project. PL Semi-Annual eval. Residents must demonstrate a commitment to carrying out Global evaluations, professional responsibilities, adherence to ethical principles PF 360 evaluations and sensitivity to a diverse patient population.. Demonstrate the ability to interact effectively with nurses, Global evaluations, ICS ancillary staff, patients and families. 360 evaluations LSU Emergency Medicine Residency Handbook 2013-14 LSU Emergency Medicine Residency Handbook 2013-14 Resident Duty Hours and the Working Environment Duty Hours a. Duty hours are defined as all clinical and academic activities related to the residency program, ie, patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent inhouse during call activities, and scheduled academic activities such as conferences. Duty hours do not include reading and preparation time spent away from the duty site. b. Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities. ED rotations: duty hours are limited to 60 hours per week. c. Residents must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities. d. Adequate time for rest and personal activities must be provided. This should consist of a 10 hour time period provided between all daily duty periods and after in-house call. e. MOONLIGHTING must be documented in New Innovations and counts toward duty hours. Moonlighting may not exceed the duty hour limits. 3. On-Call Activities The objective of on-call activities is to provide residents with continuity of patient care experiences throughout a 24-hour period. In-house call is defined as those duty hours beyond the normal work day when residents are required to be immediately available in the assigned institution. a. In-house call must occur no more frequently than every third night, averaged over a four-week period. b. Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to six additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care as defined in Specialty and Subspecialty Program Requirements. c. Interns may not exceed 16 hours of consecutive inhouse duties. d. Residents many not accept new patients after 24 hours of continuous duty. e. At-home call (pager call) is defined as call taken from outside the assigned institution. 1. The frequency of at-home call is not subject to the every third night limitation. However, at-home call must not be so frequent as to preclude rest and reasonable personal time for each resident. Residents taking at-home call must be provided with 1 day in 7 completely free from all educational and clinical responsibilities, averaged over a 4-week period. LSU Emergency Medicine Residency Handbook 2013-14 2. When residents are called into the hospital from home, the hours residents spend in-house are counted toward the 80-hour limit. 3. The program director and the faculty must monitor the demands of at-home call in their programs and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue. 4. Moonlighting a. Because residency education is a full-time endeavor, the program director must ensure that moonlighting does not interfere with the ability of the resident to achieve the goals and objectives of the educational program. b. The program director must comply with the sponsoring institution’s written policies and procedures regarding moonlighting, in compliance with the Institutional Requirements III. D.1.k. c. Any moonlighting must be documented and counted toward the 80-hour weekly limit on duty hours. 5. Oversight a. Each program must have written policies and procedures consistent with the Institutional and Program Requirements for resident duty hours and the working environment. These policies must be distributed to the residents and the faculty. Monitoring of duty hours is required with frequency sufficient to ensure an appropriate balance between education and service. b. The Disaster Call system for EM residents provides a backup support system when patient care responsibilities are unusually difficult or prolonged, or if unexpected circumstances create resident fatigue sufficient to jeopardize patient care. LSU Emergency Medicine Residency Handbook 2013-14 Duty Hours - Emergency Medicine Duty Hours on Emergency Medicine Rotations “There must at least an equivalent period of continuous time off between scheduled work periods. Residents may attend educational activities between work periods, but at some point in the 24 hour period must have an equivalent period of continuous time off between the end of one activity (work or educational) and the start of another activity (work or educational).” ACGME 2007 As a minimum, residents shall be allowed 1 full day in 7 days (averaged over 4 weeks) away from the institution and free of any clinical or academic responsibilities. While on duty in the emergency department, residents may not work longer than 12 continuous hours providing direct patient care. There must be at least 10 hours off between scheduled work periods. The residents should not work more than 60 scheduled hours per week seeing patients in the emergency department and no more than 72 duty hours per week including residency related activities. LSU Emergency Medicine Residency Handbook 2013-14 POLICIES - LSUHSC Ethics Code - LSUHSC Emergency Medicine Residency I agree to abide by the moral standards and ethical behavior deemed suitable for a training physician in emergency medicine. I will not copy or relay exam materials for other's benefit. I will present all patient cases and patient exams in a truthful manner, to the best of my knowledge and capabilities. I will not condone patient, student, or House Officer abuse or degradation. I have reviewed with the Residency Director, the LSU Emergency Medicine Residency Program Policy Manual and I understand its contents. ___________________________________________________ NAME (Print clearly) ___________________________________________________ DATE ___________________________________________________ Signature LSU Emergency Medicine Residency Handbook 2013-14 LSU Emergency Medicine Residency Handbook 2013-14 Code Of Professional Conduct The residents and faculty of the section of emergency medicine are expected to maintain the level of professionalism dictated by the School of Medicine's Code of Professional Conduct. PREAMBLE The academic community of the School of Medicine is committed to maintaining an environment of open and honest intellectual inquiry. Faculty, residents, and students have the right to enjoy an educational environment characterized by the highest standards of ethical professional conduct. The individuals who comprise the LSUMC campus come from many different cultural backgrounds. Discriminatory comments or actions relative to gender, sexual orientation, racial origin, creed, age, physical or mental status can interfere with an individual's performance and create an intimidating, hostile, and offensive educational and work environment. Individuals who manifest such unprofessional behavior in any of these areas are disruptive and in violation of the School of Medicine's Code of Professional Conduct and of LSU Medical Center Policy. Report of such conduct will be reviewed by the Council on Professional Conduct according to the "Rules of Procedure" set forth in the Code. The students, residents, and faculty share the responsibility, to themselves and to their colleagues, to protect their individual rights and those of the academic community as a whole. To this end, and to ensure the rights of due process to members of the academic community, the students, residents, and faculty of the School of Medicine have adopted this Code of Professional Conduct. This Code governs questions of professional conduct, including but not limited to, dishonest, disruptive, discriminatory, and illegal activities. Penalty for such misconduct could lead to dismissal from the LSU School of Medicine. Honor Code On my honor, I will uphold the ideals of the medical profession and protect the name of the LSU School of Medicine for the duration of my career. Continuing its tradition of excellence, I vow to leave the school better than it was left to me and expect others to do the same. Mission Statement Through an Honor Code, the students of the LSU School of Medicine affirm their adherence to several basic principles. As students at an institution of professional education and members of the medical community, we seek to promote a mutual trust and honor between faculty, students, and staff. As future physicians, we must maintain our educational pursuit at a level consistent with the integrity of our chosen profession. We believe that ethics, social responsibility, and academic integrity are an essential part of our experience as medical students in a diverse community that encompasses a wealth of people and their experiences. Violation of these basic principles will be considered an Honor Offense. An Honor Offense is not limited to, but includes: 1. Dishonesty on an examination or assignment through the use of outside materials; receiving or giving unauthorized aid on an examination or assignment 2. Plagiarism 3. Theft of property, either intellectual or physical 4. Conduct deliberately hindering the education of other students LSU Emergency Medicine Residency Handbook 2013-14 5. Illegal, unprofessional, or inappropriate behavior when representing the LSU School of Medicine at outlying facilities or on the campus of LSUHSC Any offense of the Honor Code can be reported to the Committee on Professional Conduct by faculty, students, or staff. The Committee on Professional Conduct is composed of students and faculty members of the School of Medicine. Failure to report a potential offense, while in itself not an Honor Offense, violates the spirit of the system. Report of such offenses will be reviewed by the Council on Professional Conduct according to the "Rules on Procedure" set forth in the Code of Professional Conduct. Recommendations made by the Committee on Professional Conduct range from a formal apology to dismissal from the School of Medicine. Each student will be required to read and sign a copy of the Honor Code at the beginning of the academic year prior to the completion of registration. The Pledge The pledge, to be signed by students on all examinations and assignments, is as follows: I pledge, on my honor, as a member of the medical community, to uphold the Honor Code of the LSU School of Medicine. Confidentiality Every effort will be made to maintain the confidentiality of all parties involved in an investigation and/or trial of an Honor Code offense. Anyone found to be in violation of confidentiality shall themselves be brought before the Committee and tried accordingly. Amendments This document can be amended by a two-thirds vote of the Student Government Association and a majority vote of the Student body. Grievance Policy - Academic Questions of academic grievances are addressed through procedures established specifically for that purpose. Resolving allegations of unethical professional conduct: rules of procedure 1. Composition of the Council on Professional Conduct. Initial review of an allegation of unethical professional conduct is the responsibility of the Council on Professional Conduct This Council consists of twenty-seven active Representatives. The Student Body is represented by twelve Council Representatives; each class elects three Representatives from its general membership. The Faculty is represented by five Representatives from the Basic Science Departments and five Representatives from the Clinical Science Departments, elected by the Faculty Assembly from the general full-time faculty, Resident representatives are recommended by the Chairman of each of the Departments of Medicine, OB-GYN, Psychiatry, Pediatrics and Surgery and appointed by the Dean of the School of Medicine. Chairmanship of the Council is shared by one student and one faculty Representative, elected by the twenty seven Council Representatives from their own members. In the event that a Co-Chairman is unable to serve, the vacancy shall be filled by an individual selected from the pool of remaining Committee Representatives by majority vote. The Council maintains its right to nominate additional members to the Council if the need arises. Resident Representatives are appointed for the duration of their residency. Faculty Representatives are elected for an indeterminate number of years. 2 Filing a Complaint: LSU Emergency Medicine Residency Handbook 2013-14 a. Initiation of Complaint. A student (with or without the input of the Student Advocacy Group), resident, or faculty member may initiate a complaint of unethical professional conduct against a student or resident by submitting an allegation in writing to any member of the Council on Professional Conduct, including a Co-Chairman. The written statement must include a description of the circumstances that gave rise to the charges and must be signed by the author(s). b. Deadline for Filing a Complaint. A complaint by a student (with or without the input of the Student Advocacy Group), resident, or faculty member alleging-unethical professional conduct by a student or resident must be submitted in writing to a Council member, including a Co-Chairman, within fifteen working days of the alleged unethical professional conduct. c. Confidentiality of Person Initiating Complaint. Because of the gravity of any allegation of unethical professional conduct, the identity of the author of a complaint shall be held in confidence throughout the investigation; however, a witness's identity may become known during a final hearing. d. Interim grade. If a complaint of cheating is filed against a student or resident, that student or resident shall be assigned a grade of "incomplete" for the work in question during the investigation of the complaint. A student or resident subsequently found innocent of the complaint will be evaluated for a final grade on the basis of his/her performance. 3. Investigation of Complaint and Determination of Sufficient Cause: A written allegation of unethical professional conduct is submitted to a Council member, or to one of the Co-Chairmen. The Co-Chairman shall arrange for a preliminary investigation. One faculty Representative to the Council is selected by the Co-Chairmen of the Council to assist in the preliminary investigation. In the case of an allegation against a student, the President of the Student Body will act as primary Fact Finder. In the case of an allegation against a resident, a Fact Finder will be appointed from among the LSU residents at large. Investigation of an allegation of unethical professional conduct is conducted in confidence. The purpose of the investigation is to determine all possible evidence, both tangible and testimonial, that bears on the allegation of unethical professional conduct. Inquiries by the Student Body President or Resident Representative (i.e. the Fact Finder) and the faculty Representative are strictly confidential, as is the information amassed during the course of the investigation, and the identity of the person who submits the complaint. The period of investigation is limited to five working days. During the period allotted for the investigation, the Co-Chairmen of the Council select three members of the Council to serve as an ad hoc panel for determination of sufficient cause for convening a formal hearing of the Council. The members of the ad hoc panel are excluded from further deliberations on that particular case. The Fact Finder presents the results of the investigation to the ad hoc panel. If the panel determines that there is sufficient cause for convening the Council, a formal hearing of the Council is scheduled. If the panel determines that there is insufficient cause for convening the Council, all charges are dismissed and all proceedings cease immediately. Although the circumstances constituting sufficient cause necessarily will vary from case to case, the statement of one person, with no other corroborating witness or corroborating tangible evidence, shall not be considered sufficient cause. LSU Emergency Medicine Residency Handbook 2013-14 If the ad hoc panel makes a preliminary determination of sufficient cause, the panel shall formulate the formal charges against the accused in writing, and shall set forth the witnesses to be called and the tangible evidence to be presented against or for the accused. The identity of any person filing an allegation shall remain confidential, although such person shall be listed as a witness. The Fact Finder shall present the case to the Council. Presentation of the case includes introducing tangible evidence and calling witnesses against or for the accused. 4 Formal Hearing: Council on Professional Conduct a. Notification to Council and Parties. The Co-Chairmen of the Council shall give written notification to the Council members, the accused, and the Fact Finder: 1) the determination of a possible breach of ethical professional conduct, and 2) the designated time and place for the formal hearing of the case. This notification, together with the formal charge and a list of the witnesses and evidence in support of the charge, must be distributed to' the above-named persons within two days of the determination of sufficient cause. The Fact Finder shall notify the named witnesses of the designated time and place for the formal hearing. b. Hearing Procedure. The hearing by the Council shall be conducted within five working days after the accused receives written notice of the formal charge against him/her. An extension of up to five working days may be requested by the accused under special circumstances; granting this request is within the discretion of the Co-Chairmen of the Council. In any event, the hearing must be convened within ten working days of written notification to the accused. Persons who must be Present for the formal Council hearing include: eight participating members of the Council (four faculty members and four additional Council members chosen from students and/or residents, reflecting those involved in the case), the designated witnesses against the accused, and the Fact Finder. The accused may present additional witnesses or other evidence in his or her behalf. The accused has the option of being accompanied during the hearing by any one member of the Medical Center community. This person accompanying the accused may be present as an advisor but may not address the Council. Each witness will be present only during the time devoted to his or her own testimony. The evidence and personal testimony supporting the allegations are presented to the Council by or at the request and direction of the Fact Finder. Thereafter, the accused presents his or her own defense and offers testimony of persons who support his or her defense. During the presentation of evidence and personal testimony, members of the Council may ask questions at any time. Following the presentation of evidence and personal testimony, the Fact Finder followed by the accused may summarize their positions orally; these final presentations are not interrupted by questioning. The Co-Chairmen shall control the proceedings and are charged with conducting a hearing that is both thorough and fair for all parties. The Co-Chairmen may limit duplicative testimony. The hearing is intended to allow informal but complete presentation of all relevant information. The proceedings of the Council are confidential. An appointed secretary shall take and transcribe written notes of the proceedings, which are maintained in confidence by the Co-Chairmen. No tape recorders are permitted at any hearing of the Council. LSU Emergency Medicine Residency Handbook 2013-14 c.Recommendation of the Council. Following the presentation of all evidence and testimony, the Council shall deliberate privately and determine, within two working days, the recommendation to be submitted to the Dean of the School of Medicine. The Co-Chairmen of the Council shall submit the written recommendation of the Council, the basis for its recommendation, and a transcript of the notes of the proceedings, to the Dean and the accused within two working days of the Council's decision as to a recommendation. Any member of the Council who dissents from the recommendation of the Council may submit the reasons for his or her dissent in writing at the time that the recommendation of the Council is submitted to the Dean and the accused. 5.Initial decision: Dean. School of Medicine The Dean must act upon the recommendation of the Council within five working days of receiving the recommendation. The Dean may accept or reject the recommendation of the Council, in whole or in part, or may remand the matter to the Council for further fact-finding, including additional testimony if appropriate. If additional fact-finding is requested by the Dean, such fact-finding, including additional testimony, shall be taken and a recommendation issued in accordance with procedures and time limits previously set forth. The decision of the Dean must be communicated promptly to the accused and the Co-Chairmen of the Council. 6.Appeal: Appeals Committee a. Notification of Appeal The accused may appeal the decision of the Dean of the School of Medicine as a matter of right. If the accused wishes to appeal, he or she must notify the Dean of his or her request for appellate review within five working days of receiving the decision of the Dean of the School of Medicine. The Dean must convene the Appeals Committee within five working days of receiving the request for appellate review. b. Composition of Appeals Committee Appellate review of the Dean's initial decision is the responsibility of the Appeals Committee. This Committee consists of sic members. In the case of an appeal arising from an allegation against a medical student the Student Body is represented by the presidents of the sophomore, junior, and senior classes. In the case of an appeal arising from an allegation against a resident, he or she will be represented be three residents chosen at large by the Council. The Faculty is represented by one Representative chosen by the party asserting the appeal, one Representative chosen by the Dean of the School of Medicine, and one Representative chosen by the five members designated above. This sixth member is the Chairman of the Appeals Committee. c. Appeal Procedure. The task of the Appeals Committee is to review the initial decision of the Dean on the proceedings and recommendations of the Council of Professional Conduct. The Appeals Committee reviews the transcript of the Council proceedings and may hear further arguments by the parties. However, the Appeals Committee is prohibited from soliciting or considering any new evidence. Any new evidence would be referred to the Council on Professional Conduct. The proceedings of the Appeals Committee are confidential. Written notes of the proceedings are transcribed by an appointed secretary and are maintained in confidence by the Chairman. No tape recorders are permitted at any hearing of the Appeals Committee. d. Recommendation of the Appeals Committee. After reviewing the transcript and hearing arguments, if appropriate, the Appeals Committee deliberates privately and determines, within two working days, the recommendation to be submitted to the Dean of the School of Medicine. The Chairman of the Committee shall submit the written recommendation of the Committee, the basis for its recommendation, and a transcript of the notes of the proceedings, to the Dean within two working days LSU Emergency Medicine Residency Handbook 2013-14 of the Committee's decision. A member of the Appeals Committee who dissents from the recommendation of the Committee may submit the reasons for his or her dissent in writing at the time the recommendation of the Committee is submitted to the Dean. 7. Final Disposition: Dean, School of Medicine The Dean must render a decision within five working days of receiving the recommendation of the Appeals Committee. This decision must be communicated promptly to the accused, the Chairman of the Appeals Committee, and the Co-Chairmen of the Council on Professional Conduct. The disposition of the case by the Dean of the School of Medicine after appeal is final. If a student is exonerated of all charges, all written records of the proceedings of the Council on Professional Conduct and the Appeals Committee, if applicable, are destroyed. If a student is not exonerated of all charges, all written records of the proceedings of the Council and the Appeals Committee will be maintained in confidence by the Associate Dean for Student Affairs and Records for five years after final disposition of the case. LSU Emergency Medicine Residency Handbook 2013-14 LSU QUALITY OF CARE STATEMENT MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS The Medical Center of Louisiana at New Orleans Employees and affiliates of the Medical Center of Louisiana at New Orleans (LSU) make a difference in the lives of thousands of patients on a daily basis. Each LSU employee, physician, student, contract worker, and volunteer is expected to provide quality patient care services in a safe, courteous, and professional manner. If you identify any quality of care or safety issues please report them to management and/or administrative representatives so that they can be addressed immediately. I ask that you allow the LSU management and administrative staff the opportunity to address/resolve quality of care or safety issues within the organization, but you may also report your findings to the following agencies: Louisiana State University Health Care Services Division (888) 652-7699 (toll free) State of Louisiana Department of Health and Hospitals (866) 280-7737 Joint Commission (800) 994-6610 www.icaho.orq Disciplinary actions will not be taken against employees, physicians, students, contract workers, and volunteers who report safety and/or quality of care concerns. Dwayne Thomas Chief Executive Officer 2/28/2008 MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS. 2021 PERDIDO STREET. NEW ORLEANS, LOUISIANA 70112 PHONE: 504.903.3000. FAX: 504.903.2837. WWW.LSUHOSPITALS.ORG LSU Emergency Medicine Residency Handbook 2013-14 Job Description - EM House Officer Updated July 2011 All house officers enrolled in the LSUHSC Emergency Medicine Residency training program function under the direct supervision of Emergency Medicine board certified faculty physicians. Emergency Department faculty are ultimately responsible for supervision of the House Staff while they are performing clinical activities as part of their Graduate Medical Education. House Officer I The EM intern will spend approximately 3 months at LSU Public Hospital ED, 1 month in Ochsner’s Main ED, 1 month in the VA Urgent Care Center and one month in the Ped ED at West Jefferson. During their first year of training, house officers also complete rotations in the emergency department, medicine wards, surgical wards, anesthesia, OBGYN, medical intensive care units, and community emergency departments. The intern is expected to evaluate and manage patients presenting to the emergency department under the direct supervision of the emergency medicine (EM) faculty and senior resident. All patients should be discussed with the supervising physician and/or senior resident before any treatment or tests are ordered, unless patient care is in jeopardy. The intern should focus on the fundamentals of emergency care including performing a focused history and physical, and developing an appropriate differential diagnosis and basic treatment plan. Patient care and management within the Emergency Department include the following procedures with indirect faculty supervision or upper level resident supervision: venous and arterial blood sampling, venous cannulation, nasogastric tube placement, splinting of extremities, simple laceration repair, incision and drainage of subcutaneous abscess, foley catheterization, extremity anesthesia, local anesthesia, slit lamp operation, and supervision of medical students. Additionally, first year house officers may perform and interpret waived tests which include vaginal wet preps, microscopic urinalysis, urine pregnancy tests, interpretation of stool for occult blood, and rapid Strep tests. The following procedures may only be performed under direct faculty supervision: endotracheal intubation, tube thoracostomy, paracentesis, thoracentesis, central line placement, PICC line placement, pulmonary artery catheterization, arthrocentesis, transthoracic pacing, transvenous pacing, electronic defibrillation, major trauma resuscitations, major medical resuscitations, relocation of joint dislocations, sexual assault exams, conscious sedation, vaginal deliveries, on line medical control, and cricothyroidotomy. House Officer II The resident will spend approximately 6 months in the emergency department at LSU Public Hospital, 1 month at either West Jefferson or Ochsner, 1 month at the VA Urgent Care LSU Emergency Medicine Residency Handbook 2013-14 Center, 1 month in the Peds ER at Childrens Hospital, 2 weeks elective, and 2 weeks of ground EMS. The second year resident is expected to evaluate and manage patients presenting to the emergency department under the direct supervision of the emergency medicine faculty and/or senior resident. The second year resident will have more responsibility and autonomy in the ED after successful completion of their internship, and is expected to learn to function as a charge resident, managing up to 10 patients and supervising interns and students. Second year residents will be able to initiate management and treatment decisions before their initial discussions with their supervising physicians. The second year resident is expected to manage multiple patients of varying different acuity levels thus learning appropriate organizational and patient flow skills. The second year resident is expected to recognize and stabilize unstable ED patients especially arriving by ambulance. They will also participate in the management of the airway on trauma, medical and pediatric code patients, and act as the team leader of trauma codes. The second year resident will be expected to provide appropriate on-line medical command for ground EMS units. At the House Officer II level, the resident functions as a junior charge resident. The resident continues to have primary patient care responsibilities of the House Officer I, but also assists the upper-level charge residents in the management and supervision of interns and medical students and leading rounds in the Emergency Department. Responsibility for on-line medical control for local EMS services begins during the second year of training. The following procedures may be performed with indirect faculty supervision: paracentesis, , arthrocentesis, transthoracic pacing, relocation of joint dislocations, sexual assault exams, on line medical control. The following procedures may be performed with credentialed upper-level resident direct supervision and indirect faculty supervision: thoracentesis, central line placement, PICC line placement, pulmonary artery catheterization The following procedures may be performed with direct faculty supervision: rapid sequence induction and endotracheal intubation with sedatives and paralytic agents, conscious sedation, tube thoracostomy, cricothyroidotomy, , transvenous pacing, electronic defibrillation, major trauma resuscitations, and major medical resuscitations. House Officer III The resident will spend a approximately 6 months in the ED at LSU Public Hospital, one month at either West Jefferson or Ochsner, and one month in the Pediatric ED at Oschner, the MICU, the PICU and Toxicology. Third year resident will have more responsibility and autonomy than the second year resident in patient care decision making. The resident is still responsible for involving the ED attending physician as early as possible during the patient’s care. The Third year resident is expected to supervise junior level housestaff and medical students rotating in the emergency department. The third year resident will be expected to provide appropriate online medical command for ground EMS units. LSU Emergency Medicine Residency Handbook 2013-14 Graded responsibilities increase in the third year of training. The resident continues to have primary patient care responsibilities, but assumes the role of the upper-level charge resident, in managing patient through-put in the ED. The upper-level charge resident responsibilities include online medical control of ems, working knowledge of all patients in the ED, including those awaiting a bed in the Main ER, leading rounds, and supervising junior charge residents, interns and medical students in the ED. Patient care and management within the Emergency Department to include all of the procedures granted to a House Officer Two including the supervision of lower level residents. The following procedures may be performed with indirect faculty supervision: paracentesis, , arthrocentesis, transthoracic pacing, relocation of joint dislocations, sexual assault exams, on line medical control, thoracentesis, central line placement, PICC line placement, pulmonary artery catheterization The following procedures may be performed with direct faculty supervision: rapid sequence induction and endotracheal intubation with sedatives and paralytic agents, conscious sedation, tube thoracostomy, cricothyroidotomy, , transvenous pacing, electronic defibrillation, major trauma resuscitations, and major medical resuscitations. House Officer IV The resident will spend approximately 4 months in the ED at UH/LSU, one month at either West Jefferson or Ochsner, and one month in the Pediatric ED at OLOL. Fourth year residents will have more responsibility and autonomy management and patient flow in the emergency department. The resident is still responsible for involving the ED attending physician as early as possible during the patient’s care is expected to supervise junior level housestaff and medical students rotating in the emergency department. The fourth year resident will be expected to provide appropriate on-line medical command for ground EMS units. Patient care and management within the Emergency Department to include all of the procedures granted to a House Officer Three including the supervision of lower level residents. During their second year of training, house officers complete rotations on toxicology, and the emergency department. During the PGY4 year residents are strongly encouraged to commit their elective time to a focused area of expertise with a goal of developing a niche in the arena of Emergency Medicine. The following procedures may be performed with indirect faculty supervision: paracentesis, , arthrocentesis, transthoracic pacing, relocation of joint dislocations, sexual assault exams, on line medical control, thoracentesis, central line placement, PICC line placement, pulmonary artery catheterization, conscious sedation, tube thoracostomy, cricothyroidotomy, , transvenous pacing, electronic defibrillation, major trauma resuscitations, and major medical resuscitations. The following procedures may be performed with direct faculty supervision: rapid sequence induction and endotracheal intubation with sedatives and paralytic agents. LSU Emergency Medicine Residency Handbook 2013-14 Resident Supervision Direct Supervision – the supervising physician is physically present with the resident and patient. Indirect Supervision- the supervising physician is physically within the hospital or other site of patient care, and is immediately available to provide Direct Supervision. PGY Direct by Faculty Direct by senior residents I Adult & Pediatric medical or trauma resuscitations, ED ultrasound, Cardiac pacing, Central lines, Chest tubes, Procedural sedation, Cricothyrotomy, Dislocation reduction, Intubations, Lumbar Puncture, Pericardiocentesis, Vaginal delivery, intraosseous lines, SANE exam. Slit Lamp Exam, arterial blood gas, digital nerve block, arthrocentesis, nasogastric lavage, Suturing, Abscess I&D II Adult & Pediatric medical or trauma resuscitations, Cardiac pacing, Procedural sedation, Cricothyrotomy, Intubations, Vaginal delivery, Pericardiocentesis, intraosseous line III Adult & Pediatric medical or trauma resuscitations, Cardiac pacing, Procedural sedation, Intubations, Cricothyrotomy, Vaginal delivery, Pericardiocentesis, intraosseous line ED ultrasound, Central lines, Chest tubes, Dislocation reduction, EMS online medical control. Management of ED throughput. IV Adult & Pediatric medical or trauma resuscitations, Cardiac pacing, Procedural sedation, Intubations, Cricothyrotomy, Pericardiocentesis Vaginal delivery, intraosseous line Indirect but immediately available – faculty History & Physical exam, pelvic exam, rectal exam, blood draw, IV access, foley catheter Oversight Slit Lamp Exam, arterial blood gas, digital nerve block, arthrocentesis, nasogastric lavage, Suturing, Abscess I&D ED ultrasound, Central lines, Chest tubes, Dislocation reduction, EMS online medical control. ED ultrasound, Central lines, Chest tubes, Dislocation reduction, Manage ED throughput, EMS online medical control. New Innovations and ED faculty. New Innovations and ED faculty. New Innovations and ED faculty. New Innovations and ED faculty. LSU Emergency Medicine Residency Handbook 2013-14 HOUSE OFFICER CONTRACT 2007-2008 HOUSE OFFICER AGREEMENT OF APPOINTMENT BETWEEN (print or type name) __________________________________________________________ AND BOARD OF SUPERVISORS OF LOUISIANA STATE UNIVERSITY AND AGRICULTURAL AND MECHANICAL COLLEGE (Hereinafter referred to as “University”), herein represented by Charles Hilton, M.D., Associate Dean of Academic Affairs, Louisiana State University School of Medicine in New Orleans, __________________Head, Department of _________________, Louisiana State University School of Medicine in New Orleans, and _________________, Program Director of the ______________ Program in the Department of _______________, Louisiana State University School of Medicine in New Orleans. This Agreement of Appointment shall be for one training year effective (date) __________________ and ending (date) ________________________ in the Program of ______________ through the Department of ______________. DEFINITIONS: For purposes of this Agreement of Appointment, the following terms shall have the meaning ascribed thereto unless otherwise clearly required by the context in which such term is used: House Officer – The term “House Officer” shall mean and include interns, residents and fellows. Program – The term “Program” shall mean a Resident and Fellow Training Program of University. Program Director – The term “Program Director” shall mean the University faculty physician who shall be appointed by University to assume and discharge responsibility for the administrative and supervisory services related to a Program for a Department at University, as set forth in this Agreement of Appointment. One or more Program Directors may be appointed with respect to each Program. HOUSE OFFICER RESPONSIBILITIES: (Department specific responsibilities may be appended to this document) House Officers are responsible for patient care, teaching, and scholarly activities as discussed at orientation, detailed in the House Officer Manual, and specified in Departmental Guidelines, which are available in House Officers’ Department’s Office. Specific daily responsibilities will be assigned to House Officers on the call schedule and in day-to-day work team meetings. LSU Emergency Medicine Residency Handbook 2013-14 The position of House Officer involves a combination of supervised, progressively more complex and independent patient evaluation and management functions and formal educational activities. The Department on a regular basis will evaluate the competence of Officers and confidential records of the evaluations will be maintained as departmental property to which House Officers have access. House Officers shall provide patient care commensurate with their level of advancement; competence and privileges, under the supervision of appropriately credentialed attending teaching staff. House Officers’ general obligations include: Providing safe, effective and compassionate patient care. Documentation of care by appropriate and prompt maintenance of medical records, orders, and notes. Developing and understanding of ethical, socioeconomic and medical/legal issues, and cost containment measures in the provision of patient care. Participation in the educational activities of the training program and assumption of responsibility for teaching and supervising other residents and students. Participation in institutional orientation and education programs and other activities involving the clinical staff. Participation in institutional committees and councils to which House Officers are appointed and invited. Performance of these duties in accordance with the established practices, procedures and policies of the University, its programs and clinical departments, and those of other hospitals or institutions to which the House Officer is assigned. Meeting and maintaining Louisiana State Board of Medical Examiners requirements for a permit for physicians in training or unrestricted medical licensure. FACULTY RESPONSIBILITES The supervising faculty as appointed by the department of will be responsible for providing adequate supervision of the house officer during the course of their educational experience while rotating at all training sites as embodied by both LSU School of Medicine House Staff Policy and Procedure Manual, and affiliating entity department’s staff policies. Residents will be expected to be supervised in all their activities commensurate with the complexity of care being given and the residents own abilities and experience. COMPENSATION: For and in consideration of services rendered under this Agreement of Appointment, compensation will be provided in accordance with the pay scale determined by the managing entity of the Louisiana Public Hospital System. For a House Officer (level) ____________, the salary will be $_______________ for fiscal year beginning ________. LSU Emergency Medicine Residency Handbook 2013-14 Availability of housing, meals, lab coats, etc. will vary among the hospitals to which House Officers are assigned. House Officer work hours vary within acceptable ranges determined by House Officer Program. House Officers are paid every two weeks, calculated from the above salary expressed as hourly pay for a 7-day workweek of 8 hours per day. INSURANCE: Health Plans: House Officers are eligible for the same health insurance/HMO plans as those for state employees or for Health Science Center students. Other health insurance may be chosen if desired and paid for by House Officers. As a condition of employment, House Officers agree to maintain one of these health plans or another plan with equal or better benefits. Disability Insurance: The Graduate Medical Education Office provides Long-term basic disability Medical Practice Liability Coverage: House Officers providing services pursuant to this Agreement of Appointment are provided professional liability coverage in accordance with the provisions of Louisiana Revised Statutes 40:1299.39 et seq. House Officers assigned as part of their prescribed training under this Agreement of Appointment to facilities outside the state of Louisiana must provide additional professional liability coverage with indemnity limits set by the House Officer Program. House Officers while engaged in activities outside the scope of the House Officer program, are not provided professional liability coverage under LSA-R.S. 40:1299.39, unless said services are performed at Louisiana public health care facilities. LEAVE: Vacation Leave: House Officers are permitted 21 days (three 7 day weeks) of noncumulative paid vacation leave in the first year, and 28 days (four 7 day weeks) per year thereafter, subject to Departmental policy. All vacation must be used in the year earned and may not be carried forward. All vacation leave not used at the end of the calendar year is forfeited. Sick Leave: House Officers are permitted 14 days (two 7 day weeks) of non-cumulative paid sick leave per year. Extended sick leave without pay is allowable, at the discretion of the Department and in accordance with applicable law. Maternity/Paternity Leave: To receive paid maternity leave, House Officers must utilize available vacation leave (up to 21 or 28 days depending on the House Officer level) plus available sick leave (14 days), for a total of up to 42 days. Department Heads and/or Program Directors may grant extended unpaid maternity leave as appropriate and in accordance with applicable law. Paternity Leave: To receive paid paternity leave, House Officers must utilize available vacation leave and may qualify for unpaid leave under applicable law. Under special circumstances, extended leave may be granted at the discretion of the Department Head and/or Program Director and in accordance with applicable law. LSU Emergency Medicine Residency Handbook 2013-14 Educational Leave: House Officers are permitted 5 (five) total days of educational leave to attend or present at medical meetings. Military Leave: House Officers are entitled to a total of 15 (fifteen) days of paid military leave for active duty. All military leave, whether paid or unpaid, will be granted in accordance with applicable law. Leave of Absence: Leave of absence may be granted, subject to Program Director approval and as may be required by applicable law, for illness extending beyond available sick leave, academic remediation, licensing difficulties, family or personal emergencies. To the extent that a leave of absence exceeds available vacation and/or sick leave, it will be leave without pay. Make up of missed training due to leave of absence is to be arranged with the Program Director in accordance with the requirements of the Board of the affected specialty. The Department and University reserve the right to determine what is necessary for each House Officer for make-up including repeating any part of House Officer Program previously completed. The Office of Graduate Medical Education must be notified of any sick leave extending beyond two weeks. Weekends are included in all leave days. Each type of leave is monitored and leave beyond permitted days will be without pay. Makeup of training time after extended leave is at the discretion of the Department Head and/or Program Director and governed by applicable law. Family Leave All House Officers who have worked for LSUHSC for twelve (12) months and 1,250 hours in the previous twelve (12) months, may be eligible for up to twelve (12) weeks of unpaid, job-protected leave in each twelve (12) month period, in accordance with the requirements of the Family Medical Leave Act of 1993 (FMLA). LSU HEALTH SCIENCE CENTER DRUG PREVENTION POLICY: The unlawful possession, use, manufacture, distribution or dispensation of illicit drugs or alcohol on University property, in the work place of any employee or student of University, or as any part of any functions or activities by any employee or student of University is prohibited. LSUHSC has adopted a pre-employment drug screening requirement and a drug and substance abuse policy that includes provisions for employee drug-testing. Acceptance of this offer constitutes acceptance of LSUHSC drug screening policy as a condition for employment and adherence to all related institutional policies that may be implemented now or in the future. This offer is contingent on satisfactory completion of a drug screen. LSU Emergency Medicine Residency Handbook 2013-14 OUTSIDE ACTIVITIES (Moonlighting) Professional activity outside the scope of the House Officer Program, which includes volunteer work or service in a clinical setting, or employment that is not required by the House Officer Program (moonlighting) shall not interfere in any way with the responsibilities, duties and assignments of the House Officer Program. Residents must not be required to moonlight. It is within the sole discretion of each Department Head and/or Program Director to determine whether outside activities interfere with the responsibilities, duties and assignments of the House Officer Program. Before engaging in activity outside the scope of the House Officer Program, House Officers must receive the approval of the Department Head and/or Program Director of the nature, duration and location of the outside activity. Foreign Medical Graduates sponsored for clinical training as a J-1 by ECFMG are not allowed to moonlight or perform activities outside the clinical training program. OUT-OF-STATE SERVICE If rotating to an out-of –state institution, House Officers agree to follow the rules, regulations, and/or by-laws of that institution. Educational objectives and the level of compensation will be established between the institution and the appropriate Department Head. Malpractice coverage must be arranged other than that provided by LSA-R.S. 40:1299.39. SUPPORT SERVICES FOR HOUSE OFFICERS: Confidential counseling, medical and psychological support services are available through the LSU School of Medicine Campus Assistance Program (“CAP”) for the house officer voluntarily seeking assistance. PHYSICIAN IMPAIRMENT POLICY: House Officers who work at University are expected to report to work in a fit and safe condition. A House Officers who is taking prescription medication(s) and/or who has an alcohol, drug, psychiatric or medical condition(s) that could impair the House Officer’s ability to perform in a safe manner must contact the Louisiana State Medical Society’s Physicians’ Health Program, whose mission is to assist and advocate for physicians who are impaired or potentially impaired as approved by the Louisiana State Board of Medical Examiners. If a House Officer knows of a physician or colleague who House Officer reasonably believes may be impaired or potentially impaired, House Officer may report that physician to the Physicians’ Health Program. A House Officer who is reasonably believed to be impaired or potentially impaired, but refuses to avail him/herself of assistance shall be reported to the Campus Assistance Program and/or the Physicians’ Health Program for evaluation. LSU Emergency Medicine Residency Handbook 2013-14 CANCELLATION AND RENEWAL OF AGREEMENT OF APPOINTMENT House Officer Agreement of Appointments are valid for a specified period of time no greater than twelve (12) months. During the term of this Agreement of Appointment, the House Officer’s continued participation in the House Officer Program is expressly conditioned upon satisfactory performance. This Agreement of Appointment may be terminated at any time for cause. Neither this Agreement of Appointment nor House Officer’s appointment hereunder constitute a benefit, promise or other commitment that House Officer will be appointed for a period beyond the term of this Agreement of Appointment. Promotion, reappointment and/or renewal of this Agreement of Appointment is expressly contingent upon several factors, including, but not limited to the following: (i) satisfactory completion of all training components; (ii) the availability of a position; (iii) satisfactory performance evaluation; (iv) full compliance with the terms of this Agreement of Appointment; (v) the continuation of University’s and House Officer Programs’ accreditation by the Accreditation Council for Graduate Medical Education (“ACGME”); (vi) University’s financial ability; and (vii) furtherance of the House Officer’s Program. Termination and non-renewal of this Agreement of Appointment shall be subject to appeal in accordance with the provisions delineated in the House Officer Manual. INSTITUTION/HOUSE OFFICER PROGRAM CLOSURE/REDUCTION If University itself intends to close or to reduce the size of a House Officer program or to close a residency program, University shall inform the House Officers as soon as possible of the reduction or closure. In the event of such reduction or closure, University will make reasonable efforts to allow the House Officers already in the Program to complete their education or to assist the House Officers in enrolling in an ACGME accredited program in which they can continue their education. SUMMARY SUSPENSIONS University, Program Director, or designee, Department Head, or designee, each shall have the authority to summarily suspend, without prior notice, all or any portion of House Officer’s appointment and/or privileges, whenever it is in good faith determined that the continued appointment of House Officer places the safety or health of patients or University personnel in jeopardy or to prevent imminent disruption of University operations. GRIEVANCE PROCEDURES: Policies and procedures for adjudication of House Officer complaints and grievances related to action which result in dismissal or could significantly threaten a House Officer’s intended career LSU Emergency Medicine Residency Handbook 2013-14 development are delineated in the House Officer Manual. Complaints of sexual harassment and/or other forms of discrimination may be addressed in accordance with the policy delineated in the House Officer Manual. DUTY HOURS: Duty hours must be in accordance with the institutional and ACGME policies. The house officer agrees to participate in institutional programs monitoring duty hours. Questions about duty hours should be directed to the LSUHSC Graduate Medical Education Office or Ombudsman listed in the House Officer Manual, when they can not be resolved at the program level. By signing this Agreement of Appointment, House Officer affirms that House Officer has read and agrees to all the terms and conditions delineated in the House Officer Manual. In addition House Officer agrees to comply with any and all University policies or procedures as are from time to time adopted, authorized and approved by University. This Agreement of Appointment is not valid until it is executed by: (i) the House Officer; (ii) the Program Director, or designee; (iii) the Department Head or designee; and (iii) the Associate Dean for Academic Affairs or designee. This document, with any appendices represents the entire agreement between the parties. ______________________________ _________________________________ House Officer Program Director Date: __________________________ Date: ____________________________ _______________________________ Department Head __________________________________ Associate Dean for Academic Affairs Date:_________________________ Date: _____________________________ LSU Emergency Medicine Residency Handbook 2013-14 Pay Scales - LSUHSC House Officer 2013-2014 LSUHSC House Officer Pay Scales* LSUHSC 2013-2014 2013-2014 2013-2014 2013-2014 House Officer Pay Scales 2013-2014 Annual $44,168.00 HO 1 $45,500.00 HO 2 $47,179.00 HO 3 $49,029.00 HO 4 $50,720.00 HO 5 $54,029.00 HO 6 $54,029.00 HO 7 Monthly $3,680.67 $3,791.67 $3,931.58 $4,085.75 $4,226.67 $4,502.42 $4,502.42 Semi-Monthly $1,840.33 $1,895.83 $1,965.79 $2,042.88 $2,113.33 $2,251.21 $2,251.21 Hourly $15.13 $15.58 $16.16 $16.79 $17.37 $18.50 $18.50 LSU Emergency Medicine Residency Handbook 2013-14 Emergency Fund for Residents Guidelines for use of Emergency Fund for Residents/Fellows The Emergency Fund for Residents/Fellows provides LSUHSC house officers with money in cases of emergency. In order to ensure that proper procedures are followed when using the Emergency Fund the following guidelines must be adhered to when requesting use of the Emergency Fund. Emergency funds are limited. This fund is not to be used for "advance salary" money. Requests should be for true financial emergencies. The GME Office will keep all requests confidential. An Emergency Fund Request for Payment may be in either of two categories--Loan or Grant. Loans are interest free, if approved by the Assistant Dean for Academic Affairs, and must be paid back in one lump sum payment as soon as possible within one (1) year. In exceptional circumstances, grants are given with no expected return payment from the Resident if approved by the Assistant Dean for Academic Affairs. Non-payment of loan by a resident after the time period of one (1) year will result in notification of Department Head and Departmental Residency Director by the GME Office staff. A decision will then be made by the Department Head and/or Residency Director who will determine the resolution of the loan and any penalty for the Resident. The Steps for Requesting the Emergency Fund are as follows: 1. Resident notifies his Departmental Residency Coordinator or his Residency Program Director about the Emergency situation. 2. Departmental Residency Coordinator or his Residency Program Director gives Resident an Emergency Fund Request For Payment Form (attached for departmental duplication). 3. Resident completes the Emergency Fund Request For Payment Form and Resident obtains signatures of his Residency Director or Department Head (or Acting Head in case Department Head is away.) approving of Resident request. 4. Resident presents approved Request For Payment Form to the Office of Graduate Medical Education, Room 237, Medical School Building, 1542 Tulane Avenue, for final approval or denial by the Assistant Dean for Academic Affairs. 5. If Request for Payment Form is approved by the Assistant Dean for Academic Affairs, the GME Office staff will contact the Resident to notify him when the check will be ready for pick up. Loan Repayment: When loans are paid back, the Resident must complete a Loan Repayment Form (attached for departmental duplication). The completed Form and Payment should be delivered to the Office of Graduate Medical Education. Checks should be made payable to the LSU Medical Center Foundation. LSU Emergency Medicine Residency Handbook 2013-14 Campus Assistance Program o o o The Campus Assistance Program is a free service provided by LSU Health Sciences Center in New Orleans to assist employees, faculty, staff, residents, and students in resolving personal or work related problems. LSUHSC-NO recognizes that everyone, at sometime, needs a “helping hand” or assistance. Whether you have a simple or a complex problem, the Campus Assistance Program can help. A counselor is on call 24 hours a day to assist in time of crisis. If you feel you have an emergency or need immediate assistance at any time, contact the counselor on call. You may reach a counselor by calling (504) 568-8888 CAP is located in the Lions Clinic Building on the 6th Floor 2020 Gravier St, New Orleans, LA 70112 Types of Problems CAP is a resource that offers individuals assistance with solving life, school and work problems. Any problems, regardless of severity, that are interfering with one’s peace of mind or personal effectiveness are appropriate to bring to this service. The counselors will work with you to either resolve the problem, or find the resources in the community to help you. The program also offers assistance to supervisors who are working with troubled individuals. Examples of problem areas include: Crisis Management Mental Health Interpersonal / Family Relationships Child / Adolescent Development Workplace Conflict Resolution Job Productivity Career Satisfaction Alcohol and Other Drug Use Loss / Bereavement Financial Privacy Use of program services is voluntary. All information conveyed during use of the services, including use of the service itself, is confidential. Services 24-Hour Crisis Line A counselor is on call 24 hours a day to assist in times of crisis. Community Information The Campus Assistance Program maintains up-to-date lists of community resources, treatment programs and agencies. If you are looking for a community resource, Campus Assistance Program will work with you to find the best resource in the community that can help you. Problem Assessment A counselor will help you clarify the nature of your problem and develop a plan to resolve your problem. Short-Term Counseling Short-term counseling for problem clarification is available through the Campus Assistance Program. If after talking with the counselor, a referral to a specialist within the community is needed, one will be made for the best cost-effective treatment of your problem. Cost Services are provided at no cost to the client. If a referral is made to a resource outside of the Program, the cost of that service is the responsibility of the client. Such costs may be covered by heath insurance. LSU Emergency Medicine Residency Handbook 2013-14 LSU Emergency Medicine Residency Handbook 2013-14 Fitness For Duty And Substance Abuse Policy Louisiana State University Health Sciences Center (LSUHSC) is governed by and complies with the provisions of the Drug Free Workplace Act of 1988. The applicable provisions are as follows: The unlawful manufacture, distribution, dispensing, possession and/or use of unlawful drugs at any facility of the Louisiana State University Health Sciences Center is prohibited. Penalties for violation of this policy could result in written disciplinary action, suspension, demotion, and/or immediate dismissal depending on the severity of the circumstances; or criminal prosecution. Further, all employees are required to notify the Director of Human Resource Management of any drug related criminal conviction which occurs in the workplace within five (5) days following conviction. The Director will notify the Grants Office so that they may comply with the provision for notice to the federal funding agency within ten (10) days. Notice to the federal contractor should include the sanctions imposed on the employee convicted of a drug work-related crime. Campus/Employee Assistance Program (C/EAP) is available to all House Officers of LSUHSC. Abiding by this policy and any other drug policy established by LSUHSC or other House Officer training facility, regardless of when promulgated, is a condition of the House Officer’s employment with LSUHSC. (Revised May 2000 by the Campus Assistance Program Office) FITNESS FOR DUTY POLICY The Louisiana State University Health Sciences Center (LSUHSC) promotes and protects the well being of faculty, staff, residents, students, and patients. Any individual who works or is enrolled at Louisiana State University Health Sciences Center (LSUHSC) is expected to report to work/school in a fit and safe condition. An individual who has an alcohol, drug, psychiatric, or medical condition (s) that could be expected to impair their ability to perform in a safe manner must self report their medical status to their supervisor and provide a signed medical release indicating their fitness for work/school to the Campus/Employee Assistance Program (C/EAP). LSUHSC requires all faculty, staff, residents, students or other LSUHSC workers who observe an individual who is believed to be impaired or is displaying behavior deemed unsafe at work/school to report the observation (s) to their supervisor for appropriate action. Supervisors are then required to make an administrative referral to the Drug Testing Program and C/EAP. An individual who is referred to C/EAP and found to be impaired must provide C/EAP, prior to returning to work, with a signed medical release indicating they are fit to resume their work or school responsibilities at LSUHSC. LSUHSC will, as a condition of continued employment/enrollment, require an “at risk” individual to maintain a continued care plan either recommended or approved by C/EAP and sign a Continuation of Employment/Enrollment Contract. This policy applies to all faculty, staff, residents, students, contract and subcontract workers, medical staff, volunteers, laborers, or independent agents who are conducting business on behalf of, providing services for (paid or gratis), or being trained at LSUHSC. (Revised May 2000 by the Campus Assistance Program Office) LSU Emergency Medicine Residency Handbook 2013-14 FATIGUE and FITNESS FOR DUTY All EM residents and faculty members must demonstrate responsiveness to patient needs that supersedes self-interest. Residents and faculty members must demonstrate an understanding and acceptance of their personal role in the following: o assurance of the safety and welfare of patients entrusted to their care; o assurance of their fitness for duty; o management of their time before, during, and after clinical assignments; o recognition of impairment, including illness and fatigue, in themselves and in their peers; What is the Process? All EM faculty and residents will complete online modules and didactic sessions in alertness management and fatigue mitigation processes. Effectiveness of Process? End of year evaluations include questions about fatigue and are monitored for complaints. How Is It Monitored? End of rotation evaluations include questions about fatigue. Use of strategic napping: All EM residents and faculty members must demonstrate responsiveness to patient needs that supersedes self-interest. Residents and faculty members must demonstrate an understanding and acceptance of their personal role in the following: o o o o assurance of the safety and welfare of patients entrusted to their care; assurance of their fitness for duty; management of their time before, during, and after clinical assignments; recognition of impairment, including illness and fatigue, in themselves and in their peers; What is the Process? All residents are instructed on the usefulness of strategic napping used when oncall or when working swing and night shifts. The transition of care form is to be used to transfer care during strategic napping. Effectiveness of Process? End of year evaluations include questions about fatigue and are monitored for complaints. How Is It Monitored? End of rotation evaluations include questions about fatigue. LSU Emergency Medicine Residency Handbook 2013-14 Work Related Injury/Illness Department: Employee Health Services Policy Title: Work-related Injury/Illness (Needle Sticks and Exposures Which are Covered by Specific Policies and Procedures) Effective Date: Prior 11/96 Purpose: To outline Employee Health Services policy and procedure for handling the employee who is injured on the job. This policy is set forth to ensure maximum protection of the employee and the Medical Center of Louisiana (MCL) in the event that an accident or exposure, causing illness or injury, occurs while the employee is on duty at MCL. Policy: The Medical Center of Louisiana offers screening, evaluation and treatment and referral, as indicated, for work-related accidents or illnesses. In the event of a work-related accident or illness, an employee must notify the supervisor if at all possible. An Employee Accident Report Form must be completed and handled as per hospital policy. Employees who are injured after hours or are seriously injured or need prompt medical attention due to such things as loss of blood, loss of consciousness or loss of mobility are immediately sent to the Emergency Room by their supervisor or other appropriate personnel. The Employee Accident Report Form is given to the Emergency Room as soon as possible after any potentially life-threatening needs are attended to. In the event of minor injury, if the employee requests medical attention, the supervisor is to send the employee to Employee Health Services with the Employee Accident Report Form. If the injury is of a more serious or severe nature, the Employee should be sent to the Emergency Room for treatment first. In cases where medical attention is needed and Employee Health Services is closed or the Employee Health Services physician is not available, the supervisor sends the employee to the Emergency Room with the Employee Accident form. The Emergency Room should notify Employee Health Services of those MCL employees who have been injured on the job. The supervisor and Emergency Room should instruct the employee to report to Employee Health Services at the first available opportunity following treatment for work-related injury in the Emergency Room. Employee Health Services provides follow-up assessment for employees treated in the Emergency Room and will initiate follow-up treatment or referral, as indicated. Emergency Room Patient Discharge Instructions should be brought to Employee Health Services during regular office hours and return follow-up visit. Employee Health Services provides instructions to injured employee regarding treatment, referral and appointments and return-to-work. Employee Health Services schedules appointments or facilitates the scheduling process for appointments to return to Employee Health or to see other medical care providers. Employee Health Services instructs employee to return with instructions and/or clearances from other medical care providers regarding return-to-work recommendations and to return to Employee Health Services for case-management. Employee Health maintains contact with employees on Workers' Compensation and the Workers' Compensation representative concerning duration of disability for employees. Employee Health Services gives documentation slip to employee returning with return to work clearance from own physician. Said work clearance paperwork is maintained in confidential Employee Health Services employee file. At the discretion of Employee Health Services, Employee Health Services physician may see employee at return to work. LSU Emergency Medicine Residency Handbook 2013-14 Dress Code 1. Residents must abide by the dress code of each hospital to which they rotate. 2. The general principles of the programs dress code are listed below. a. One way a physician indicates his professionalism and his respect for the patient and his family is by his appearance. b. Residents should present a neat, clean, and professional appearance at all times. c. Scrubs are acceptable attire in the ED and when on call, as are neat pants, skirts and shirts. No sandals or open-toe shoes are allowed. d. No attire bearing messages or pictures is to be worn. 3. Emergency medicine residents spend about 50% of their residency on non-emergency department rotations interacting with residents, faculty, and administrators. The appearance of our residents influences how our entire department is viewed. Residents are encouraged to keep this, in mind when dressing. Events such as conferences are also professional activities and residents should dress appropriately. Shorts, tee shirts with messages or images, and sandals are not to be worn to conference. 4. Please refer to the LSU personal appearance policy below: LSU Emergency Medicine Residency Handbook 2013-14 LSU Emergency Medicine Residency Handbook 2013-14 LSU Emergency Medicine Residency Handbook 2013-14 LSU Emergency Medicine Residency Handbook 2013-14 LSU Emergency Medicine Residency Handbook 2013-14 LIBRARY - LSUHSC 433 Bolivar St., Box B3-1 New Orleans, LA 70112-2223 Help Desk: (504) 568-6102 http://www.lsumc.edu/campus/library/no-lib.htm Much of the library can be accessed from your LSU Desktop. Go to www.lsuhsc.edu, go to quicklink dropdown menu and click on desktop/psdesktop . Use your assigned username and password that you use to get on the LSU system. The next frame go to “Install web client” and click on Internet explore 4.0 and above (desktop) and follow the instructions in the dialog box. The Library is excited to announce that access to a whole new set of databases will be provided by software from Ovid Technologies, Inc. Access to the OVID databases is via a Web browser and is available through the library's Web page at http:/www.Isumc.edu/campus/library/no-lib.htm or directly to http://ovid.Isumc.edu. MD CONSULT- Can be accessed from your LSU Desktop, click on Medical package or go to www.lsuhsc.edu, click INTRANET, click MD Consult. Use your assigned username and password that you use to get on the LSU system. If you are accessing the system out of campus for the first time, after clicking on INTRANET on the next frame click “Desktop ECA client Download” and follow the instructions in the dialog box. LSU Emergency Medicine Residency Handbook 2013-14 WELLNESS CENTER The Wellness Center is dedicated to promoting the health and well being of all members of the LSU Health Sciences Center community in a safe and educational environment. Mon.-Fri. Sat. Sun. Hours of Operation 6:30 am - 8:00 pm 9:00 am - 1:00 pm Closed Contact Information 450 S. Claiborne Avenue New Orleans, LA 70112 Phone: (504) 568-3700 Fax: (504) 568-3720 Email: wellness Amenities 18,000 square feet Cardiovascular equipment: treadmills, bikes (upright and recumbent), ellipticals, rowers, and stair climbers Selectorized weight equipment: Nautilus Nitro Plate loaded/free weights A multipurpose room for group exercise activities, such as group cycling, mind body (yoga/pilates mat), step, resistance training, etc. Lounge area / Wireless Internet Spacious locker rooms with shower facilities Entry granted with a valid LSUHSC or MCLNO I.D. Membership Requirements All individuals must show a valid LSUHSC I.D. on the 3rd floor of Stanislaus Hall for entrance into the Wellness Center. In addition, initially, each individual member must complete an Express Assumption of Risk Release of Liability Form and a PAR-Q. Forms Express Assumption of Risk Release of Liability Form PAR Q Free Admission is granted to: LSUHSC Students, Residents, Faculty, and Staff Spouses and Children 16 years or older of LSUHSC Students, Residents, Faculty, and Staff *MCLNO Staff ONLY *HCSD Staff ONLY LSU Emergency Medicine Residency Handbook 2013-14 HOUSE STAFF CLEARANCE FORM Each resident completing final rotations (prior to graduation) must have a form processed before a final certificate will be issued. Signatures indicate that your medical records are complete. NAME OF RESIDENT SCHOOL/DEPARTMENT DATE OF DEPARTURE Signature MEDICAL RECORD SERVICES Doctor’s Dictation area All records dictated and signed up to including departure date and reassignment form completed. RESIDENCY PROGRAM DIRECTOR Completed form should be submitted to the Medical Staff Office Date LSU Emergency Medicine Residency Handbook 2013-14 MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS MEDICAL RECORD SERVICES CERTIFICATE REQUEST Certificates are awarded only when you have completed entire program –internship, residency and fellowship, if applicable. This form must be approved by your Residency Program Director. Please complete, as you want your certificate to read. Name:________________________________________________________________________ First Middle Last Degree Status: (circle one) School: Intern (circle one) Resident LSU or Fellow TULANE Department:____________________________________________ Dates:_______________________to_________________________ If any year was in a different program, please provide that information. Status: (circle one) School: Intern (circle one) Resident LSU or Fellow TULANE Department:____________________________________________ Dates:________________________to________________________ Permanent forwarding address for mailing certificate: ________________________________________________________________ ________________________________________________________________ _______________________________________________________________ ________________________________________________________________ APPROVAL: I have reviewed applicant’s request for MCL certificate and verify that information provided above is accurate. _____________________________________________________________________ Residency Program Director Date CERTIFICATE REQUESTS THAT HAVE NOT BEEN APPROVED BY RESIDENCY PROGRAM DIRECTOR WILL NOT BE PROCESSED. LSU Emergency Medicine Residency Handbook 2013-14 POLICIES – Section of EM Mission Statement The mission of LSUHSC-New Orleans Emergency Medicine Residency Program is to deliver superior patient care, foster medical education, promote research, and provide service to our community, the LSUHSC system and the specialty of emergency medicine. GOALS and OBJECTIVES The overall goal of LSU EM training program is to prepare physicians for the independent practice of emergency medicine. This goal is achieved via teaching the fundamental skills, knowledge, and humanistic qualities that constitute the foundations of emergency medicine practice. Residents, under the guidance and supervision of a qualified faculty, develop a satisfactory level of clinical maturity, judgment, and technical skills, by being exposed to progressive levels of responsibility in clinical experiences that enable effective management of acute care problems. Upon completion of the program, residents will be capable of independently practicing emergency medicine, able to incorporate new skills and knowledge during their careers, and able to monitor their own physical and mental well being. Specific objectives include: 1. Manage life-threatening conditions competently and efficiently 2. Support and stabilize the acutely ill patient and arrange appropriate management and referral 3. Recognize, evaluate and initiate management of non-acute illness and injury. 4. Manage multiple patients concurrently, and establish appropriate treatment priorities. 5. Demonstrate full integration of the ACGME core competencies: a. PATIENT CARE: Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. b. MEDICAL KNOWLEDGE: Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and socialbehavioral) sciences and the application of this knowledge to patient care. LSU Emergency Medicine Residency Handbook 2013-14 c. PRACTICE BASED LEARNING & IMPROVEMENT: Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence and improve their patient care practices. d. INTERPERSONAL AND COMMUNICATION SKILLS: Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their families and professional associates. e. PROFESSIONALISM: Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population. f. SYSTEMS BASED PRACTICE: Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. LSU Emergency Medicine Residency Handbook 2013-14 Role of the Residency in the Emergency Department All patient care in the Emergency Department of LSU is provided and supervised by the residents and faculty of the LSUHSC EM Residency Program. Emergency medicine teaching faculty from the LSUHSC EM Residency Program are on duty in the department at all times and review the care of every patient treated before that patient is discharged. The faculty provides supervision and teaching of residents, interns and students, and are ultimately responsible for all patient care in the ED. All faculty are ABEM eligible or certified. Emergency medicine residents at the PGY 1,2,3, and 4 levels are assigned to the department each month. Emergency medicine residents perform several functions in the department under the supervision of the Emergency Medicine faculty including primary triage of all patients presenting for care, supervision of all patient care activities and teaching of interns from all services assigned to the emergency department and of medical students taking emergency medicine rotations, direction of resuscitation of critically ill or injured patients, arrangement for appropriate consultation, and direction of pre-hospital care via radio communication. Procedures in the emergency department are supervised either directly or indirectly by the ED attending physicians depending on the level of training of the resident performing the procedure. The faculty are ultimately responsible for all procedures performed in the ED. The emergency medicine faculty of the residency program fills the medical administrative positions in the department such as Director of the Emergency Department and the Director of EMS, Director of Disaster Planning, etc. The faculty also participates in the Quality Assurance and Peer Review functions of the Department. . LSU Emergency Medicine Residency Handbook 2013-14 EM Residency Applicants Selection of residents for LSUHSC Emergency Medicine residency involves all members of the Section of Emergency Medicine. The program directors and chief residents perform the initial screening of applications received via ERAS. Candidates are then invited for an interview and are then interviewed by the program director, associate program director, at least one general faculty member and one chief resident. The applicants go to lunch with EM residents on the day of their interview and attend an informal gathering with the residents the night before their interview. The applicant’s interaction with our residents is the most important aspect of the interview process and is instrumental part in the recruitment of future residents. Qualified applicants should at least be in their final year of medical school training and have successfully passed USMLE Step 1. USMLE Step 2 is encouraged but not required before interviewing but must be successfully completed to be ranked. A dean’s letter and at least 3 letters of recommendations are required. We participate in ERAS for all applicants. Applicants must be citizens of the United States or possess a green card or J-1 visa. We do not sponsor H1b visas. Our resident’s appraisal of the applicant, along with our faculty’s impressions and assessments, combined with the applicant’s letters of recommendation, medical school dean’s letter, and personal statement makes up the file for each applicant. All files are then carefully reviewed by the program directors and chief residents, and a match list is compiled for the computerized national match of R-1's. Our residency program participates in the National Residency Matching Program (NRMP) and as such, is obligated to follow all rules and regulations set forth by the NRMP. LSU Emergency Medicine Residency Handbook 2013-14 Residency Promotions LSUHSC Emergency Medicine residents are evaluated each year in a formative and summative fashion. These evaluations, in-service exam scores and resident self reflections offer the basis for successful promotion from one year to the next. Residents that do not show appropriate improvement and progress based on a combination of formative and summative evaluations, in-service exam scores and maintenance of residency requirements are required to remediate for 3 month periods with subsequent re-evaluations by the Program Director at those times. The Program Director in conjunction with the resident’s advisor, offer residents focused feedback on their areas of weakness and residents are asked to seek daily feedback on their clinical performance in the Emergency Department. Once residents meet their residency requirements and address their weakness they are promoted to their appropriate class level. Residents who fail to reach the standards after 12 months of remediation are dismissed. LSU Emergency Medicine Residency Handbook 2013-14 Supervision of Residents EM residents must present every patient in the ED to the assigned faculty member within two hours of the patient’s arrival to a bed. Immediate faculty involvement is required in all cases of hemodynamic instability or resuscitation. PGY Direct by Faculty Direct by senior residents I Adult & Pediatric medical or trauma resuscitations, CODE MI, stroke activations, ED ultrasound, Cardiac pacing, Central lines, Chest tubes, Procedural sedation, cricothyrotomy, Dislocation reduction, Intubations, Lumbar Puncture, Pericardiocentesis, Vaginal delivery, intraosseous lines. Slit Lamp Exam, arterial blood gas, digital nerve block, arthrocentesis, nasogastric lavage, Suturing, Abscess I&D II Adult & Pediatric medical or trauma resuscitations, CODE MI, stroke activations, Cardiac pacing, Procedural sedation, Cricothyrotomy, Intubations, Pericardiocentesis, Vaginal delivery, intraosseous line Adult & Pediatric medical or trauma resuscitations, CODE MI, stroke activations, Cardiac pacing, Procedural sedation, Cricothyrotomy, Intubations, Pericardiocentesis Vaginal delivery, intraosseous line Adult & Pediatric medical or trauma resuscitations, CODE MI, stroke activations, Cardiac pacing, Procedural sedation, Cricothyrotomy, Intubations, Pericardiocentesis, Vaginal delivery, intraosseous line ED ultrasound, Central lines, Chest tubes, Dislocation reduction III IV Indirect but immediately available – faculty History & Physical exam, pelvic exam, rectal exam, blood draw, IV access, foley catheter Oversight Slit Lamp Exam, arterial blood gas, digital nerve block, arthrocentesis, nasogastric lavage, Suturing, I&D New Innovations and ED faculty. ED ultrasound, Central lines, Chest tubes, Dislocation reduction New Innovations and ED faculty. ED ultrasound, Central lines, Chest tubes, Dislocation reduction New Innovations and ED faculty. New Innovations and ED faculty. LSU Emergency Medicine Residency Handbook 2013-14 Transition of Care Policy ED Handoff Tools: PLAN ED Patient (age, sex, name, room number and chief complaint) Label with working diagnosis or differential diagnosis Assessment (key elements of history, physical exam, labs, diagnostic imaging) Next steps and nursing assessment (pending labs, diagnostic imaging, consultants) Everything else (social issues, handed off before, systems issues) Disposition General Handoff Guidelines a. Plan to spend 1 to 3 minutes on each patient, depending on complexity b. Spend approximately 5 minutes on clinical teaching c. Be on time and prepare for handoff early d. Organize handoffs “bedside walking rounds” Proven Techniques for Effective Handoffs a. Incorporate the use of written notes and/or electronic medical records (EMR) in handoffiv (has been proven to reduce physical exam and lab result memory errors, especially for patients who have been in the ED for prolonged periods of time) b. “Repeat back”: accepting provider repeats plan of care to outgoing provider to create closed-loop verification of critical informationvi c. Engage in interactive questioningvi d. Reduce interruptionsiii, vi e. Reduce signal-to-noise ratio (background noise)vi Other General Recommendations a. Officially admitted patients (have bed request and orders) should have a very brief handoff by the outgoing resident provides the handoff to the accepting attending. b. Within the first 2 hours of the shift, patients that were handed off should have had their chart, laboratory and other findings reviewed and the resident should have physically introduced himself or herself. 1. Include only relevant information. 2. Be brief. 3. Be orderly by using the PLAN ED framework. 4. Be honest. If someone asks a question that you are not 100% sure about (i.e. lab value or result of a scan), find out the answer after the handoff and follow up with the most accurate answer. LSU Emergency Medicine Residency Handbook 2013-14 Hand Off Tool BED# Patient Label Working dx: Time: Pert +/- Consult: Pending: Admit: Problems: BED# Patient Label Working dx: Time: Pert +/- Consult: Pending: Admit: Problems: BED# Patient Label Working dx: Time: Pert +/- Consult: Pending: Admit: Problems: BED# Patient Label Working dx: Time: Pert +/- Consult: Pending: Admit: Problems: BED# Patient Label Working dx: Time: Pert +/- Consult: Pending: Admit: Problems: BED# Patient Label Working dx: Time: Pert +/- Consult: Pending: Admit: Problems: BED# Patient Label Working dx: Time: Pert +/- Consult: Pending: Admit: Problems: BED# Patient Label Working dx: Time: Pert +/- Consult: Pending: Admit: Problems: LSU Emergency Medicine Residency Handbook 2013-14 LSU Emergency Medicine Residency Handbook 2013-14 Liaison & Oversight Policy Records of EM resident evaluations are maintained by the EM Program Director. These files are generally available to the individual trainees, training faculty, Program Director. Residents are formally evaluated by the program director and/or faculty advisor twice a year. Both strengths and weaknesses are documented and discussed in the evaluation process as well as plans to remediate any deficiencies. Evaluation of Residents routinely includes comments by multiple evaluators such as the Program Director, clinic faculty, chief resident, and others. Additionally, each House Officer is expected to participate in departmental selfassessment. The EM residency program maintains a standard of Satisfactory Academic Standing which is maintained on all the off-site and off-service rotations. The program director meets with the director of each rotation on an annual basis and, then electronically on a monthly basis. The director of each rotation completes a standardized evaluation of each rotating EM resident which is promptly reviewed by the program director. The EM residents are also required to complete rotation reviews after completing each rotation. If a unacceptable evaluation score is given by either the director of a rotation or the rotating resident, the EM program director immediately solicits full information and addresses the issue. LSU Emergency Medicine Residency Handbook 2013-14 Dismissal Policy PRELIMINARY INTERVENTION Substandard disciplinary and/or academic performance is determined by each Department. Corrective action for minor academic deficiencies or disciplinary offenses which do not warrant remediation as defined below, shall be determined and administered by each Department. Corrective action may include oral or written counseling or any other action deemed appropriate by the Department under the circumstances. Corrective action for such minor deficiencies and/or offenses is not subject to appeal. PROBATION House Officers may be placed on probation for, among other things, issuance of a warning or reprimand; or imposition of a remedial program. Remediation refers to an attempt to correct deficiencies which if left uncorrected may lead to a non-reappointment or disciplinary action. In the event a House Officer’s performance, at any time, is determined by the House Officer Program Director to require remediation, the House Officer Program Director shall notify the House Officer in writing of the need for remediation. A remediation plan will be developed that outlines the terms of remediation and the length of the remediation process. Failure of the House Officer to comply with the remediation plan may result in termination or non-renewal of the House Officer’s appointment. A House Officer who is dissatisfied with a departmental decision to issue a warning or reprimand, impose a remedial program or impose probation may appeal that decision to the Department Head informally by meeting with the Department Head and discussing the basis of the House Officer’s dissatisfaction within ten (10) working days of receiving notice of the departmental action. The decision of the Department Head shall be final. CONDITIONS FOR REAPPOINTMENT Programs will provide notice in writing of the intent to non-renew or non-promote residents 4 months prior to the end of the current contract except in the case when the cause for nonpromotion/non-reappointment occurred within the final 4 months. In such cases house officers will be notified in writing with as much notice as possible (revised 6/21/2007) TERMINATION, NON-REAPPOINTMENT, AND OTHER ADVERSE ACTION A House Officer may be dismissed or other adverse action may be taken for cause, including but not limited to: i) unsatisfactory academic or clinical performance; ii) failure to comply with the policies, rules, and regulations of the House Officer Program or University or other facilities where the House Officer is trained; iii) revocation or suspension of license; iv) violation of federal and/or state laws, 8 regulations, or ordinances; v) acts of moral turpitude; vi) insubordination; vii) conduct that is detrimental to patient care; and viii) unprofessional conduct. The House Officer Program may take any of the following adverse actions: i) issue a warning or reprimand; ii) impose terms of remediation or a requirement for additional training, consultation or treatment; iii) institute, continue, or modify an existing summary suspension of a House Officer’s appointment; iv) terminate, limit or suspend a House Officer’s appointment or privileges; v) non- LSU Emergency Medicine Residency Handbook 2013-14 renewal of a House Officer’s appointment; vi) dismiss a House Officer from the House Officer Program; vii) or any other action that the House Officer Program deems is appropriate under the circumstances. DUE PROCESS Dismissals, non-reappointments, non-promotion (revised 6/21/2007) or other adverse actions which could significantly jeopardize a House Officer’s intended career development are subject to appeal and the process shall proceed as follows: Recommendation for dismissal, non-reappointment, or other adverse action which could significantly threaten a House Officer’s intended career development shall be made by the Program Director in the form of a Request for Adverse Action. The Request for Adverse Action shall be in writing and shall include a written statement of deficiencies and/or charges registered against the House Officer, a list of all known documentary evidence, a list of all known witnesses and a brief statement of the nature of testimony expected to be given by each witness. The Request for Adverse Action shall be delivered in person to the Department Head. If the Department Head finds that the charges registered against the House Officer appear to be supportable on their face, the Department Head shall give Notice to the House Officer in writing of the intent to initiate proceedings which might result in dismissal, non-reappointment, summary suspension, or other adverse action. The Notice shall include the Request for Adverse Action and shall be sent by certified mail to the address appearing in the records of the Human Resource Management or may be hand delivered to the House Officer. Upon receipt of Notice, the House Officer shall have five (5) working days to meet with the Department Head and present evidence in support of the House Officer’s challenge to the Request for Adverse Action. Following the meeting, the Department Head shall determine whether the proposed adverse action is warranted. The Department Head shall render a decision within five (5) working days of the conclusion of the meeting. The decision shall be sent by certified mail to the address appearing in the records of the Human Resource Management or hand delivered to the House Officer and copied to the Program Director and Academic Dean. If the House Officer is dissatisfied with the decision reached by the Department Head, the House Officer shall have an opportunity to prepare and present a defense to the deficiencies and/or charges set forth in the Request for Adverse Action at a hearing before an impartial Ad Hoc Committee, which shall be advisory to the Academic Dean. The House Officer shall have five (5) working days after receipt of the Department Head’s decision to notify the Academic Dean in writing whether the House Officer would challenge the Request for Adverse Action and desires an Ad Hoc Committee be formed. If the House Officer contends that the proposed adverse action is based, in whole or in part on race, sex (including sexual harassment), religion, national origin, age, Veteran status, and/or disability discrimination, the House Officer shall inform the Academic Dean of that contention. The Academic Dean shall then invoke the proceedings set out in the Section entitled “Sexual Harassment 9 Policy” of this Manual. The hearing for adverse action shall not proceed until an investigation has been conducted pursuant to the Section entitled “Sexual Harassment Policy.” LSU Emergency Medicine Residency Handbook 2013-14 The Ad Hoc Committee shall consist of three (3) full-time clinical faculty members who shall be selected in the following manner: The House Officer shall notify the Academic Dean of the House Officer’s recommended appointee to the Ad Hoc Committee within five (5) working days after the receipt of the decision reached by the Department Head. The Academic Dean shall then notify the Department Head of the House Officer’s choice of Committee member. The Department Head shall then have five (5) working days after notification by the Academic Dean to notify the Academic Dean of his recommended appointee to the Committee. The two (2) Committee members selected by the House Officer and the Department Head shall be notified by the Academic Dean to select the third Committee member within five (5) working days of receipt of such notice; thereby the Committee is formed. Normally, members of the committee should not be from the same program or department, In the case of potential conflicts of interest or in the case of a challenge by either party, the Academic Dean shall make the final decision regarding appropriateness of membership to the ad hoc committee.(rev. 7-1-2005) Once the Committee is formed, the Academic Dean shall forward to the Committee the Notice and shall notify the Committee members that they must select a Committee Chairman and set a hearing date to be held within ten (10) working days of formation of the Committee. A member of the Ad Hoc Committee shall not discuss the pending adverse action with the House Officer or Department Head prior to the hearing. The Academic Dean shall advise each Committee member that he/she does not represent any party to the hearing and that each Committee member shall perform the duties of a Committee member without impartiality or favoritism. The Chairman of the Committee shall establish a hearing date. The House Officer and Department Head shall be given at least five (5) working days notice of the date, time, and place of the hearing. The Notice may be sent by certified mail to the address appearing in the records of the Human Resource Management or may be hand delivered to the House Officer, Department Head, and Academic Dean. Each party shall provide the Committee Chairman and the other party a witness list, a brief summary of the testimony expected to be given by each witness, and a copy of all documents to be introduced at the hearing at least three (3) working days prior to the hearing. The hearing shall be conducted as follows: The Chairman of the Committee shall conduct the hearing. Each party shall have the right to appear, to present a reasonable number of witnesses, to present documentary evidence, and to cross-examine witnesses. The parties may be excluded when the Committee meets in executive session. The House Officer may be accompanied by an attorney as a nonparticipating advisor. Should the House Officer elect to have an attorney present, the Department Head may also be accompanied by an attorney. The attorneys for the parties may confer and advise their clients upon adjournment of the proceedings at reasonable intervals to be determined by the Chairman, but may not question witnesses, introduce evidence, make objections, or present argument during the hearing. However, the right to have an attorney present can be denied, discontinued, altered, or modified if the Committee finds that such is necessary to insure its ability to properly conduct the hearing. Rules of evidence and procedure are not applied strictly, but the Chairman shall exclude irrelevant or unduly repetitious testimony. The Chairman shall rule on all matters related to the conduct of the hearing and may be assisted by University counsel. 10 The hearing shall be recorded. At the request of the Dean, Academic Dean, or LSU Emergency Medicine Residency Handbook 2013-14 Committee Chairman, the recording of the hearing shall be transcribed in which case the House Officer may receive, upon a written request at his/her cost, a copy of the transcript. Following the hearing, the Committee shall meet in executive session. During its executive session, the Committee shall determine whether or not the House Officer shall be terminated, or otherwise have adverse actions imposed, along with reasons for its findings; summary of the testimony presented; and any dissenting opinions. In any hearing in which the House Officer has alleged discrimination, the report shall include a description of the evidence presented with regard to this allegation and the conclusions of the Committee regarding the allegations of discrimination. The Academic Dean shall review the Committee’s report and may accept, reject, or modify the Committee’s finding. The Academic Dean shall render a decision within five (5) working days from receipt of the Committee’s report. The decision shall be in writing and sent by certified mail to the House Officer, and a copy shall be sent to the Department Head and Dean. If the Academic Dean’s final decision is to terminate or impose adverse measures and the House Officer is dissatisfied with the decision reached by the Academic Dean, the House Officer may appeal to the Dean, with such appeal limited to alleged violations of procedural due process only. The House Officer shall deliver Notice of Appeal to the Dean within five (5) working days after receipt of the Academic Dean’s decision. The Notice of Appeal shall specify the alleged procedural defects on which the appeal is based. The Dean’s review shall be limited to whether the House Officer received procedural due process. The Dean shall then accept, reject, or modify the Academic Dean’s decision. The decision of the Dean shall be final. A House Officer who at any stage of the process fails to file a request for action by the deadline indicates acceptance of the determination at the previous stage. Any time limit set forth in this procedure may be extended by mutual written agreement of the parties and, when applicable the consent of the Chairperson of the Ad Hoc Committee. SUMMARY SUSPENSIONS The House Officer Program Director, or designee, or the Department Head or designee shall have the authority to summarily suspend, without prior notice, all or any portion of the House Officer’s appointment and/or privileges granted by University or any other House Officer training facility, whenever it is in good faith determined that the continued appointment of the House Officer places the safety of University or other training facility patients or personnel in jeopardy or to prevent imminent or further disruption of University or other House Officer training facility operations. Within two (2) working days of the imposition of the summary suspension, written reason(s) for the House Officer’s summary suspension shall be delivered to the House Officer and the Academic Dean. The House Officer will have five (5) working days upon receipt of the written reasons to present written evidence to the Academic Dean in support of the House Officer’s challenge to the summary suspension. A House Officer, who fails to submit a written response to the Academic Dean within the five (5) day deadline, waives his/her right to appeal the suspension. The Academic Dean shall accept or reject the summary suspension or impose other adverse action. Should the Academic Dean impose adverse action that could significantly threaten a House Officer’s intended career, the House Officer may utilize the due process delineated above. 11 The Department may LSU Emergency Medicine Residency Handbook 2013-14 retain the services of the House Officer or suspend the House Officer with pay during the appeal process. Suspension with or without pay cannot exceed 90 days, except under unusual circumstances. OTHER GRIEVANCE PROCEDURES Grievances other than those departmental actions described above or discrimination should be directed to the Program Director for review, investigation, and/or possible resolution. Complaints alleging violations of the LSUHSC EEO policy or sexual harassment policy should be directed to the appropriate supervisor, Program Director, Director of Human Resource Management and EEO/ AA Programs, or Ms. Flora McCoy, Labor Relations Manager (568-742). Resident complaints and grievances related to the work environment or issues related to the program or faculty that are not addressed satisfactorily at the program or departmental level should be directed to the Associate Dean for Academic Affairs. For those cases that the resident feels can’t be addressed directly to the program or institution s/he should contact the LSU Ombudsman. (GMEC October 2007) OMBUDSMAN Dr. Joseph Delcarpio, Associate Dean for Student Affairs is available to serve as an impartial, third party for House Officers who feel their concerns cannot be addressed directly to their program or institution. Dr. Delcarpio will work to resolve issues while protecting resident confidentiality. He can be reached at 504-568-4874. (3/2010) REVIEW OF TRAINING PROGRAMS Each House Officer Program at the LSU School of Medicine-New Orleans will be reviewed regularly between accreditation site visits and in accordance with the ACGME guidelines. The Graduate Medical Education Committee (GMEC) is a standing school committee charged with the oversight of Graduate Medical Education. Program evaluation is accomplished by a detailed internal site visit process quite similar to the regular ACGME site visit. At the conclusion of the GMEC review, the committee should make recommendations, formulate a suggested action plan if necessary, and summarize its findings for each program reviewed. Minutes and summary reports should be filed in the GME Office. Serious programmatic problems should be brought to the attention of the Department Head and the Dean. LSU Emergency Medicine Residency Handbook 2013-14 Satisfactory Academic Standing The EM residency program maintains a standard of satisfactory academic standing. The program director will assess your standing at minimum twice a year and will notify you if you are not meeting these minimum standards and assist you in formulating a remediation plan. The definition of satisfactory academic standing in our residency includes, but is not limited to the following: a. Conference (didactic and asynchronous learning) and Journal Club attendance overall 70 percent or more. b. Carry out assigned lectures and journal clubs. c. Take and teach BLS, ACLS, PALS or any residency associated course when assigned. d. Meet all scheduling requirements of each monthly rotation. e. Complete all medical records in a timely fashion. f. Meet all ACGME and residency requirements for duty hours. g. Score at or above the national average for your level of training on the National InService examination. h. Complete and submit monthly evaluation forms prior to the 15 th of next month. i. Maintain a procedure log which is updated at least quarterly. j. Abide by moonlighting policy in the Moonlighting Policy. k. Maintain a minimum performance level of “acceptable” based on monthly rotation evaluations. LSU Emergency Medicine Residency Handbook 2013-14 Evaluations Resident Evaluation Resident Monthly Rotation Evaluation Resident 6 Month Faculty Advisor Evaluation Resident End of the Year Evaluation Resident 360 Evaluation: filled out by peers, faculty and nurses Resident Post Graduate Survey and Evaluation Program Evaluations Rotation and Special Topic Evaluations EM Lecture Evaluation EM Resident Anonymous Annual Faculty Evaluations End of the Year Program Evaluation GME End of the Year Questionnaire EM Faculty Peer Review LSU Emergency Medicine Residency Handbook 2013-14 Monthly evaluation of Residents by Faculty FROM: LSUHSC-New Orleans Emergency Medicine Residency Program (or may be complete online in New Innovations) (504) 903-3594 Fax: 903-0321 TRAINEE ______________________________ SERVICE:______________________________ DATE OF ROTATION______________________________ LOCATION: ______________________________ Scale: (na) Not Applicable, not observed, Unacceptable, Acceptable, Outstanding If Unacceptable or Outstanding, please provide example. MEDICAL KNOWLEDGE : □ n a □ Inadequate: Does not display understanding of basic science or clinical information, or unable to relate knowledge to cases. Does not recognize life-threatening conditions. Unable to sequence critical actions. Example: □ Acceptable. Has appropriate knowledge base for level of training and is able to relate it to clinical setting. Recognizes lifethreatening conditions; may require assistance in sequencing critical actions. □ Outstanding. Superior knowledge & mature application of knowledge to clinical setting. Consistently able to sequence critical actions for patient care and generate a differential diagnosis for an undifferentiated patient. Example: □ Acceptable. Usually complete and accurate, identifying major & minor problems with an appropriate differential diagnosis list. □ Outstanding. Comprehensive information, thorough, precise. Mature analysis & synthesis of data by priority, extensive differential diagnosis. Example: □ Adequate: Uses proper technique, organizes equipment; Occasional difficulty with complicated procedures. □ Outstanding. Precise, efficient performance with ease & dexterity, puts patient at ease Example: □ Adequate: Orders & interprets diagnostic tests, consults appropriately. □ Outstanding. Has planned alternative strategies based on pending diagnostic test results. Consultations are timely and wellcoordinated with plan of care. Example: □ Adequate: Decisions typically accurate and safe, uses common sense. Able to triage patients and problems by level of acuity. □ Outstanding. Mature, safe, decisions based on sound integration of data & reason. Prioritizing and critical actions are consistently appropriate. Example: PATIENT CARE: H&P, Differential Diagnosis □ n a □ Inadequate: Incomplete or inaccurate, misses major problems. Unable to make appropriate differential diagnosis or problem list. Example: PATIENT CARE: Procedural Skills □ n a □ Inadequate: Doesn’t use proper technique, awkward, bypasses steps, avoids procedures or disorganized. Example: PATIENT CARE: Diagnostic Tests & Consultations □ n a □ Inadequate: Overlooks basic tests, unable to interpret results, consults are inappropriate or untimely. Example: PATIENT CARE: Decision-making □ n a □ Inadequate: Decisions are risky, unsafe or inappropriate. Example: PRACTICE-BASED LEARNING: Evidence Based Medicine And Self-Education □ n a □ Inadequate: Doesn’t know patients, no reading or online learning evident. Example: □ Adequate: Supplements patient care with current literature, textbooks or online readings. □ Outstanding. Extensive supplemental reading, knows disease process of own and other patients. Example: □ Adequate: Participates in teaching opportunities. Actively teaches students & junior residents, motivates learning. □ Outstanding. Develops teaching opportunities, motivates, and teaches with enthusiasm and dedication. Example: □ Adequate: Management and discharge plan is appropriate for patient, with consideration given to patient and hospital resources. □ Outstanding. Management plan is typically comprehensive, precise, and resource- & costeffective. Example: □ Adequate: Attends required activities, □ Outstanding. Consistently attends extra PRACTICE-BASED LEARNING: Teaching □ n a □ Inadequate: Does not participate in teaching students or other residents. Example: SYSTEMS-BASED PRACTICE: Resource Utilization □ n a □ Inadequate: Unable to formulate an appropriate, resource- or cost-effective management plan. Example: PROFESSIONALISM: Work Habits □ □ Inadequate: Poor attendance, shirks LSU Emergency Medicine Residency Handbook 2013-14 n a responsibility, frequently late, prolonged absence on shifts. Prevaricates. Example: accepts responsibility, usually punctual and organized. Occasionally performs extra functions, showing some independent initiative. functions, displays leadership role, highly efficient. Stays late to help. Example: □ Adequate: Accepts constructive criticism, appropriately asks for assistance and feedback. □ Outstanding. Assesses own limitations & responds constructively to feedback. Example: □ Adequate: Responsive to patient’s age, culture or gender issues. Demonstrates respect, compassion and integrity. □ Outstanding. Consistently acts as an outstanding role model, demonstrating compassion and integrity in response to cultural, gender, age or disability issues. Example: PROFESSIONALISM: Insight And Self-Assessment □ n a □ Inadequate: Doesn’t accept criticism, displays little insight. Example: PROFESSIONALISM: Ethical and cultural sensitivity □ n a □ Inadequate: Not responsive to patient’s age, culture, disability or gender issues. Unaware of patient as a person. Example: INTERPERSONAL & COMMUNICATION SKILLS: Team Member □ n a □ Inadequate: Doesn’t work well with others. Alienating, disrespectful to nurses, peers, consultants. Example: □ Adequate: Maintains good working relationship with team. Respected by nurses, peers, consultants. □ Outstanding. Highly regarded by team. Consensus-builder. Role model. Example: INTERPERSONAL & COMMUNICATION SKILLS: Verbal, nonverbal and documentation skills □ n a □ Inadequate: Unable to create or sustain a therapeutic or ethical relationship with patients. Ineffective listener. Unacceptable documentation. Example: □ Adequate: Creates and sustains therapeutic and ethical relationships with patients and families. Effective listening, verbal, nonverbal and writing skills. □ Outstanding. Excellent verbal, nonverbal and writing skills. A role model Example: □ Adequate □ Outstanding SUMMARY RATING: □ n a □ Inadequate EVALUATOR: ______ SIGNATURE____________________________________ DATE: ADDITIONAL COMMENTS:_____________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________ _______________________________________________________________ LSU Emergency Medicine Residency Handbook 2013-14 Annual evaluation of Faculty by Residents RESIDENT EVALUATION OF EMERGENCY MEDICINE FACULTY SECTION OF EMERGENCY MEDICINE, LSU HEALTH SCIENCES CENTER, NEW ORLEANS ATTENDING: RATING SCALE: Please use the following 1-5 numbered rating scale. You may use decimal points. 1) Unsatisfactory 2) Marginal 3) Satisfactory 4) Good 5) Outstanding CLINICAL PERFORMANCE: 1. Overall knowledge 2. Clinical judgment 3. Communicates effectively with patients, staff, etc 4. Availability during shifts 5. Organization/administration of department 6. Is generally available during clinical shifts 7. Teaches while working clinical shifts 8. Sees patients while working clinical shifts _______________ _______________ _______________ _______________ _______________ _______________ _______________ _______________ CLINICAL TEACHING: 9. Quality of teaching skills 10. Encourages questions and discussion 11. Provides appropriate supervision for resident=s level 12. Promotes practical application of knowledge 13. Conducts regular patient rounds _______________ ______________ _______________ ______________ _______________ DIDACTIC TEACHING: 14. Provides regular lectures 15. Attends conference/journal club 16. Quality of lectures 17. Didactic knowledge of Emergency Medicine 18. Provides/offers assistance with research _______________ _______________ _______________ ______________ _______________ ROLE MODEL: 19. Approaches responsibilities with enthusiasm 20. Demonstrates a genuine interest in residents 21. Displays professional and ethical behavior 22. Maintains good relations with house staff ______________ ______________ ______________ _______________ OVERALL CONTRIBUTION TO RESIDENCY PROGRAM: ADDITIONAL COMMENTS: LIST AT LEAST ONE AREA WHERE THIS ATTENDING COULD IMPROVE: LSU Emergency Medicine Residency Handbook 2013-14 Evaluation of Rotations by Residents Rotation:_____________________________________________ Unacceptable Acceptable Outstanding n/a Patient Pathophysioloy Charting, documentation, administration Faculty Supervision Faculty Teaching Efforts Nursing/ancillary Support Duty hours Balance between service & education Clear goals & objectives Please comment on any rating of unacceptable: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ ___________________________________________ Anything that you think should be improved? _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _________________________________________________________ LSU Emergency Medicine Residency Handbook 2013-14 Evaluation of Program by Residents (part of year-end self eval) The residency What do you like best about our residency? What would you like to see changed about our residency? Yearly residency requirements Have you met with your advisor this year? Are all ACGME required procedures logged into New Innovations? Have all your monthly evaluations been completed? Have you submitted all scholarly activities and lectures to be filed in your portfolio? Does your conference attendance (including home study modules and journal club) exceed 70%? Have you completed the Core Competencies? Have you submitted your 20 patient follow-ups? Are you in compliance with the ACGME mandated duty-hour maximum of an average of 60 hours per week (in ED), and 1 day off in 7, and minimum 10 hours off between shifts? LSU Emergency Medicine Residency Handbook 2013-14 6 month Evaluation of each Resident by Advisor Resident: Date: _____________________________________ __________ HO-I HO-II HO-III HO-IV Monthly Evaluations July Aug Rotation Eval Sept Oct Nov Dec Jan Feb Mar Apr May Current National In-Service Examination score: _______ Goal for next year_________ New Innovations Data (Obtain from EM Coordinator prior to meeting) Conference attendance above 70% Yes No Procedure Log up to date Yes No Compliance with duty hours Yes No If answer “no” to any of above, please refer to Dr. Haydel immediately Scholarly Activity: Topic: ___________________________________ Faculty: __________________________________ Progress: Completed: Y N Short-term goals: Long-term goals: Plans for PGY4 subspecialty track: Resident comments, suggestions, requests, input: Recommendations to resident: Signatures: ____________________ Faculty ____________________ Resident June LSU Emergency Medicine Residency Handbook 2013-14 Yearly Eval and Final Exit Evaluation of Resident by Program Director PGY1 Meeting Date______________ Medical Knowledge: In-service score: _________ Goal for next year:________________ Plan:________________________ Mean monthly CORD test score:_____________ 70% conference attendance: yes no Medical Knowledge Monthly evals: inadequate _____ adequate _______ outstanding ______ Medical Knowledge 360 degree: inadequate _____ adequate _______ outstanding ______ Medical Knowledge Self evaluation: inadequate _____ adequate _______ outstanding ______ Medical Knowledge action plan initiated: no yes_________________________________________ Patient Care: Patient Care monthly Evals: Procedure log vs ACGME targets Patient care Self evaluation: Patient care 360 degree: Patient Care action plan initiated: inadequate _____ adequate _______ outstanding ______ inadequate _____ adequate _______ outstanding ______ inadequate _____ adequate _______ outstanding ______ inadequate _____ adequate _______ outstanding ______ no yes_____________________________________________ Practice-Based Learning & Improvement: Journal Club attendance 70 %: yes no 20 patient follow-ups completed: yes no PB learning monthly evals: inadequate _____ adequate _______ outstanding ______ PB learning Self eval: inadequate _____ adequate _______ outstanding ______ PB learning 360 eval: inadequate _____ adequate _______ outstanding ______ PB learning action plan initiated: no yes ______________________________________________ ____________________________________________________________________________________ Systems Based Practice: SBP Monthly Evaluation: inadequate _____ adequate _______ outstanding ______ SBP 360 degree inadequate _____ adequate _______ outstanding ______ SBP Self evaluation: inadequate _____ adequate _______ outstanding ______ Systems Based Practice action plan initiated: no yes ____________________________________ ____________________________________________________________________________________ Professionalism: Professionalism monthly evals: inadequate _____ adequate _______ outstanding ______ Prof 360 degree inadequate _____ adequate _______ outstanding ______ Prof Self evaluation: inadequate _____ adequate _______ outstanding ______ Conference attendance >70 % yes no Professionalism action plan initiated: no yes ________________________________________ ____________________________________________________________________________________ Interpersonal Communication Skills: ICS monthly evals: inadequate _____ adequate _______ outstanding ______ ICS 360 degree: inadequate _____ adequate _______ outstanding ______ ICS Self evaluation: inadequate _____ adequate _______ outstanding ______ ICS action plan initiated: no yes ______________________________________________ ____________________________________________________________________________________ Resident signature__________________________________________ Program Director___________________________________________ LSU Emergency Medicine Residency Handbook 2013-14 PGY 2 Meeting Date______________ Medical Knowledge: In-service score: _________ Goal for next year:________________ Plan:________________________ Mean monthly CORD test score:_____________ 70% conference attendance: yes no Medical Knowledge Monthly evals: inadequate _____ adequate _______ outstanding ______ Medical Knowledge 360 degree: inadequate _____ adequate _______ outstanding ______ Medical Knowledge Self evaluation: inadequate _____ adequate _______ outstanding ______ Medical Knowledge action plan initiated: no yes_________________________________________ ____________________________________________________________________________________ Patient Care: Patient Care monthly Evals: inadequate _____ adequate _______ outstanding ______ Procedure log vs ACGME targets inadequate _____ adequate _______ outstanding ______ Patient care Self evaluation: inadequate _____ adequate _______ outstanding ______ Patient care 360 degree: inadequate _____ adequate _______ outstanding ______ Patient Care action plan initiated: no yes_____________________________________________ ____________________________________________________________________________________ Practice-Based Learning & Improvement: Journal Club attendance 70 %: yes no 20 patient follow-ups completed: yes no PB learning monthly evals: inadequate _____ adequate _______ outstanding ______ PB learning Self eval: inadequate _____ adequate _______ outstanding ______ PB learning 360 eval: inadequate _____ adequate _______ outstanding ______ PB learning action plan initiated: no yes ______________________________________________ ____________________________________________________________________________________ Systems Based Practice: SBP Monthly Evaluation: inadequate _____ adequate _______ outstanding ______ SBP 360 degree inadequate _____ adequate _______ outstanding ______ SBP Self evaluation: inadequate _____ adequate _______ outstanding ______ Systems Based Practice action plan initiated: no yes ____________________________________ ____________________________________________________________________________________ Professionalism: Professionalism monthly evals: inadequate _____ adequate _______ outstanding ______ Prof 360 degree inadequate _____ adequate _______ outstanding ______ Prof Self evaluation: inadequate _____ adequate _______ outstanding ______ Conference attendance >70 % yes no Professionalism action plan initiated: no yes ________________________________________ ____________________________________________________________________________________ Interpersonal Communication Skills: ICS monthly evals: inadequate _____ adequate _______ outstanding ______ ICS 360 degree: inadequate _____ adequate _______ outstanding ______ ICS Self evaluation: inadequate _____ adequate _______ outstanding ______ ICS action plan initiated: no yes ______________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Resident signature__________________________________________ Program Director___________________________________________ LSU Emergency Medicine Residency Handbook 2013-14 PGY 3 Meeting Date______________ Medical Knowledge: In-service score: _________ Goal for next year:________________ Plan:________________________ Mean monthly CORD test score:_____________ 70% conference attendance: yes no Medical Knowledge Monthly evals: inadequate _____ adequate _______ outstanding ______ Medical Knowledge 360 degree: inadequate _____ adequate _______ outstanding ______ Medical Knowledge Self evaluation: inadequate _____ adequate _______ outstanding ______ Medical Knowledge action plan initiated: no yes_________________________________________ ____________________________________________________________________________________ Patient Care: Patient Care monthly Evals: inadequate _____ adequate _______ outstanding ______ Procedure log vs ACGME targets inadequate _____ adequate _______ outstanding ______ Patient care Self evaluation: inadequate _____ adequate _______ outstanding ______ Patient care 360 degree: inadequate _____ adequate _______ outstanding ______ Patient Care action plan initiated: no yes_____________________________________________ ____________________________________________________________________________________ Practice-Based Learning & Improvement: Journal Club attendance 70 %: yes no 20 patient follow-ups completed: yes no PB learning monthly evals: inadequate _____ adequate _______ outstanding ______ PB learning Self eval: inadequate _____ adequate _______ outstanding ______ PB learning 360 eval: inadequate _____ adequate _______ outstanding ______ PB learning action plan initiated: no yes ______________________________________________ ____________________________________________________________________________________ Systems Based Practice: SBP Monthly Evaluation: inadequate _____ adequate _______ outstanding ______ SBP 360 degree inadequate _____ adequate _______ outstanding ______ SBP Self evaluation: inadequate _____ adequate _______ outstanding ______ Systems Based Practice action plan initiated: no yes ____________________________________ ____________________________________________________________________________________ Professionalism: Professionalism monthly evals: inadequate _____ adequate _______ outstanding ______ Prof 360 degree inadequate _____ adequate _______ outstanding ______ Prof Self evaluation: inadequate _____ adequate _______ outstanding ______ Conference attendance >70 % yes no Professionalism action plan initiated: no yes ________________________________________ ____________________________________________________________________________________ Interpersonal Communication Skills: ICS monthly evals: inadequate _____ adequate _______ outstanding ______ ICS 360 degree: inadequate _____ adequate _______ outstanding ______ ICS Self evaluation: inadequate _____ adequate _______ outstanding ______ ICS action plan initiated: no yes ______________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Resident signature__________________________________________ Program Director___________________________________________ LSU Emergency Medicine Residency Handbook 2013-14 PGY 4 Meeting Date______________ Medical Knowledge: In-service score: _________ Goal for next year:________________ Plan:________________________ Mean monthly CORD test score:_____________ 70% conference attendance: yes no Medical Knowledge Monthly evals: inadequate _____ adequate _______ outstanding ______ Medical Knowledge 360 degree: inadequate _____ adequate _______ outstanding ______ Medical Knowledge Self evaluation: inadequate _____ adequate _______ outstanding ______ Medical Knowledge action plan initiated: no yes_________________________________________ ____________________________________________________________________________________ Patient Care: Patient Care monthly Evals: inadequate _____ adequate _______ outstanding ______ Procedure log vs ACGME targets inadequate _____ adequate _______ outstanding ______ Patient care Self evaluation: inadequate _____ adequate _______ outstanding ______ Patient care 360 degree: inadequate _____ adequate _______ outstanding ______ Patient Care action plan initiated: no yes_____________________________________________ ____________________________________________________________________________________ Practice-Based Learning & Improvement: Journal Club attendance 70 %: yes no 20 patient follow-ups completed: yes no PB learning monthly evals: inadequate _____ adequate _______ outstanding ______ PB learning Self eval: inadequate _____ adequate _______ outstanding ______ PB learning 360 eval: inadequate _____ adequate _______ outstanding ______ PB learning action plan initiated: no yes ______________________________________________ ____________________________________________________________________________________ Systems Based Practice: SBP Monthly Evaluation: inadequate _____ adequate _______ outstanding ______ SBP 360 degree inadequate _____ adequate _______ outstanding ______ SBP Self evaluation: inadequate _____ adequate _______ outstanding ______ Systems Based Practice action plan initiated: no yes ____________________________________ ____________________________________________________________________________________ Professionalism: Professionalism monthly evals: inadequate _____ adequate _______ outstanding ______ Prof 360 degree inadequate _____ adequate _______ outstanding ______ Prof Self evaluation: inadequate _____ adequate _______ outstanding ______ Conference attendance >70 % yes no Professionalism action plan initiated: no yes ________________________________________ ____________________________________________________________________________________ Interpersonal Communication Skills: ICS monthly evals: inadequate _____ adequate _______ outstanding ______ ICS 360 degree: inadequate _____ adequate _______ outstanding ______ ICS Self evaluation: inadequate _____ adequate _______ outstanding ______ ICS action plan initiated: no yes ______________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ Resident signature__________________________________________ Program Director___________________________________________ LSU Emergency Medicine Residency Handbook 2013-14 Final summary Meeting Date:______________________ Date started residency__________________ Graduation date______________________ The graduation requirements met for: Medical Knowledge: Patient Care: Practice Based Learning: Systems Based Practice: Professionalism: Interpersonal Communication Skills yes yes yes yes yes yes no no no no no no Based on the observations of the program director and faculty of the LSU Emergency Medicine Residency Program, this resident has demonstrated sufficient professional ability to practice independently without supervision, and is eligible to take the ABEM boards. Resident signature & date _________________________________________________ Program Director & date __________________________________________________ Comments _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ ________________________________________________________________________________________ LSU Emergency Medicine Residency Handbook 2013-14 Definitions The ACGME which oversees all residency review committees has recommended that residents be taught and evaluated using 6 core competencies. At LSUHSC-New Orleans, the Emergency Medicine residency program uses the following parameters to evaluate our residents within the 6 core competencies. 1. Medical Knowledge: Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. Residents are expected to demonstrate an investigatory and analytic thinking approach to clinical situations and to know and apply the basic and clinically supportive sciences which are appropriate to their discipline. We use the monthly CORD tests, the annual National inservice and monthly resident evaluations to evaluate medical knowledge and each year a Medical Knowledge (MK) action plan is developed by the program director and the resident. 2. Patient Care: Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to: 1. communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families 2. gather essential and accurate information about their patients 3. make informed decisions about diagnostic and therapeutic interventions based on patient information, preferences, up-to-date scientific evidence, and clinical judgment 4. develop and carry out patient management plans 5. counsel and educate patients and their families 6. use information technology to support patient care decisions and patient education 7. perform competently all medical and invasive procedures considered essential for the area of practice 8. provide health care services aimed at preventing health problems or maintaining health 9. work with health care professionals, including those from other disciplines, to provide patient-focused care We use core competency based monthly evaluations and the yearly 360 degree evaluation to measure the ability of a resident to provide acceptable patient care. Any deficiencies are addressed in a Patient Care (PC) action plan developed by the program director and the resident. 3. Practice Based Learning and Improvement: Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Residents are expected to: 1. Analyze practice experience and perform practice-based improvement activities using a systematic methodology 2. Obtain and use information about their own population of patients and the larger population from which their patients are drawn 3. Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems 4. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness 5. Use information technology to manage information, access on-line medical information; and support their own education 6. Facilitate the learning of students and other health care professionals We evaluate our residents performance in the area of Practice Based Learning and Improvement by participation in our monthly Journal Club, completion of assigned online problem based learning tasks, teaching ACLS, PALS and/or ATLS, completion of monthly patient follow-ups and death summaries and monthly resident evaluations. Any deficiencies are addressed in the year-end evaluation and a Problem Based Learning (PBL) action plan is developed by the program director and the resident. LSU Emergency Medicine Residency Handbook 2013-14 4. Systems Based Practice: Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Residents are expected to: 1. Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources 2. Practice cost effective health care and resource allocation that do not compromise quality of care 3. Advocate for quality patient care and assist patients in dealing with system complexities 4. Partner with health care managers and health care providers to assess, coordinate We evaluate our resident’s progress in the area of Systems Based Practice by means of the monthly resident evaluations and the yearly 360 degree evaluation. Any deficiencies are addressed in the year-end evaluation and a System Based Practice (SBP) action plan is developed by the program director and the resident. 5. 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: 1. Demonstrate respect, compassion and integrity 2. Demonstrate a commitment to ethical principles 3. Demonstrate sensitivity and responsiveness to patients’ culture, age, gender and disabilities We evaluate Professionalism in our residents via the 360 degree evaluation and monthly evaluations, and maintaining conference attendance of 70%. Any deficiencies are addressed in the year-end evaluation and a Professionalism (P) action plan is developed by the program director and the resident. 6. Interpersonal and Communication Skills: Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates. Residents are expected to: 1. create and sustain a therapeutic and ethically sound relationship with patients 2. use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills 3. work effectively with others as a member or leader of a health care team or other professional group We evaluate Interpersonal and Communication Skills in each resident via the monthly evaluations, yearly 360 degree evaluation and punctuality for assigned shifts. Any deficiencies are addressed in the year-end evaluation and an Interpersonal and Communication Skills (ICS) action plan is developed by the program director and the resident. LSU Emergency Medicine Residency Handbook 2013-14 Faculty Advisors Evaluation of Resident Documents Policy Residents must meet once a year with their faculty advisors to review their evaluations, discuss their research project, present their procedure books, and generally give feedback regarding their experiences and performance in the residency. An evaluation must be filled out, signed and placed in the Resident file following each meeting, HO I year –twice a year, HO II year - at six months HO III year - at six months HO IV year - at six months` All house officers will meet with the Residency Program Director to review goals, procedures and future direction annually. Faculty advisor assignments for all residents are listed every year. LSU Emergency Medicine Residency Handbook 2013-14 Procedure and Patient Experience Documentation Each resident must document patient experiences and procedures during residency. The program must be able to demonstrate to its accrediting agency that you receive adequate experience. You will also be asked to document your experience for future employers. This is considered part of your residency portfolio and will be reviewed quarterly by the program director. Residents without documentation of patient care experience will not be allowed to proceed to next house officer level or graduate from the residency program. The residency director will not certify your competence for your future employers if you have not documented adequate competency in emergency medicine procedures. Typical procedures that requiring minimal representation in procedure logs include intravenous access, foley catheter placement, nasogastric tube placement, gastric lavage, extremity splinting, simple suturing, simple incision and drainage, institution of mechanical ventilation. Typical procedures requiring maximal representation include chest tubes, intubation rapid sequence intubations, pediatric and adult sedation, central line placement, cricothyroidotomy, throracotomy, fracture/dislocation reduction, urethrogram, cystogram, complex lacerations, complex incision and drainage, intravenous pacemaker placements, trauma resuscitation, cardiac arrest resuscitation, complex medical resuscitation, rape examinations, obstetrical deliveries, and foreign body removal. Supervision and instruction of procedures should be documented on the web based worksheet (New Innovations). Procedures And Resuscitations –ACGME goals Numbers include both patient care and laboratory simulations Adult medical resuscitation 45 Adult trauma resuscitation 35 ED Bedside ultrasound # Cardiac pacing 06 Central venous access 20 Chest tubes 10 Procedural sedation 15 Cricothyrotomy 03 Dislocation reduction 10 Intubations 35 Lumbar Puncture 15 Pediatric medical resuscitation 15 Pediatric trauma resuscitation 10 Pericardiocentesis 03 Vaginal delivery 10 The primary responsibility for the determination of procedural competency rests with the program director and the faculty. The RRC accredits programs, and does not certify or credential individuals. ACGME2007 LSU Emergency Medicine Residency Handbook 2013-14 # See ultrasound guidelines below. Ultrasound The ACEP policy statement recommends that an emergency physician receive didactic training and hands-on experience to become proficient in bedside emergency ultrasound. There are six commonly recognized "primary applications" for bedside emergency ultrasound. These applications, and the minimum number of training exams ACEP recommends for proficiency are outlined below: Primary Application Training Exams FAST (Focused Abdominal Sonography in Trauma) 25 RUQ 25 Renal 25 AAA 25 Cardiac 25 Early pregnancy transabdominal transvaginal 25 25 The ACEP guidelines further state that in order for a training scan to count towards credentialing, the findings of the scan must be confirmed by direct supervision, over-read of saved images, other confirmatory testing (ultrasound, CT, MRI, etc.), or clinical outcome. These must be documented on New Innovations. The residency is required to make a statement about each resident's competency in certain procedures. Please remember to document all procedures, including simulation and cadaver labs in New Innovations. You must complete all readings and Cord post-tests before the end of PGY2. You are required to submit, at minimum, documentation that you have completed the ACGME targets before you graduate. We have provided yearly targets to help you stay on track. In addition, you must submit formal evaluations of some procedures, which will be kept in you LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 84 New Innovations NEW INNOVATIONS COMPUTER SOFTWARE PROGRAM House Officers will be required to comply with institutional policy regarding duty hour and procedure documentation through the use of New Innovations Computer Program. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 85 Educational Stipend Updated 7/1/2013 The Educational Stipend is cancelled until further notice due to financial restrictions within the section. Previously: The program has a Fund for the EM residents, which is managed by LSU. Subject to the annual LSU EM budget, $1,000.00 is allotted to each resident for conference expenses and medical texts aside from those that the program provides. Residents must obtain ADVANCED approval by Dr. DeBlieux to use these funds. The residency program will reimburse residents participating in conferences as presenters of case reports and research above the allotted $1,000.00. Meetings located outside of the continental U.S. are evaluated on a case-by-case basis. In order to obtain reimbursement for books, the original receipts must be turned in to the coordinator of the section of emergency medicine. This is different from the forms for travel and the travel reimbursement. Laptops and personal computers CANNOT be covered by the stipend. For travel expenses and conference fees reimbursement, the request MUST be made 1 month BEFORE the conference, NOT afterwards (or you may not be paid). Information that should accompany the request is the following: 1. 2. 3. 4. 5. Name and location of the conference. Date of conference. Registration Fee. Airfare. Official brochure of conference. PLEASE NOTE: The amount of money that is reimbursed for travel expenses is determined by state regulations and may only partially cover airfare, food and lodging expenses. In order to receive money, residents must be in good standing and must not have any outstanding obligations to the residency program. All procedure logs, rotation evaluations, rotation study guide answers, remedial assignments, faculty resident meetings, etc. must be completed before checks can be issued. Travel Forms https://intranet.lsuhsc.edu/forms/ Get the Prior Approval Request For Travel Form PDF format, and Travel Expense Voucher Form PDF format For air travel you need to pay with the LSU corporate credit card VISA Application Form for Corporate Travel Card PDF format LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 86 Mailboxes/ Email Residents have a mailbox in the residency office on the 5th floor which serves as a major means of communication in the program. Residents are expected to check their box daily and are required to do so once a week in order to receive important memos and messages on a timely basis. Ignorance of assigned activities due to failure to check your mailbox will not be considered a legitimate excuse. The boxes in the residency office are for program communications only. Please have journals and other mail sent to your home or your mailbox in the Mailroom in the basement of the hospital. If you have email and wish to have your memos delivered via this method as well as your traditional mail box notify the secretary of your request. Each resident is required to maintain an active LSUHSC email account. You are required to check your LSUHSC email at least once a week. Official LSU communications are provided by LSU email. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 87 Beepers You are LOANED a beeper for your use during your residency. The beepers are leased by and coordinated through LSU which gives a certain number to each residency program. The program is given the responsibility of issuing beepers to you and receiving them back from you at the end of your residency in order to reissue them to incoming residents. You are responsible for the proper care and use of the beeper and for returning it in working condition to the residency whenever requested. If your beeper is stolen, lost, or broken, you must report this immediately to the residency program. A $50 charge is assessed to the resident by the medical school to replace the beeper. A check for $50.00 payable to LSU Medical Center should be given to the residency program secretary who will forward it with appropriate paperwork in order to obtain a new beeper. Replacement batteries are available in the Residency Office. The residency program must be able to reach you by phone or beeper at all times. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 88 Vacation Each HO I receives 3 weeks of vacation which must be taken in one 2-week period and one 1-week period. The 1-week vacations must be taken during the first or last week of the month and the 2-week vacations during the first or second half of the month, not during the middle. HO II, II, and IV receive (2)two week vacations totaling 28 days. Interns and Residents who request vacation during the second half of February must be in town to take the National InService Exam which is given the last Wednesday in February. Interns and Residents may not request vacation during the last half of December. Indicate your first and second choices for each of your vacation periods.. Two-week Vacation Two-week Vacation lst choice ____________ ____________ (month) (1st or 2nd half) _____________ ____________ (month) (1st or 2nd half) 2nd choice ____________ _____________ _____________ _____________ (month) (1st or 2nd half) (month) (1st or 2nd half) We will try to honor your requests but cannot guarantee that you will receive the choices indicated above. Yearly Schedule Requests Vacation requests -Vacation will be assigned based on seniority. Once the annual schedule has been published, NO changes are allowed, other than due to extraordinary circumstances. (Example: marriage, or birth of a child). Concerns or questions regarding the annual schedule should be addressed in writing to the Residency Director. If a schedule change is made an official notification will be sent to the Residency Director, the LSU payroll, the resident and the resident file. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 89 ED Schedules 1. Seniority: Preference will be given to 5th years, then 4th years, then 3rd years concerning upper level schedules. Please be mindful of this when choosing your selections. The scheduling chief has data sheets on all residents in the program, and will be tracking your choices, special requests, schedule given, disaster calls, etc. The purpose is to accommodate all, while maintaining parity within the schedule. 2. Final Schedule: The final schedule for a month will be finished by the 1 st of the month prior. After the final schedule is made, the scheduling chief will not make changes to your schedule unless speaking with you first. If glaring concerns arise or if someone is pulled off the rotation, then the chief will have to readjust the schedules. Otherwise, the only changes made to a monthly schedule after being finalized will be switches among residents or switches make only after consultation with that individual resident/s. 3. Resident Switches: When a switch occurs, the switch must be emailed to the Scheduling Chief. BOTH RESIDENTS MUST EMAIL THE CHIEF THE SWITCH. Please always remember when you are working, as forgetting that you are working will not be tolerated by any of the Chiefs or the program director. Missed shift will result in (at minimum) making up that shift and being assigned an additional penalty shift. Once the switch is made and both residents have emailed me, then the switch is final and valid. The responsibility of the shift is then on the resident who accepted the shift, not the original resident who was working the shift. If both residents do not email me, then the responsibility of the shift lies with the resident who is on the original schedule. When switching occurs, be mindful that 2nd years can only switch with 2nd years. 3rd 4th and 5th s can switch with each other. The only exception is if the 2nd year switches a shift with an upper level into an area where second years are allowed. As long as there exists a 3rd and 4th year in the MER at all times, then the switch can occur. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 90 TARDINESS One of the Core ACGME Competencies is Professionalism: All ED shifts start 15 minutes prior to the hour. If you will not arrive 15 minutes prior to the hour the shift starts, you must call into the on-duty charge resident or this will be unexcused tardy. The disciplinary chief maintains a log of unexcused tardiness and will implement the following under the direction of the program director: 1st unexcused tardy: warning 2nd unexcused tardy: extra ED shift on following schedule 3rd unexcused tardy: extra ED shift on following schedule 4th unexcused or more: see Program Director to set up daily evaluations. Failure to remediate results in probation. If a resident fails to show up for a scheduled shift, the chief residents and program director must be notified immediately. All missed shifts will be made up, and the program director will initiate a remediation plan and/or probation after a second failure to show. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 91 Disaster Call Purpose: To provide a uniform, consistent approach for coverage of emergency department (MER & RTA) resident shifts left vacant or uncovered due to sudden illness, personal emergencies and scheduled leave of absences, including maternity and paternity leave. Disaster coverage does not cover community and offsite rotations, so if a resident must miss a shift in the community, they must notify the faculty at the community rotations, as well as Dr. Haydel and the chief residents. Furthermore, the resident is required to make up the shift within one month. Description: The back-up call system will be addressed by two mechanisms: standard back-up policy and the LSUHSC Sick Leave Policy. These systems will remedy short-term and long-term absences, respectively. The short-term policy will be utilized for absences of 1-2 days, while the extended policy will be invoked for absences of greater than 2 days. Standard Back-Up Policy Residents on off service rotations such as, Elective, Toxicology, and all others will be scheduled for Disaster Call. If at all possible, that resident will not be required to do more than 2 days of ED work. The residents providing back-up coverage will be PGY II, III, IV. The resident who misses a shift must arrange to ‘pay back’ that shift within two months to the resident called into work the shift. Extended Back-up Call Schedule If the resident's absence extends beyond 2 days, the resident must notify Kathy Whittington to initiate institutional sick leave. When this occurs, another resident will be pulled from his/her rotation to cover the remaining shifts. The resident will be pulled from the rotation from which he or she is most expendable and which impacts ACGME training requirements the least. Qualifying situations: Situations deemed appropriate for the use of the disaster call schedule are inclusive, but not limited to, the following events: Illness Family death Maternity/ Paternity leave (as defined by LSU under the Family Medical Leave Act) Personal hardship (evaluated on an individual basis) Emotional hardship/illness (as defined by LSU Human Resources Dept) Disaster Call Scheduling 1.Disaster Call schedules will be made in accordance with the monthly ED Schedule. Any special requests concerning disaster call should be made 6 weeks prior to the month. The number of calls taken per month will be dependent on seniority and needs of the schedule. A full month LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 92 disaster call can result in a maximum of 5 calls, and a ½ month of disaster call can result in a maximum of 3 calls. If extra coverage is required beyond this, residents working an ED month may have to take 12-24 hours of disaster call per month. These situations are rare but may arise. 2. Covering Rotations: Residents on the following rotations will be on disaster call for that particular month: Elective, Toxicology and Administration. 1st years do not take disaster call. Disaster call is taken by 2nd, 3rd, 4th and 5th years only. 3. Time Covered: REMEMBER, the disaster call day starts at 7am, the morning of your date, and ends at 7am the next day. This coincides with the shifts. Even though M3 and F3 shifts go into another day, they started on the previous day. 4. Disaster Activations: The resident with an emergency is to call the scheduling chief and leave a message with Kathy Whittington. The resident must also notify the faculty member in the ER. The Chief on call will activate the disaster resident. If you are on Disaster Call, it is your responsibility to have your pager on at ALL TIMES. If you are unable to be found while on disaster call, this will result in a penalty shift. The chief residents will serve as back-up disaster call in case two activations occur in one day. Each chief will take one week of back-up call per month. This year, each chief will be taking 3 months of back-up disaster call throughout the year. 5. Disaster switches: Email all switches to the Scheduling Chief Resident and copy ALL parties involved in the switch. Disaster Call & Duty Hours Under no circumstances, will disaster duties exceed ACGME duty hour guidelines. See Duty Hours - Emergency Medicine LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 93 Code Grey – Hurricane Guidelines These guidelines have been setup in coordination with the Directors of Emergency Preparedness, Dr. Aiken and Dr. Hardy. Category 1 Hurricane — winds 74-95 mph--No real damage to buildings. Category 2 Hurricane — winds 96-110 mph--Some damage to building roofs, doors and windows. Some trees blown down. Category 3 Hurricane — winds 111-130 mph (Katrina at landfall) Some structural damage to small residences and utility buildings. Large trees blown down. Terrain may be flooded well inland. Category 4 Hurricane — winds 131-155 mph. Major erosion of beach areas. Terrain may be flooded well inland. Category 5 Hurricane — winds 156 mph and up. Complete roof failure on many residences and industrial buildings. Some complete building failures with small utility buildings blown over or away. Flooding causes major damage to lower floors of all structures near the shoreline. Massive evacuation of residential areas may be required. Definitions: Media Definitions (what you will see on the news) o A HURRICANE WATCH- you could experience hurricane conditions within 36 hours. o A HURRICANE WARNING -winds of at least 74 mph are expected within 24 hours or less. Hospital Definitions: o Code Grey- Hurricane Code Grey Watch: expected landfall 96 hours (4 days out) Code Grey Warning: expected landfall 72 hours (3 days out) Code Grey Activation: expected landfall 48 hours until 24 hours after landfall Code Grey Recovery: 24 hours after landfall Code Grey Evacuation: Hospital evacuation may be required and will be coordinated by the Directors of Emergency Preparedness. Overview: At the beginning of each academic year, the chief residents will develop a list of residents for the activation and recovery teams. Assignment to the ACTIVATION team is strictly voluntary and will provide coverage for hospital and off-sites areas that we will cover during a storm. The activation team is committed to be in-house 48 hours before landfall and will stay until the recovery team arrives. When a Code Grey is initiated, the chief residents will assign residents currently rotating in the LSU Public Hospital/UH ED, toxicology, administration and local electives to the activation team and recovery team. The activation team consists of 9 residents. (3/shift in the ED, 2/shift off-site coverage) LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 94 The recovery team consists of 9 residents—this will allow equal time off for the activation team after the storm threat has passed. In theory, the recovery time period will cover the same amount of time as the activation time period. Residents will be assigned to 12-hour shifts either in the ED or at an off-site staging area. Potential Off-Site Staging Areas: Lakefront airport, Convention Center, etc, to be assigned by the Directors of Emergency Preparedness. Residents not assigned to either team are expected to be available during the recovery period for unexpected assignments. The recovery team is expected to be prepared to report for duty 24 hours after landfall. EM residents in the MICU and TICU will follow the MICU and TICU protocol for activation and recovery. Residents on Lallie Kemp, OLOL, Children’s, West Jeff, Ochsner, Slidell ED rotations will be released from duty if a Category 3 or above is expected to strike the area where that hospital is located. Residents will then be expected to be available for recovery shifts at those hospitals. All interns will follow the guidelines on the service where assigned that month—in general, expect to be released from duties if a Category 3 or above storm is expected. Interns on an ICU rotation may be asked to remain for Activation, but if you don’t want to participate, please notify Dr. Haydel and the chief residents immediately. The EM offices on the 5th floor UH will act as the Residency Central Command Center and will be staffed by the program director and a chief resident during the Code Grey Warning phase. Section of Emergency Medicine Telephone Activation Tree The purpose is to facilitate the flow of information from the Program Director to all members of the residency. The tree will be activated at the onset of Code Grey Watch, and at least every 12 hours thereafter, until termination of the Code Grey, or termination of recovery. It is the responsibility of every faculty member to provide the Program Director with 2 reliable telephone numbers, and 1 alternative email address. Please sign up for the LSU emergency notification alert system: http://www.lsuhsc.edu/alerts/ In addition, Dr. Haydel will serve as EM section communication officer during code grey activations. It is anticipated that she will evacuate at the onset of code grey activation, and establish a location from which she can act as a central point of contact and will disperse updates via email and cell phone text messaging. In the event of a major storm with hospital service disruption, the program directors, program coordinators and chief residents will meet at a pre-assigned location to continue with the oversight of the residency. In the event that communications are compromised the yahoo website will be updated regularly, and temporary access will be given to family members and friends that identify themselves as looking for information about a specific resident on the activation team: http://health.groups.yahoo.com/group/LSUEM/ LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 95 Phone Tree: PGY4s PGY3s Haydel & PGY2s APDs PGY1s IM/EM Chief IM/EM residents on EM side Chiefs Timeline Under the direction of the Section Chief, the program director will activate the notification tree, based upon the anticipated time required for residents to secure their homes and initiate their personal hurricane plans. This will be no later than initiation of the hospital wide plan. 96 hours to landfall (Code Grey Watch) o Program Director and Chief Residents meet and establish the command center for residency in 5th floor EM offices. o A list of the Activation team must be sent to the medical director's office as soon as a Code Grey Watch is announced. o Activation Team notified in order to pack and prepare for activation. 72 hours to landfall (Code Grey Warning) o Activation Team physically checks into hospital to obtain arm bands, call rooms, parking passes and discuss plan of action with Chiefs and Program Director in EM office/5th floor. After checking in, the activation team may leave the hospital to continue home preparation and packing. o 12-hour shifts implemented in order to facilitate preparations. 48 hours to landfall (Code Grey Activation) o Activation Team must remain in-house until recovery team arrives. o Community ED residents released from duty if Cat 3 or above. o Non-essential interns released from duty at UH. Advanced Personal Preparation: Each resident is urged to formulate a personal hurricane preparation plan. This should include: A list of critical actions that must be accomplished during the short time available before the storm, such as securing pets, evacuation of family, securing the home. A list of items to pack, including 10-14 days of clothing, non-perishable food, water, bedding. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 96 A list of items that should be purchased in advance, such as rechargeable lights and batteries, a power inverter for your car (to recharge cell phones, lights, radios when the electricity fails), toiletries. A list of items needed to return to work during recovery, assuming that the city will be without power and water at the time return to work is required. Secure professional paperwork, licenses, personal photos, etc in ziplock bags. What to expect if you stay at UH during a Cat 3 or above storm: Power will go out and generators will go on. Generator power means no a/c, no elevators, no pumps in the basement, no pumping of water up to upper floors. No sewer system and no drinkable tap water. Upper floor windows will be blown out by strong winds. Communication within the hospital will be compromised, and communication with people outside the hospital will be almost nonexistent: The pager system and intranet can be expected to fail. Cell towers will be lost—although text messaging may remain intact for some. Patients and equipment will have to be moved from the first floor to the second floor if flooding occurs. Residents in the hospital will provide care to inpatients and walk-ins until the hospital is evacuated or the recovery team arrives. Residents assigned to off- site areas will provide care to patients who are at the staging areas awaiting evacuation. If the hospital is closed due to damages, the Recovery teams will be assigned (with faculty) to other sites to provide emergency care until the hospital can be reestablished. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 97 Advanced Life Support Programs Policy Revised May, 2004 All Emergency Medicine and Emergency Medicine/Internal Medicine combined program Residents must maintain certification at the provider level for Basic Life Support Healthcare Provider (BLS-HP), Advanced Cardiac Life Support (ACLS), Pediatric Advanced life Support (PALS), and Advanced Trauma Life Support (ATLS). BLS, ACLS, and PALS courses are provided through the LSU Emergency Medicine / American Heart Association Community Training Center. ATLS courses are provided through Tulane University Hospital Life Support Office. Certification in each of these courses must be completed before December 31 of the intern year, and maintained throughout residency. The costs of initial provider courses are covered by the residency program. ATLS re-certification course costs are the responsibility of the resident. Failure to attend a scheduled provider course without the prior approval of the Residency Director will result in rescheduling of the course at the resident’s expense. All residents are required to become certified as ACLS and PALS instructors. Normally, Emergency Medicine house officers (PGY-I) receive ACLS and PALS instructor courses during intern orientation. Instructor status is maintained throughout residency by participation in a minimum of 2 ACLS courses each year. Additionally, all residents are encouraged to certify as an instructor in 1 of the 2 other disciplines (ATLS, BLS). ATLS Instructor programs are offered through Tulane University Hospital Department of Community Education. Participation in the instructor program is by invitation of the Residency Program Director. Instructors may sign a contract with Tulane agreeing to provide service as an instructor in lieu of paying course tuition. The cost of the course is usually paid after teaching at 4-5 courses. Instructors must teach a lecture and corresponding small group session at least once per year. At the end of each 4 year cycle, an instructor in good standing may take the ATLS provider test to renew provider and instructor status. Schedules for ATLS courses are available through Tulane at 588-2212. Scheduling of instructors for ACLS, PALS, and BLS courses is the responsibility of the Chief Residents and the Training Center Coordinator. Failure to teach at an assigned course without prior notice will result in disciplinary action. (In the event that a resident encounters an unforeseen emergency that interferes with a scheduled course, he must notify the responsible Chief Resident 72 hours in advance of the course. Excuses less than 72 hours in advance require the approval of the Director of the CTC, or the Residency Director. Confirmation of compliance with this policy is required at each faculty advisor interval evaluation. Failure to satisfy the policy requirements will result in disciplinary action, at the discretion of the residency director. Disciplinary action may include suspension of moonlighting privileges and additional life support teaching responsibilities. Revision 05/08/04 RS LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 98 Addendum – ACLS/PALS Course Directors (effective July 2004) ACLS/PALS teaching and scheduling are an important part of resident education, community outreach, and chief responsibility. Previously, however, non-chief residents with a real interest in ACLS/PALS had little opportunity for initiative or responsibility. The following change seeks to improve resident investment in the ACLS/PALS courses without compromising the courses’ quality. Chief Residents will continue to make the overall master schedule for the year of who teaches what when. Every month, the 4th (and possibly 3rd) year resident on elective will be that month’s ACLS/PALS director. This resident is responsible for reminding residents scheduled to teach and assigning a lecture/small group slot to each; touching base with Nona and Kathleen in the immediate pre-course period to confirm room locations etc.; supervising resident lectures; and filling in when there is a gap in one of the lectures or stations. Directors will each receive a handout with information and a timeline that would have to be completed and turned in to the Chief Residents at the completion of the course for documentation and quality assurance purposes. Being the director would count as one’s ACLS/PALS requirement for the year – chiefs would oversee the activities of the director and remain “on-call” as double backup for lectures, etc. Chiefs, in coordination with the monthly ACLS/PALS director, would handle any disciplinary issues related to residents not showing up to teach, not doing a good job, etc. Any failure to teach when assigned and properly notified ahead of time would result in an extra ED shift (as noted above). LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 99 Moonlighting Policy Updated 3/12/2014 Definition: Moonlighting is extra work for extra pay, outside of the trainees approved training program curriculum. 1. Moonlighting activities may not compromise your residency training or to detract from your learning experience. CORD’s Position Statement on Moonlighting: Residents should not engage in the independent practice of emergency medicine. 2. Moonlighting is permitted for emergency medicine residents who maintain a satisfactory academic status and meet all their residency associated clinical and teaching responsibilities. Residents who wish to moonlight must: a. Adhere to all conference attendance policies with a minimum of 70% attendance. Any absence due to moonlighting will result in a permanent loss of moonlighting privileges for that academic year. b. Meet all scheduling requirements of each monthly rotation. Schedules will not be modified to accommodate moonlighting commitments. c. Complete all medical records within 2 weeks of notification. d. Procedure logs must be updated quarterly e. Pass the National In-service Exam with a score of at least 75. f. Any resident who does not achieve the national average on the inservice examination and wishes to moonlight, must actively participate in the monthly board review program. g. All moonlighting activities must be documented in New Innovations and apply to your duty hour limits. h. The following is the current LSU EM graduated moonlighting guideline: I. No moonlighting is allowed during the first post-graduate year. II. PGY2 residents may moonlight in an ED or Urgent Care Setting with direct faculty oversight. III. PGY3 residents may moonlight an urgent care setting without direct faculty oversight, or an ED with direct faculty oversight. IV. PGY4 residents may moonlight in an Emergency Department without direct faculty oversight. 3. Residents may not enter into any contractual agreements to provide any type of service on a regularly scheduled basis. 4. Any resident who has been placed on probation for any reason may not moonlight during the probation period and for at least three months thereafter. Permission of the residency director must be obtained before moonlighting. 5. MALPRACTICE: Residents must secure their own malpractice insurance for moonlighting. ACKNOWLEDGEMENT OF MOONLIGHTING POLICY I have read and understand the Emergency Medicine Department's Moonlighting Policy and agree to accept the terms and conditions set forth in such policy. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 Name_________________________________ Signed___________________________ 100 Date________ LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 101 Call Room The resident lounge on 5west is available if you would like to rest before or after a shift; contact Ms.Whittington for the code. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 102 Conference Attendance Policy (July 2013 update) Didactic Resident Conference is 7am-11am, each Wednesday University Hospital Basement Classroom Journal Club is 7:00pm-9:30pm the 2nd Thursday of each month. Conference and journal club attendance is mandated by the Emergency Medicine Residency Review Committee. Conference is comprised of 4 hours of didactic lectures per week and 4 hours of asynchronous learning per month. Asynchronous learning may be done earlier than the month scheduled, but no later than 1 month after the scheduled month. Emergency Medicine Residents must attend 70 % of conferences (didactic and non-didactic). You are excused from conference and journal club while you are Vacation. If you have difficulty being released from your clinical duties on ANY rotation, address this problem immediately with the chief residents or Program Director. If you think your conference attendance is in violation of your duty hours, please notify the Program Director immediately. Attendance Goals: A reasonable goal is > 80% conference attendance, when accounting for vacation and excused absences. The RRC requires 70% minimum attendance throughout the year, without considering excused absences. You may choose to attend conference after a night shift, but you may not attend conference if it will cause a duty hour violation. If you think that attending conference will be a duty hour violation, please contact your chief resident or program director immediately to rectify the problem. mhayde@lsuhsc.edu LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 103 Journal Club 2nd Thursday each Month 7:00 pm The purpose of Journal Club is to discuss articles relevant to Emergency medicine. Whether these articles are "good" or "bad" is not important. What is important is to gain an understanding of research design, statistics, and interpretation of data. Hopefully this will enable you to gain a better understanding of the article: you read as well as help you in your own research projects. Journal Club Procedures will be as follows: a. The purpose of Journal Club is to discuss articles relevant to Emergency medicine, and to gain an understanding of research design, statistics, and interpretation of data. b. Dr Slaven is the director of Journal Club c. Each year one of the Chief Residents coordinates Journal Club dinner and makes the annual schedule of resident leaders and presenters. d. A PGY3 resident is assigned each month to be the Leader and select a topic and articles (approved by Haydel) and lead the discussion. e. 2-3 other residents will be Presenters and present the articles using the critique template which follows and is posted on the yahoo website. f. Articles will be distributed via email and the yahoo website one week prior to Journal Club: http://groups.yahoo.com/group/LSUEM/ g. Unless excused or working, attendance and preparation are required. h. Failure to present for Journal Club may be grounds for disciplinary action. Journal Club Responsibilities The Journal Club Chief Resident is responsible for selecting articles, organizing dinner and the location for each Journal Club. The section coordinator will notify all of the location each month once things are lined up. Presenters should present the article and engage the audience using the Standard Journal Club Presentation Format below: Journal Club Literature Critique Article title and journal: Study objectives: Hypothesis: LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 104 Outcome measures(dependent variables): Methods Design type _ Observational _ Case-control _ Cohort _ Experimental _ Cross-over _ Other: __________ Design features Randomized no yes: Blinded no yes: (single or double) Prospective or Retrospective Controlled no yes : Sample: Number of data points or sample size (n) __________ Inclusion criteria: Exclusion criteria: Treatment (independent variables): Sampling type: __ convenience _ consecutive _ randomized _ systematic __other: Describe each treatment group and indicate number (n) for each: Data type: __nominal (named ie yes, no) __ordinal (ordered, numbers) ___interval (specific differences) Statistics: What statistical analysis is used? Are the statistics used appropriate for the data? What are the confidence intervals? Results: Is the hypothesis accepted or rejected? Does the study answer the question asked? How could the study be redesigned to better answer the question asked? Were adverse effects of treatment, limitations to the study, and intention to treat discussed? Conclusions: Is the study biased? Are conclusions supported by the data? Is the study good or not? Does it affect your practice? LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 105 Patient Safety Presentations The following will be presented in a PowerPoint Presentation. This is a “Question – Answer” case with HPI, H&P, Labs, ED course: First Slides: HPI, Physical exam The first question: What is the differential diagnosis? Other questions: (Diagnostic) What tests would you order? (Management) Appropriate actions would include? Second Slides: Course of action, what happened to the patient. Presenting resident will summarize the case At this point a member of the audience will be ask to critique the management of the case. Was this the proper course of action?. Would you have done something different?. Why?. Last Slides: two questions: (Clinicopathologic questions) Referenced, relevant and pertinent question to the case presented. (No true or false, No all the above.) In A, B, C, D, E best single answer format. Example: 64 y/o Hispanic male arrives to the ED c/o Left flank pain of sudden onset of one hour duration. PMH. - Left kidney stone 2 yr. ago. and Hypertension. Social - Smoker 1 ppd x 30 yr., retired. Meds. - blood pressure meds. NKDA. PE - BP 90/60, 72, 98.2, 26. The patient appears in severe pain, can't get comfortable on the stretcher. HEENT - Gr II HTN retinal changes, Neck - no JVD, Lungs -Clear, Heart - rr, no murmur, Abd. - diffusely tender, quiet, Rectal - neg hemetest. Pulses - 1+ Symmetric. Q. #1. Differential Diagnosis: Nephrolithiasis Diverticulosis Ruptured Viscus Leaking/Ruptured AAA Ischemic Bowel Q. #2 Diagnostic: Q. #3 Management: ABC"s EKG IV x 2 - Fluid bolus, Labs 02 high flow LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 106 Stat Surgical Consult Clinical course: (Presenting Resident) This patient was admitted to the monitor cubicle, primary assessment, IV x 2 started, blood drawn for CBC, Chem., high flow 02, cardiac monitor, Secondary assessment. Pressure support with Dopamine, IV fluids. A CT scan of the Abdomen was done 1 hour latter. The patient was taken from the CT table to Surgical OR due to the patient's clinical deterioration and died while in Surgery. Audience Critique: (Designated by Staff Present or Chief Resident) After initial resuscitation of the patient and the initial ancillary tests this patient should have been moved to the OR for immediate Surgical intervention. Even Though the mortality of a ruptured AAA is over 80% this patient could have had a better chance if there would not have been a delay in administering pressure support drugs and obtaining a CT scan. Q. #4 Clinicopathological: 1.) The most common presentation of AAA is? a. b. c. e. f. Answer: painless, pulsatile mass found on routine exam tearing flank pain, like kidney stone patient usually dead on arrival chest pain nausea, vomit and abdominal cramping a 2.) Indications for CT in pt's with AAA a.) b.) c.) d.) e.) Answer unstable patients with no inmediate surgeon available in differentiating pancreatitis from ruptured AAA with pt's V S P-130, BP- 90/60, R- 20 patients suspected of having chronic contained rupture at surgeon's request for preparative planning in ruptured AAA in differentiating AAA vs. appendicitis in pregnant female with history of Hypertension and tobacco use. c Ref. Tintinalli, Emergency Medicine - A Comprehensive Guide, 4th ed. ch.59 LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 107 LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 Medical Records EPIC- training during orientation. You are required to empty your EPIC/Pelican In-Basket Weekly. 108 LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 109 Research Requirement Every resident is required to participate significantly in a research project or scholarly activity in order to successfully complete the residency program. Optimally residents will gain an understanding of the research process by participating in an entire project from origination of a hypothesis through submission of the completed article to a peer review journal. Not every resident may have the opportunity to perform each step involved in a particular project, but is expected to work with a faculty mentor to complete one of the following scholarly activities: All rotations approved as research electives must have evaluation forms completed for the prescribed time by the supervising faculty advisor. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 110 Chief Resident Responsibilities Scheduling residents for PALS, ATLS, ACLS IGMEC – Graduate Medical Education Committee delegate monthly meeting LSU Residency fair, junior medical student residency day Committees: ED Leadership, ED Throughput, Hospital (Stroke, MI, Trauma), CQI/EQiPP Journal Club ED daily and annual Schedule, ED intern schedule Graduation dinner Discipline Social/Wellness Coordination Annual review of goals and objectives for each rotation Residency Manual annual review Simulation and Cadaver Lab Coordinator EM resident application review Interview Coordination Chief Resident Questionnaire Third year residents are asked to respond to the following questions. Please comment on the existing chief resident’s responsibilities. Would you suggest additions, deletions, or other changes? What do you think are the three most important issues facing the EM residency program and how would you resolve these issues? If considering becoming a Chief Resident, what would be your overall goal? If considering becoming a Chief Resident, why do you think you are suited for the position of Chief Resident? LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 111 Residency Curriculum The EM residency curriculum is composed of several components. 2. 3. 4. 5. The Clinical Rotations as described in the Rotation Guide The Weekly didactics, following a comprehensive 24 month curriculum The House officer year Special Topic Sessions Supplementary Advanced Life Support, Hazmat Training. The didactics and reading 18 month curriculum is based upon the Model Curriculum for Emergency Medicine, the RRC for Emergency Medicine Training Guidelines and the ABEM certification goals. Model For Emergency Medicine Link to the Model Curriculum for Emergency Medicine Residency Training: http://www.saem.org/model/intro.htm LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 112 Reference Book Loan-Out Policy 1. Medical center of Louisiana Library -reference books are not to be removed -computer cd's - can be accessed from many different terminals; can’t be checked out -EM main residency office -books may be checked out for 3 day intervals. -sign out sheet can be obtained by the section secretary 2. Slidell memorial hospital -emergency room -books are not to be removed 3. Ochsner medical library -books are not to be removed LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 113 Medical License For up-to-date information on Louisiana Medical License go online to www.lsbme.louisiana.org Louisiana License, Training Permit & STEP 3: All LSUHSC House Officers must have a valid license or permit to practice medicine in the State of Louisiana. The Training Permit is only available during the PGY1 & PGY2 years (24month period) when the resident has not yet taken and passed STEP 3 USMLE. From the LSBME website, “The applicant who has not taken and passed the USMLE Step 3 prior to the expiration of the PGY1 or PGY2 permit may not be licensed by the LSBME until such time that the applicant has taken and passed the USMLE Step 3” House Officers who fail to pass Step 3 by the start of PGY3 will be assigned non-clinical duties until a valid Medical License has been obtained. Non-clinical rotations consist of any unused vacation and non-clinical elective rotations for that training year. Once all non-clinical rotations have been completed, the resident will be assigned to a leave-without-pay status and will be dismissed from the EM program if the resident fails to obtain a Louisiana Medical License within three months of starting the leave of absence. Step 3 Checklist You must take and pass Step 3 prior to beginning your PGY3 year, therefore the EM residency requires you to complete the application process during your PGY 1 year. Prior to applying to take Step 3, you must meet the following requirements: Pass both USMLE Steps 1 and 2 (CK and CS). FMGs must obtain certification by the ECFMG. Once you choose a month to take Step 3, you will need to begin the application process 4-8 weeks prior to the chosen month. Once you finish the process you will have 3 months to take the exam. USMLE Step 3 Applicants Can Simultaneously Apply for Credentials Verification o The Federation Credentials Verification Service offers a service to USMLE candidates who complete their Step 3 application online. As a convenience to examinees, information entered on their Step 3 online application can be used to begin a personalized FCVS Physician Information Profile that contains their primary-source verified credentials. The state of Louisiana requires applicants for full licensure to complete the FCVS. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 114 Apply for Step 3 via the website at FSMB - Click on Exam Services the Step 3 Homepage Check to make sure you are eligible for Louisiana License State Requirements - See guidelines below: POSTGRADUATE STATE BOARD ATTEMPT LIMIT TIME LIMIT TRAINING REQUIREMENTS LOUISIANA Unlimited attempts at You mus t c hec k with the s tate medic al USMLE Step 1. Unlimited None APPLICATION FOR LICENSURE REQUIRED WHEN APPLYING FOR STEP 3 YES board to determine lic ens ure applic ation proc ess ing times. Your Step 3 Four attempts at applic ation c an not be approved until we USMLE Step 2. rec eive approval from the s tate medic al board. If we have not rec eived approval Four attempts at by September 5, 2008, y our Step 3 USMLE Step 3. applic ation will be c anc elled. State Licensure After you have applied for you state license, it will come in the mail automatically after the state receives your passing scores on Step 3. Full license rules Minimum Postgraduate Training Required Number of attempts at Licensing Examination Time Limit for Completing Licensing Examination Sequence Louis iana (504) 568-6820 License fee $382.00 nonrefundable Requires FCVS 1 year; 3 years IMG No limit at Step 1or COMLEX Level 1; 4 attempts each at Steps 2 and 3 or COMLEX Levels No limit on the USMLE or COMLEX DEA number Apply for state CDS license first . Cost: $20 and needs to be mailed in. Once you have been approved for the state license, you can apply for a Federal DEA number . Select Form 224. Cost: $551 - will only take credit card if you do it online, otherwise mail it in with a check. NPI number Goto http://www.cms.hhs.gov/NationalProvIdentStand/ Tips for filling out the form: o The primary address should be LSUHSC 433 Bolivar NO,LA 70112 LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 o o o o 115 The mailing address may be your program office Use the program office phone number The taxonomy code is "Student in an Organized Health Care/Education/Training Program" Once they have their NPI numbers, then need to link it to Louisiana Medicaid, especially to write scripts @ http://www.lamedicaid.com/provweb1/Hipaa/npi.htm Notary Ms. Kathy Muslow, provides notary services each Wednesday from 12:00 noon to 1:00 PM for university business only. kmuslo@lsuhsc.edu 568-5135 Medical License or Permit On July 1, 2008 all House Officers MUST have a valid Louisiana State Board of Medical Examiners (LSBME) permit (GETP, PGY 1, PGY2, PGY3, or any other valid LSBME permit), or license to practice Medicine in Louisiana and begin or continue residency/fellowship training. In April, at the quarterly Coordinator’s meeting, Medical License information from New Innovations was handed out showing the expiration dates of each House Officer’s permit or license, along with a document from the LSBME explaining the items needed to receive and renew each type of permit, along with USMLE Step 3 information. This information was distributed to avoid the submittal of late or no information to LSBME for initial permit/license or renewal of permits. For the past few days we have printed LSBME License/Permit data from New Innovations and cross referenced it against the information on the LSBME website. There are MANY New Hire House Officers with no permit/license information on the LSBME website and MANY Continuing House Officers with Permits that will expire June 30, 2008 or shortly thereafter. We know LSBME is in the process of updating many files on the website but there are also many House Officers that have not submitted renewal fees or documents to LSBME Yolanda Lundsgaard Coordinator GME LSUHSC School of Medicine 2020 Gravier St, Ste B New Orleans, LA (504) 568-3407 FAX: (504) 599-1453 Guidelines to Rotations/Goals & Objectives LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 116 Rotations and Scheduling 1. All rotations at all hospitals begin on the first day of the month, regardless of the day of the week. The only exception to this is the month of January for which the Medical Director of LSU sets the first day in order to provide opportunity for all residents to have time off for either Christmas or New Years. This date will apply to all hospitals and rotations. 2. Schedule requests must be submitted as delineated in the Rotation Guide. Be sure to request off the days you are assigned to take or teach advanced life support courses or to take In-Service Examination. 3. Failure to report to work any assigned shift at any hospital or any service may result in suspension or dismissal. Residents are required to notify the emergency medicine staff person on duty at the hospital and the chief resident on duty (chief pager 423-2537) and the chief resident of the non-emergency department service to which they are assigned in advance if they are unable to report for duty. The resident must notify the residency office by phone on the day of the absence and the Residency Director in writing within one week of the reason of absence. In case of illness, residents are required to report to the emergency department for diagnosis and management. 4. Residents are expected to be punctual for their shifts. Repeated tardiness will result in disciplinary action. Residents may not leave early without permission from the supervising attending. 5. Professionalism: It is the expectation that the intern and resident will work in harmony with the ER RN to accomplish all tasks. Residents may not leave early without permission from the supervising attending. All shifts start 15 minutes prior to the hour, if you will be tardy, you must call into the on-duty charge resident. Unexcused tardiness will result in disciplinary action. 1st unexcused tardy: warning 2nd unexcused tardy: extra ED shift on following schedule 3rd unexcused tardy: extra ED shift on following schedule 4th unexcused or more: see Program Director to set up daily evaluations LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 117 LSU Public Hospital Emergency Department Dr.__________________________, You are assigned to the ED Orientation: Mandatory for all interns, (day, night or off shift) at 7am on the first day of the month. (see section below for orientation review for residents) Schedule: A choice of a prearranged schedule will be available on a first come first serve basis around the middle of the month preceding your schedule rotation in the emergency medicine office. Please see Kathy or the scheduling chief for schedule template. Responsibilities: Interns and Residents are expected to manage their individual patients as well as assist in other areas as needs arise. Professionalism: It is the expectation that the intern and resident will work in harmony with the ER RN to accomplish all tasks. Residents may not leave early without permission from the supervising attending. All shifts start 15 minutes prior to the hour, if you will be tardy, you must call into the on-duty charge resident. Unexcused tardiness will result in disciplinary action. 1st unexcused tardy: warning 2nd unexcused tardy: extra ED shift on following schedule 3rd unexcused tardy: extra ED shift on following schedule 4th unexcused or more: see Program Director to set up daily evaluations Conference: All resident are expected to attend conferences on the appropriate day. Extras: All procedures must be recorded and turned in at the end of the month. Supervision: You will be supervised by board certified Emergency Medicine physicians. Evaluations: Daily evaluations. What follows are the goals and objectives for the LSU ED rotation, that will range from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take place at the LSU University Hospital. The year of training may include PGY 1-5. EMERGENCY DEPARTMENT RESIDENT ORIENTATION General Be on time for start of your shift. Dress and act professionally. (see Dress Code) Place a note on every chart. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 118 Work with other residents and nurses to enhance patient flow in the ED and Fast Track. Notify attendings as soon as possible of disposition problems caused by lab, X-ray, or consultant delays. Make frequent rounds with attendings and discuss management of complex cases prospectively. Use the available hand-off tool for organizing patient care. (see Handoff Tool) Educational Give lectures as assigned by chief residents. (see Patient Safety Presentations) Supervise and teach junior residents, interns, and students through their patient care experiences. Provide a written evaluation of each intern you work with using the form provided to you at the end of the month. o If an intern shows a consistent pattern of problems in any area including punctuality, attendance, attitude, knowledge, skills, or interpersonal relationships, notify Dr. DeBlieux, the EMS director immediately so that intern can be counseled. o No intern should receive a below average evaluation (4 or below) in any area without having feedback and an opportunity to improve. o Interns from other services such as OB-GYN and Pediatrics are allowed to attend their required Continuity Clinic one half-day per week when assigned to the ED. Surgery residents are allowed to attend conference on Saturday morning. They must "sign-out" with the emergency medicine resident before leaving to ensure continuity of patient care. Attend conference as required by Conference Attendance Policy (see Conference Attendance Policy) Document all procedures on New Innovations (see Error! Reference source not found.) Request autopsy results on all deaths: email Dr. Robin McGoey in the Dept of Pathology (rmcgoe@lsuhsc.edu) Documentation Document the initial time the patient was seen, Document the times consults placed and answered. Time all progress notes, procedure notes, and other significant events such as LOPA referrals, child abuse referrals, etc. Time all orders for lab, X-ray, medication, and other treatment. If you use a separate order sheet, write "See separate order sheet" in orders section on route sheet. Chart documentation must be legible and must conform to HCFA/AMA Guidelines. The appropriate boxes indicating patient disposition and condition at discharge must be checked and time and date of discharge filled in. Residents are to write the initial documentation of history, physical exam, medical decision-making, and management for all medical and trauma resuscitation patients LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 119 including procedure notes. The resident who runs the resuscitation is to complete the chart. Consultants must document a written consult when they first evaluate the patient. If additional studies such as CT scans are requested, that should be included in the initial written consult. The consult can be updated and completed by the consultant when all studies are complete. The initial consult should address on-going management issues, e.g., steroids for possible spinal injury. Be sure all imaging studies have been reviewed by a radiologist before discharging any patient and that documentation of results indicates this review. The Diagnosis box on the route sheet must always be filled in. When a patient leaves AMA or deserts during treatment or is a "No Answer x 3", this status must be recorded in the Diagnosis box on the route sheet, e.g., Diagnosis #1 Scalp laceration, Diagnosis #2 Desertion. An AMA form must be completed in layman's language and signed by the patient, the resident, and a witness for all AMA patients. Written discharge instructions should always be given to AMA patients and should indicate that patient has been encouraged to return at any time to complete treatment. Orders All X-ray and lab slips must have the intern or resident's name and the attending's name in the "ordering physician" blank. ICD-9 codes are mandatory on the lab and x-ray requests. The ECD-9 code list is located on the back of each billing sheet attached to the medical chart. All X-ray and lab slips must have an appropriate indicator in the-"reason for study" box. o The indicator must be a sign or symptom such as ankle pain, chest pain, or shortness of breath. "R/O" diagnoses and such things as "MVA" or "S/P fall" are not acceptable. o ICD- 9 codes are required on all x-ray and lab requests. Residents must use their name stamp below their signature on every medical record. Consultation Be familiar with the various consult policies, e.g., faces, hands, MICU, spinal injuries, cellulitis, etc. Don't delay consults for lab results or other reasons when the need for consultation is clear from the initial history and physical exam. Document time of consult and time answered on ED medical record in space provided. All consults must be written on the hospital's consultation form. Rapid Sequence Intubation The decision to use RSI, the selection of protocol, drug dosages, and the actual orders must be by the attending physician. Nurses cannot accept orders for RSI from a resident. The entire RSI procedure is supervised by the ED attending who makes all decisions regarding RSI. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 120 Interns may not participate in RSI. RSI must be documented on the chart in a procedure note and the RSI CQI form must be completed by the resident and signed by the resident and attending physician. Medical Control Medical Control calls should be answered immediately. Medical Control must be provided by an HO 2 or greater level resident. Interns may observe but may not provide medical control. Remember, all medical control calls are recorded. Sexual Assault Residents must give this exam priority as forensic evidence disappears rapidly in these patients. Ovral is used for pregnancy prophylaxis when UPT negative. o Physician must document counseling of patient regarding risks and benefits. o Two pills are given in the ED and 2 are dispensed BY the physician to the patient to be taken in 12 hours. o The physician must write "Ovral 2 pills dispensed to patient by M.D. to be taken in 12 hours." in the Orders section of the chart. This language is needed by the Pharmacy Department when it undergoes JCAHO review. Trauma Center Trauma Center patients are identified by anatomic, physiologic, and mechanism of injury criteria. All children up to and including 12 years of age must be "Room 4" activation level. Those patients greater than 12 years of age meeting only the mechanism criteria can be designated as "Trauma Bay" activation level by the emergency medicine attending physician only. All adult patients in Region One meeting anatomic or physiologic criteria are "Room 4" activations. Be familiar with the anatomic, physiologic, and mechanism criteria. All trauma center patients must receive ETOH and urine tox screens. Responsibility for patient assessment, communication with recording nurse, intubation, and performance of invasive procedures in Room 4 patients is that of the HO 2 or above resident and cannot be "passed down" to interns. Be sure all trauma center patients receive a written surgery consult. Interns may not sign the emergency blood release forms. Only a senior surgery or EM resident or EM or surgery faculty may sign. Universal Precautions Residents are expected to use universal precautions (gloves, gown, mask, and eye shield) in the ED whenever performing exams or invasive procedures and to make sure that interns, students, and others under their supervision do so also. Any intern or resident who sustains a blood or body fluid exposure while on duty should report the exposure to the attending physician, complete a hospital incident report, and LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 121 get a route sheet to obtain treatment and document the -exposure. Anti-viral treatment is immediately available through Employee Health during the day and in the ED after hours. ED ROTATION GENERAL GOALS and OBJECTIVES At the completion of rotations in the ED, the intern/resident will be able to: 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) Understand the interrelationships of the pre-hospital, emergency department, and inhouse trauma team and perform as a team member of the emergency department trauma team. 5) 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. 6) Demonstrate basic understanding of the principles of ACLS resuscitation as applied to persons in cardio-respiratory arrest. 7) 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. 8) 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. 9) 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. 10) Learn to evaluate and appropriately manage a variety of patient complaints such as LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 122 chest pain, abdominal pain, dizziness, headache, syncope, etc. 11) 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. 12) Learn appropriate use of diagnostic lab and imaging studies for emergency patients and to have basic competence in their interpretations. 13) Learn to use the following diagnostic aids: central venous pressures, pulse oximetry, arterial blood gases, EKG’s. 14) 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. 15) 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. 16) Be able to arrange appropriate follow-up for discharged patients and give adequate discharge instructions. 17) Learn and use the available contributions of the Social Services Dept. to patient care in the ED and for discharge planning. 18) Learn appropriate medical evaluation of mentally disturbed patients including techniques for restraint and control of violent patients. Residents and interns will participate in the management of all emergency department patients under the supervision of emergency medicine faculty. The clinical and didactic experiences used to meet those objectives included daily patient care of the LSU Emergency Department patients, along with bedside teaching. The rotating resident is to attend lectures as part of the greater emergency medicine curriculum, as scheduled by the LSU EM residency program. The feedback mechanisms and methods used to evaluate the performance of the resident include daily self and faculty evaluations. Immediate feedback may also be given to the resident, and any significant problems will be discussed during the rotation with the LSU EM administration. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 123 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 surgery and emergency medicine. The residents will have access to the resources of the hospital including call rooms, the LSU Medical Library, Emergency medicine texts, medical records and meals. The clinical experiences, duties and responsibilities the resident will have on the rotation: Residents will act as a part of the Emergency Medicine team under the supervision of a staff physician. The residents will participate in the management of patients in the emergency department. 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 direct and indirect supervision while on the rotation. All patient care and medical charts will be reviewed and signed by the EM faculty prior to patient discharge. Duty hours for this rotation will not exceed an average of 60hrs/week, call not longer and will include 1 in 7 days off. This rotation summary has been reviewed and agreed to by the service director and LSU Program Director. ED: Specific Competency-based Goals & Objectives: PGY1-4 1. While in the LSU ED, the resident will demonstrates 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 LSU ED, the resident will demonstrates 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 LSU ED, the resident will demonstrates skill in “Patient Management” that includes but not limited to: LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 124 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 LSU ED, the resident will demonstrates 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 LSU ED, the resident will demonstrates 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 LSU ED, the resident will demonstrates 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 LSU 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: Teaches leadership skills 8. While in the LSU 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 (*PR) LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 125 d. PGY4: Models and teaches respect, compassion, and integrity (*PR) 9. While in the LSU 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) b. PGY2: Appropriately documents medical decision making (*PC) c. PGY3: Documents LSU ED course including re-evaluation of patient if applicable (*PC) d. PGY4: Models and teaches appropriate and timely documentation in the ED to lower leve residents. (*PC) 10. While in the LSU 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 (*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 Systems-Based Practice to lower levels. (*SBP, PC) 11. While in the LSU ED, the resident will demonstrate an awareness of the importance of “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 care (* PBL, PC) c. PGY3: Facilitates the learning of professional associates (* PBL, MK) d. PGY4: Models and teaches practice based learning to lower levels. (* PBL, MK) (* denotes core competency area: PC-Patient Care, MK-Medical Knowledge, ICS-Interpersonal and Communication skills, PRProfessionalism, SBP-Systems Based Practice, PBL-Practice Based Learning and Improvement). LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 126 ANESTHESIA & US You are assigned to Anesthesia & US Orientation: If this is your first rotation at West Jefferson, report to the GME office (347-5511) in the week prior to starting rotation to obtain ID, parking info and electronic medical record access and orientation. Contact Kacy Petit kacy.petit@wjmc.org (504) 349 – 1897) to be oriented to the electronic medical records system two weeks prior to starting. For US, please email Dr. Christy Butts cbutts@lsuhsc.edu two weeks prior to starting the month to confirm your meeting places. Anesthesia Schedule: Report to Anesthesia at 6am on the first weekday of the month or the week before. Introduce yourself to the coordinator, Miss Suzaunne. (her office is in the anesthesia lounge/work room) Conference: You are to attend EM conference. Extras: All procedures must be recorded and turned in at the end of the month. Evaluations: Global Rotation evaluation, via NewInnovations. Supervision: All intubations, rapid sequence inductions and associated procedures are supervised by Anesthesia faculty and CRNA’s. All Ultrasounds will be supervised by Emergency US faculty. Meals: The resident’s responsibility. Intern Ultrasound Block Objectives: 1. Become familiar with the basics of using the ultrasound machines available at UH 2. Learn how to record images in Q-Path. 3. Develop a basic knowledge of performing and interpreting FAST, AAA, RUQ, and OB ultrasound Requirements: 1. Email Dr. Butts 2 weeks prior to starting the rotation. cbutts@lsuhsc.edu 2. Be present in the ED every Tuesday and Thursday afternoon from 1p-5p perform ultrasound – if the anesthesia cases that day have special learning circumstances that prolong your day, you will be permitted to reschedule your US day. 3. Record your studies in Q-Path. 4. Perform a minimum of studies as detailed below: LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 1. 2. 3. 4. 127 FAST 10 RUQ 10 AAA 10 OB 5 6. Meet with Dr. Butts at the conclusion of your rotation to review your recorded studies and turn in your log (you will not get credit for your rotation until this step is complete). Anesthesia & US Rotation GOALS and OBJECTIVES The year of training is typically PGY 1. OVERALL OBJECTIVES: Anesthesia: To gain the greatest possible mastery of: airway management, placement and the interpretation of non-invasive and invasive monitors, clinical pharmacology and physiology relevant to the administration of as types of Anesthesia, techniques of providing general and regional Anesthesia. US: The EM Resident will gain experience and knowledge of the anatomy, physiology, and pathophysiology pertinent to the use of US in Emergency Medicine. The EM Resident will acquire the ability to perform an appropriate and accurate emergency US. GENERAL GOALS: Residents will participate in the evaluation and management of patients admitted for surgery. Residents will function as a member of the anesthesiology team and assist with the direct management of patients undergoing Anesthesia. The US experience will allow the EM residents to gain experience in the normal US anatomy and pathophysiology. The clinical and didactic experiences used to meet those objectives include evaluation of pre operative patients, post operative patients, intubation and management of general Anesthesia, along with bedside teaching. The US experience will allow the EM residents the opportunity to evaluate patients with both pathologic and normal US anatomy. This rotation experience is part of the greater emergency medicine curriculum, including weekly didactics concerning airway management and topics relating to Anesthesia and US (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. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 128 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 Anesthesia and 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 Anesthesia team in a community hospital under the supervision of a staff physician. 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 faculty prior to patient discharge. Duty hours for this rotation will not exceed an average of 80hrs/week, do not include call, and will include 1 in 7 days off. This rotation summary has been reviewed and agreed to by the service director and LSU Program Director. Anesthesia: Specific Competency Based Goals & Objectives 12. While on Anesthesia, the resident will demonstrates skill in “Data Gathering” that includes appropriate focused history and physical exam and ordering and interpretation of ancillary tests (* PC, MK, ICS, PR) 13. While on Anesthesia, the resident will demonstrate skills in “Problem Solving” that includes appropriate and complete differential diagnosis for an undifferentiated patient. Appropriate organization of data collection in relation to patient management decisions. (* PC, MK, PBL) 14. While on Anesthesia, the resident will demonstrates skills in “Patient Management” that includes a basic treatment plans and timely recognition of complicated anesthesia patients. (* PC, MK, SBP) 15. While on Anesthesia, the resident will demonstrate skill in “Medical Knowledge” appropriate for level of training that demonstrates a basic fund of medical knowledge and the ability to seek the scientific basis for their patient care decisions (*MK, PBL) 16. While on Anesthesia, the resident will demonstrate technical proficiency in “Procedural Skills” consistent with level of training that includes supervised intubations, central venous access and arterial access. (*PC) 17. While on Anesthesia, the resident will demonstrate appropriate “Interpersonal and Communication Skills” that includes effective information exchange with patients, their families, and professional associates. Demonstrates appropriate conflict resolution skills. (*ICS, PR) LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 129 18. While on Anesthesia, the resident will demonstrate appropriate “Professionalism” that includes introduces self to patient and/or family. Respectful of patient’s privacy and confidentiality (*PR) 19. While on Anesthesia, the resident will demonstrates an understanding of a “Systems-Based Practice” that includes understanding basic resources available for care of the anesthesia patient. (*SBP, PC) 20. While on Anesthesia, the resident will demonstrate “Practice Based Learning and Improvement” skills that includes use of appropriate information resources (ie, texts, online web sites, etc.) for care of patient (* PBL, PC) (* denotes core competency area: PC-Patient Care, MK-Medical Knowledge, ICS-Interpersonal and Communication skills, PRProfessionalism, SBP-Systems Based Practice, PBL-Practice Based Learning and Improvement). LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 130 ANESTHESIA and US at ILH This rotation is primarily for IM/EM residents. Orientation: Dr. Judith Johnson jjohn1@lsuhsc.edu is the rotation director for Anesthesia at UH/LSU Public Hospital. You will be assigned to anesthesia at 7am on Mondays and Fridays, and will be assigned to ED shifts on the other days. Email Dr. Butts 2 weeks prior to starting the rotation. cbutts@lsuhsc.edu Schedule: You will attend Anesthesia every Monday and Friday morning Conference: You are to attend EM conference Extras: All procedures must be recorded and turned in at the end of the month. Evaluations: Global Rotation evaluation, via NewInnovations. Supervision: All intubations, rapid sequence inductions and associated procedures are supervised by Anesthesia faculty and CRNA’s Meals: The resident’s responsibility. Intern Ultrasound Block Objectives: 1. Become familiar with the basics of using the ultrasound machines available at UH 2. Learn how to record images in Q-Path. 3. Develop a basic knowledge of performing and interpreting FAST, AAA, RUQ, and OB ultrasound Requirements: Email Dr. Butts 2 weeks prior to starting the rotation. cbutts@lsuhsc.edu Be present in the ED every Tuesday and Thursday afternoon from 1p-5p perform ultrasound – if the anesthesia cases that day have special learning circumstances that prolong your day, you will be permitted to reschedule your US day. Record your studies in Q-Path. Perform a minimum of studies as detailed below: 1. FAST 10 2. RUQ 10 3. AAA 10 4. OB 5 LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 131 7. Meet with Dr. Butts at the conclusion of your rotation to review your recorded studies and turn in your log (you will not get credit for your rotation until this step is complete). Anesthesia & US Rotation at ILH GOALS and OBJECTIVES The year of training is typically PGY 1. OVERALL OBJECTIVES: Anesthesia: To gain the greatest possible mastery of: airway management, placement and the interpretation of non-invasive and invasive monitors, clinical pharmacology and physiology relevant to the administration of as types of Anesthesia, techniques of providing general and regional Anesthesia. US: The EM Resident will gain experience and knowledge of the anatomy, physiology, and pathophysiology pertinent to the use of US in Emergency Medicine. The EM Resident will acquire the ability to perform an appropriate and accurate emergency US. GENERAL GOALS: Residents will participate in the evaluation and management of patients admitted for surgery. Residents will function as a member of the anesthesiology team and assist with the direct management of patients undergoing Anesthesia. The clinical and didactic experiences used to meet those objectives include evaluation of pre operative patients, post operative patients, intubation and management of general Anesthesia, along with bedside teaching. This rotation experience is part of the greater emergency medicine curriculum, including weekly didactics concerning airway management and topics relating to Anesthesia and US (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 Anesthesia and emergency medicine. The residents will have access to the resources of the hospital including medical texts, medical records, doctor’s lounge and cafeteria. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 132 The clinical experiences, duties and responsibilities the resident will have on the rotation: Residents will act as a part of the Anesthesia team in a community hospital under the supervision of a staff physician. 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 faculty prior to patient discharge. Duty hours for this rotation will not exceed an average of 80hrs/week, do not include call, and will include 1 in 7 days off. This rotation summary has been reviewed and agreed to by the service director and LSU Program Director. Anesthesia: Specific Competency Based Goals & Objectives 1. While on Anesthesia, the resident will demonstrates skill in “Data Gathering” that includes appropriate focused history and physical exam and ordering and interpretation of ancillary tests (* PC, MK, ICS, PR) 2. While on Anesthesia, the resident will demonstrate skills in “Problem Solving” that includes appropriate and complete differential diagnosis for an undifferentiated patient. Appropriate organization of data collection in relation to patient management decisions. (* PC, MK, PBL) 3. While on Anesthesia, the resident will demonstrates skills in “Patient Management” that includes a basic treatment plans and timely recognition of complicated anesthesia patients. (* PC, MK, SBP) 4. While on Anesthesia, the resident will demonstrate skill in “Medical Knowledge” appropriate for level of training that demonstrates a basic fund of medical knowledge and the ability to seek the scientific basis for their patient care decisions (*MK, PBL) 5. While on Anesthesia, the resident will demonstrate technical proficiency in “Procedural Skills” consistent with level of training that includes supervised intubations, central venous access and arterial access. (*PC) 6. While on Anesthesia, the resident will demonstrate appropriate “Interpersonal and Communication Skills” that includes effective information exchange with patients, their families, and professional associates. Demonstrates appropriate conflict resolution skills. (*ICS, PR) 7. While on Anesthesia, the resident will demonstrate appropriate “Professionalism” that includes introduces self to patient and/or family. Respectful of patient’s privacy and confidentiality (*PR) LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 133 8. While on Anesthesia, the resident will demonstrates an understanding of a “Systems-Based Practice” that includes understanding basic resources available for care of the anesthesia patient. (*SBP, PC) 9. While on Anesthesia, the resident will demonstrate “Practice Based Learning and Improvement” skills that includes use of appropriate information resources (ie, texts, online web sites, etc.) for care of patient (* PBL, PC) (* denotes core competency area: PC-Patient Care, MK-Medical Knowledge, ICS-Interpersonal and Communication skills, PRProfessionalism, SBP-Systems Based Practice, PBL-Practice Based Learning and Improvement). LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 134 LALLIE KEMP EMERGENCY DEPARTMENT Orientation: Residents must contact Melanie Zaffuto prior to their rotation in order to arrange their orientation and obtain their name tag. Her contact info is: 985-878-1349 or mzaffu@lsuhsc.edu. Please also speak with Kathy Whittington prior to the rotation so you can fill out the application to rotate there - this application will contain all of the information Lallie Kemp needs to allow you to rotate. Mrs. Zaffuto is usually in her office between 7:45 and 4:30. Orientation begins at 8:00a.m. and lasts about 45 minutes. You may meet with her the morning of your first shift, orient and then begin your shift at 9:00. Upon arrival on the day of your orientation, enter the hospital through the front (main) entrance and ask the operator to contact Mrs. Zaffuto for you. For questions, comments or issues, your general go-to person is Dr. Beran @ (david.i.beran@gmail.com) or (504)432-1321 and Dr. Mills @ (tjmno@yahoo.com) or 504-7231628. Schedule: Residents doing a two week rotation are required to do 7 ten hour day shifts (9a-7p). Resident contact Dr. Beran @ (504)432-1321 or david.i.beran@gmail.com and Dr. Mills @ (504) 4231628 or (tjmno@yahoo.com)2 weeks prior to start of rotation to obtain schedule. Housing: There are two apartments available - one female and one male. Both have two single beds and WiFi. If you think you'll be needing them, let Mrs. Zaffuto know so she make sure it will be clean and ready for you. This is especially helpful if are working several shifts in a row and do not wish to drive back to New Orleans. Directions: The hospital is located at 52579 Highway 51 South, Independence, LA 70443. Their phone number is (985)878-9421. Their map is found here: http://www.lsuhospitals.org/hospitals/lk/LK-map.htm. When arriving at the hospital on Highway 51, you will come to a flashing yellow light. Make a left at this light and then take the second left to find the parking lot in the back of the hospital. If you have an access card, you can enter through the back. If you have not yet obtained one, you can enter through the main entrance in the front of the hospital Conference: You are required to attend EM conference and journal club. Extras: All procedures must be recorded in NewInnovations. Residents must document gas mileage in order to be reimbursed for travel expenses. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 135 Supervision: EM Residents receive continuous supervision by EM boarded faculty while rotating through Lallie Kemp Medical Center. Evaluations: Composite evaluation at the end of the rotation on New Innovations will be completed by Dr. Beran. Responsibilities: EM residents are expected to function as integral team members of this community-based Emergency Department, participating in the management of trauma and medical ED patients. Duties include independently evaluating patients, which includes performing a timely, focused history and physical examination, and formulating a diagnostic evaluation and management plan. Residents present all patients to the attending emergency physician and discuss their assessment and plan. Residents are expected to manage multiple patients simultaneously, and must be aware of the status of pending diagnostic tests, and patient response to any medications administered. Residents are responsible for the ongoing management and disposition of their assigned patients while in the Emergency Department. GOALS and OBJECTIVES of Community ED rotations 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: LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 136 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: LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 137 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) LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 138 EMS- New Orleans EMS You are assigned to New Orleans EMS Orientation: 2 weeks prior to beginning your rotation, contact Jeffrey Elder, M.D. at jmelder@cityofno.com or 504-818-8139 to discuss the rotation and confirm your schedule. Schedule: You will work eight 12 hour shifts over 2 weeks. The shifts will be 11am-11pm. Changes in shift times will only be accepted if approved by EMS administration. Directions: Report to 300 Calliope at the beginning of each shift. Obtain your radio from the Paramedic in the Rescue office. (Trailer on the left) Return the radio to the charger at the end of each shift. You will be required to check out an ANSI reflective jacket and traffic vest prior to the beginning of the rotation and to return the equipment at the end of the rotation. According to federal law, all first responders are to wear the reflective gear while on the interstate highway system. Uniform: Residents will be required to wear the issued LSU Emergency Medicine polo shirt, tucked in. Pants will be either blue or kaki. A brown or black belt must be worn to secure the medical control radio. Boots are preferred over tennis shoes. Conference: You are required to attend conference. Extras: All procedures must be recorded and turned in at the end of the month. Supervision: Dr. Jeff Elder and the EMS fellow on duty. Evaluations: From Dr. Elder or the EMS fellows. Contact one of the EMS physicians during the rotation to complete your evaluation. LSU Emergency Medicine Residency Program New Orleans EMS Rotation GOALS and OBJECTIVES What follows are the goals and objectives for the New Orleans EMS rotation, a 2 week rotation, as assigned by the Program Director. The rotation will take place in the prehospital environment under the direction of the New Orleans EMS physicians. The year of training may include PGY 25. The educational goals and objectives for the New Orleans EMS rotation are to provide residents with an opportunity to experience and learn about the initial evaluation and management of LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 139 emergency patients in the prehospital environment. The resident will also learn about EMS system management, leadership and education. 1) Perform basic assessment of patients with a variety of moderate and major medical and traumatic conditions. 2) Develop a working knowledge of EMS Systems 3) Become familiar with all the components of EMS Systems and how they integrate. 4) Understand the duties, responsibilities and authority of an EMS Medical Director. 5) Work as online medical control for New Orleans EMS via radio communications. 6) Perform on scene medical control for New Orleans EMS, interacting with New Orleans EMS Paramedics as well as direct patient care. 7) Become familiar with the many elements of MCI management and Disaster Planning including but not limited to Incident Command, Field Triage and Communications. 8) Demonstrate basic understanding of the principles of ACLS, PALS and ATLS resuscitation as applied to persons in prehospital cardio-respiratory arrest. 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 clinical experiences, duties and responsibilities the resident will have on the rotation: Residents will act as a part of the New Orleans Emergency Medical Services. The resident will work as online medical control as well as assist in direct patient care. 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. Duty hours for this rotation will not exceed an average of 60hrs/week, and will include 1 in 7 days off. This rotation summary has been reviewed and agreed to by the service director and LSU Program Director. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 140 CHILDREN’S HOSPITAL ED Orientation: Dr. Mangat, the head of the LSU Pediatrics Emergency Medicine Division, will orient you to the ER on the first weekday of the month. It will be held at 8am in Administration Conference Room B on the first floor of Children’s Hospital. If you have any questions for Dr. Mangat, it’s best to contact her by email: rmanga@lsuhsc.edu. Dr. Druby Hebert is the Director (896-9229). The ER # is 896-9474 and the main # is 899-9511. Schedule: If you do not receive an email from the Peds Chief resident two weeks before your rotation, please call their office: 896-9329. You will work approximately 15 shifts in a month. Please do not schedule a shift during conference or Journal club: each Wed 7a11a or the 2nd Thurs each month 7a10p. You can view your shift schedule at http://www.amion.com. The password is “lsupeds”. If you have any questions or requests, you can call us at (504) 8969329 Directions: Children’s Hospital is located in Uptown New Orleans, near Audubon Park and Tulane University. Take Henry Clay Avenue off St. Charles Avenue and Magazine Street toward the river and Children’s Hospital will be on the right as you Approach the Mississippi River. The address is 200 Henry Clay Avenue. Conference: You are required to attend conference. Extras: All procedures must be recorded and turned in at the end of the month. Supervision: Provided by PER faculty. Evaluations: Compiled and pooled from evaluations of the PER faculty. Meals: Lunch is provided by Children’s Hospital. Lab System (CERNER): You will be assigned a unique username for the cerner lab computers; come by the Chief Resident’s office to pick up a form to sign for the lab department. The Chief’s office is at Children’s Hospital in the Ambulatory Care Center on the 2nd floor – room 2304. GOALS and OBJECTIVES What follows are the goals and objectives for the CHILDRENS’ Pediatric ED rotation, that will range from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take place at the CHILDRENS’ Hospital in the Pediatric ED. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 141 The educational objectives of the CHILDRENS’ Pediatric ED rotation are to: 1) Gain expertise in the recognition and management of pediatric emergencies. 2) Gain expertise in pediatric resuscitation, including Pediatric Advanced Life Support, emergent intubation, fluid administration, and drug dosages. 3) Become familiar with the management of non-emergent pediatric conditions which commonly present to the Emergency Department. 4) Gain expertise in the performance of routine procedures such as venipuncture and arterial puncture. 5) Become familiar with pediatric medication dosages. The clinical and didactic experiences used to meet those objectives included daily patient care in the CHILDRENS’ Pediatric ED, along with bedside teaching. The rotating resident is encouraged to attend lectures available at CHILDRENS’ pertaining to the care of the pediatric patient. This rotation experience is part of the greater pediatric emergency medicine curriculum, also including PALS 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 pediatrics and emergency medicine. There is a rent free, secure apartment available during the rotation for resident use. The residents will have access to the resources of the hospital including medical texts, medical records 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 pediatric hospital under the supervision of a staff physician. The residents will participate in the initial management of emergency department patients, to include pediatric trauma 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. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 142 Duty hours for this rotation will not exceed an average of 60hrs/week, and will include 1 in 7 days off. This rotation summary has been reviewed and agreed to by the service director and LSU Program Director. Children’s ED: Specific Competency Based Goals & Objectives: 1. While in the pediatric ED at Children’s Hospital, the resident will demonstrates skill in “Data Gathering” that includes appropriate focused history and physical exam and ordering and interpretation of ancillary tests (* PC, MK, ICS, PR) 2. While in the pediatric ED at Children’s Hospital, the resident will demonstrate skills in “Problem Solving” that includes appropriate and complete differential diagnosis for an undifferentiated pediatric ED patient. Appropriate organization of data collection in relation to patient management decisions. (* PC, MK, PBL) 3. While in the pediatric ED at Children’s Hospital, the resident will demonstrates skills in “Patient Management” that includes a basic treatment plans and timely recognition of complicated pediatric ED patients. (* PC, MK, SBP) 4. While in the pediatric ED at Children’s Hospital, the resident will demonstrate skill in “Medical Knowledge” appropriate for level of training that demonstrates a basic fund of medical knowledge and the ability to seek the scientific basis for their patient care decisions (*MK, PBL) 5. While in the pediatric ED at Children’s Hospital, the resident will demonstrate technical proficiency in “Procedural Skills” consistent with level of training that includes supervised suturing, abscess I&D, dislocation reductions, ultrasound, pediatric medical and trauma resuscitations,conscious sedation, intubations, central venous access and arterial access. (*PC) 6. While in the pediatric ED at Children’s Hospital, the resident will demonstrate appropriate “Interpersonal and Communication Skills” that includes effective information exchange with patients, their families, and professional associates. Demonstrates appropriate conflict resolution skills. (*ICS, PR) 7. While in the pediatric ED at Children’s Hospital, the resident will demonstrate appropriate “Professionalism” that includes introduces self to patient and/or family. Respectful of patient’s privacy and confidentiality (*PR) 8. While in the pediatric ED at Children’s Hospital, the resident will demonstrates an understanding of a “Systems-Based Practice” that includes understanding basic resources available for care of the pediatric ED patient. (*SBP, PC) 9. While in the pediatric ED at Children’s Hospital, the resident will demonstrate “Practice Based Learning and Improvement” skills that includes use of appropriate information resources (ie, texts, online web sites, etc.) for care of patient (* PBL, PC) LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 143 MICU Schedule: Contact the LSU Medicine Chief Resident 568-5600, 2 weeks prior to your rotation to receive your schedule and/or make any schedule requests. Call: Your call will be every third night. Every attempt will be made to provide each resident with one full weekend off. Weekends are managed by two of the three call teams. The maximum duty hours are 80 hours per week averaged over 4 weeks. Interns may not stay on duty longer than 16hours. Residents may not take new patients after 24hours of duty, but may stay an additional 4 hours to complete work. Responsibilities: The MICU residents will function as a team leader responsible for the care of all patients in the MICU. Additionally, the MICU resident is responsible for all consults in MER and floor for MICU admission. The MICU resident must also respond to all codes within the hospital. An intern and possibly medical students will be assigned to your team. The resident is responsible for supervision, education and directions for the call team. Conference: You must attend EM conference and Journal Club. Extras: All procedures must be recorded and turned in at the end of the month. Supervision: The 1st two weeks are staffed by LSU Pulmonary and Tulane Cardiology. The 2nd two weeks are staffed by Tulane Pulmonary and LSU Cardiology. Evaluations: Compiled from pooling all LSU/Tulane Pulmonary Critical Care faculty and fellows who supervised you throughout the month. You are responsible for delivering your evaluations to the faculty at the completion of their 2-week supervision. Meals: The resident’s responsibility. Location: The MICU and MICU call room is located on the 6th floor of UH. GOALS and OBJECTIVES What follows are the goals and objectives for the University Hospital MICU rotation, that will range from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take place at the LSU University Hospital. The year of training is typically PGY 1 and 4. OBJECTIVES: The educational objectives of the MICU rotation is to provide residents with an opportunity to experience and learn about the initial evaluation and management of MICU patients in the community setting and to become proficient in the diagnosis and treatment of: CHF, pulmonary edema, pneumonia, pneumothorax, pulmonary embolus, ARDS, respiratory distress, asthma, COPD, AMI, acute coronary syndrome, cardiomyopathym, pericarditis, HTN, stroke, LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 144 pancreatitis, acute renal failure, hepatitis, pyelonephritis, acute hepatic failure, toxicologic emergencies, acute drug overdose, consultation, living wills, do not resuscitate, rehabilitation, IV access, induction and paralytic agents. Hemodynamic monitoring, airway and ventilator management, sedative/hypnotic agents. . GOALS: Residents will act as a part of the MICU team in a community hospital, under the supervision of a staff physician. The resident will participate in the management of MICU patients, to include evaluation, admission management of all MICU requests from the floor and emergency department as well as patients already in the MICU. The resident is responsible for the daily management and disposition planning of all patients admitted by his/her team. Rounds occur daily with the ICU staff, pulmonary fellow and cardiology staff. The resident is responsible for attending and leading all in house cardiac arrests and subsequent management. The clinical and didactic experiences used to meet those objectives include evaluation of ICU patients, in the ED and in the ICU, along with bedside teaching. This rotation experience is part of the greater emergency medicine curriculum, including weekly didactics concerning critically ill and injured patients (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 ICU care. The residents will have access to the resources of the hospital including call rooms, medical texts, medical records, and meals. The clinical experiences, duties and responsibilities the resident will have on the rotation: Residents will act as a part of the ICU team in under the supervision of a staff physician. 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 faculty each day and prior to patient discharge. Duty hours for this rotation will not exceed an average of 80hrs/week, call not to exceed 24 hours, and will include 1 in 7 days off. This rotation summary has been reviewed and agreed to by the service director and LSU Program Director. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 145 Specific Competency Based Goals & Objectives based on Level of Training: 1. While in the MICU, the resident will demonstrates skill in “Data Gathering” that includes but not limited to: a. PGY1: Perform an appropriate focused history and physical exam and ordering and interpretation of ancillary tests (* PC, MK, ICS, PR) b. PGY3: Gather essential and accurate information from all available sources. Challenges assumptions. Able to establish rapport in order to obtain historical data in difficult situations. (* PC, IPC SBP & PR) 2. While in the MICU, the resident will demonstrates skill in “Problem Solving” that includes but not limited to: a. PGY1: Generate an appropriate and complete differential diagnosis for an undifferentiated patient. Appropriate organization of data collection in relation to patient management decisions. (* PC, MK, PBL) b. PGY3: Generate an expanded differential diagnosis including possible atypical presentations. Able to supervise and teach problem-solving skills to lower level residents. (* PC, MK, PBL) 3. While in the MICU, the resident will demonstrates skill in “Patient Management” that includes but not limited to: a. PGY1: Development of a basic treatment plan and timely recognition and appropriate emergency stabilization of the unstable patient (* PC, MK, SBP) b. PGY3: Institutes appropriate advanced treatment plans autonomously. Multitasks, appropriately utilizes resources, facilitates triage of patient care in the MICU. (* PC, MK, ICS, PR, SBP) 4. While in the MICU, the resident will demonstrates skill in “Medical Knowledge” appropriate for level of training that includes but not limited to: a. PGY1: Demonstrates a basic fund of medical knowledge. Seeks the scientific basis for their patient care decisions (*MK, PBL) b. PGY3: Demonstrates an advanced fund of knowledge and challenges assumptions using problem-based learning techniques. (*MK, PBL) 5. While in the MICU, the resident will demonstrates technical proficiency in “Procedural Skills” consistent with level of training that includes but not limited to: a. PGY1: lumbar puncture, closely supervised intubations and central venous access(*PC) b. PGY3: Conscious sedation, ultrasound, and direction of medical resuscitation, generally supervised intubations and central venous access (*PC) 6. While in the MICU, 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. PGY3: Works effectively with others as a leader. Demonstrates appropriate conflict resolution skills (*ICS, PR) LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 146 7. While in the MICU, the resident will demonstrate appropriate “Professionalism” that includes but not limited to: a. PGY1: Introduces self to patient and/or family. Respectful of patient’s privacy and confidentiality (*PR) b. PGY3: Demonstrates respect, compassion, and integrity. Models compassionate approach to patient care in all circumstances. (*PR) 8. While in the MICU, 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 MICU patient. Utilizes the consultation process appropriately (*SBP, PC) b. PGY3: Makes appropriate bed triage decisions. Makes appropriate step-down and transfer decisions. (*SBP, PC) 9. While in the MICU, the resident will demonstrate “Practice Based Learning and Improvement” skills 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. PGY3: Facilitates the learning of professional associates. Applies knowledge of scientific studies to care (* PBL, MK, PC) (* denotes core competency area: PC-Patient Care, MK-Medical Knowledge, ICS-Interpersonal and Communication skills, PRProfessionalism, SBP-Systems Based Practice, PBL-Practice Based Learning and Improvement). LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 147 OB Ochsner LSU Emergency Medicine Residency Program OBGYN Rotation at Ochsner Duty Hours: No more than 80 hours of duty per week averaged over 4 weeks, with one full day in 7 free from duties. An intern may not be on duty more than 16 hours. The intern may take home call in addition to scheduled shifts in order to participate in vaginal deliveries. If the resident is called in, duty hours start when the resident travels to Ochsner. If the resident spends much of the night or day on the L&D unit, he/she should contact the resident/faculty supervisor to modify their duties for the following assigned shift to allow for an adequate rest period. Prior to beginning your first rotation at Ochsner, contact Reonda Victor of the Ochsner GME Department (842-4937) to schedule a time to get your ID and parking cards. You will be required to give a $10 refundable deposit for the cards. Detailed information concerning orientation and the rotation are in the Ochsner resident handbook you will be given. Program Director: Dr Gala rgala@ochsner.org OB Chief Resident: Christopher Rodrigue chrodrigue@ochsner.org Sarah Drennan sruggier@gmail.com DUTY PERIODS: Your shift will be every Thursday, Friday, Sunday & Monday from 5pm to 5:30 am. You will report to the labor and delivery unit (8th floor) at 4:50 pm. Rounds start at 5pm. Didactics: Emergency Medicine residents are required to attend EM conference every Wednesday from7am to 11am, and journal club the end Thursday of each month from7pm10pm. Recommended OB Reading: Review independently Tintinalli’s chapters on Pregnancy and Emergencies: 1. Tintinalli’s via AccessEM on the LSUHSC website. (see attached hard copy) Normal Pregnancy Chapter 103 Emergencies after 20 Weeks of Pregnancy and the Postpartum Period Chapter 104 Emergency Delivery Chapter 105 2. OTHER USEFUL SOURCES: Rosen’s Emergency Medicine: Concepts and Clinical Practice (5th ed.) Chapter 31: Trauma in Pregnancy LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 3. 4. 5. 148 Chapter 61: Sexual Assault Chapter 93: Genital Infections Volume Three, Part Five, Section II: The Pregnant Patient The Clinical Practice of Emergency Medicine, (3rd edition), Harwood-Nuss Section II, Part IX: Emergency Aspects of Obstetrics Roberts/Hedges: Clinical Procedures in Emergency Medicine (3rd ed.) Section 9: Ob/Gyn Procedures Prior to the start of the rotation, watch the OB ultrasound videos on the AccessEmergencyMedicine website (available through either the LSU library or the LSU EM residency webpage). OBJECTIVES: Gain expertise in the management of obstetrical and gynecological emergencies. Learn the priorities and procedures of labor and delivery. Become an integral part of the OBGYN team and respond to deliveries along with junior, senior, OBGYN staff and gain exposure to OR sterile techniques and surgical techniques. GOALS: The educational goals include gaining knowledge about the progression of normal labor, delivery and immediate post-partum care. The resident will also gain expertise in the initial management of gynecological emergencies. Participate in any teaching rounds Evaluate OBGYN patients in the Emergency Department and L&D unit. Participate in OBGYN Procedures, both in the OR and in Labor and Delivery Participate in the routine care of OBGYN patients Participate in consults to the OBGYN Service The clinical and didactic experiences used to meet those objectives included daily patient care of OBGYN patients, along with bedside teaching. The rotating resident is encouraged to attend lectures pertaining to the care of the OBGYN patient. This rotation experience is part of the greater emergency medicine curriculum, also including 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 OBGYN LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 149 and emergency medicine. The residents will have access to the resources of the hospital including call rooms, the Medical Library, Hospital medical texts, medical records and the cafeteria. The clinical experiences, duties and responsibilities the resident will have on the rotation: Residents will act as a part of the OBGYN team under the supervision of a staff physician. The residents will participate in the initial management and care of OBGYN 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 by upper level residents and OB faculty. All patient care and medical charts will be reviewed and signed by the OBGYN faculty daily and prior to patient discharge. Duty hours for this rotation will not exceed an average of 80hrs/week, call not longer than 16 consecutive hours and will include 1 in 7 days off. Obstetrics and Gynecology Core Competency-based Goals and Objectives Emergency Medicine Residency Training Program Curriculum Goal: Develop the ability to evaluate, stabilize, and treat OB patients in a manner consistent with the expectations of the knowledge and skills of an Emergency Physician. Objectives: 1. 2. 3. 4. Communicate effectively with patients, their families, and professional associates (*ICS). Demonstrate respect, compassion, and integrity (*PR). Demonstrate the ability to perform an appropriate history and physical exam (*PC). Demonstrate the ability to develop an appropriate differential diagnosis and treatment plan (*MK). 5. Demonstrate appropriate clinical decision making skills (*PC). 6. Learn the principles of fetal monitoring techniques (*PC). 7. Demonstrate the ability to perform a vaginal delivery (*PC). 8. Demonstrates the principles of basic ultrasonography (*PC). 9. Learn the basic resources available for the care of the obstetrical patient (*SBP). 10. Learn the appropriate information resources (i.e., textbooks, handbooks, online resources, etc.) available for care of obstetrical patient (*PBL). (* denotes core competency area: PC-patient care, MK-medical knowledge, ICS-interpersonal and communication skills, PR-professionalism, SBP-systems based practice, PBL-practiced based learning and improvement) Evaluation: LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 1. 2. 3. 4. 5. 150 Daily verbal feedback by supervising OB/Gyn. Formal written evaluation of resident at end of rotation by Ob/Gyn, via the residency management software: New Innovations. Written evaluation of rotation by E.M. resident. Formal testing on annual ABEM in-service exam and departmental quizzes on topics addressed on rotation and didactics. Annual curriculum review by program director, faculty and residents. This rotation summary has been reviewed and agreed to by the service director and LSU Program Director and the OB-GYN Rotation Director at Ochsner. Didactics: Emergency Medicine residents are required to attend EM conference and journal club. Recommended OB Reading: Review independently: 6. Rosen’s Emergency Medicine: Concepts and Clinical Practice (5th ed.) Chapter 31: Trauma in Pregnancy Chapter 61: Sexual Assault Chapter 93: Genital Infections Volume Three, Part Five, Section II: The Pregnant Patient 7. The Clinical Practice of Emergency Medicine, (3rd edition), Harwood-Nuss Section II, Part IX: Emergency Aspects of Obstetrics 8. Roberts/Hedges: Clinical Procedures in Emergency Medicine (3rd ed.) Section 9: Ob/Gyn Procedures LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 151 OCHSNER ED You are assigned to Ochsner Clinic Foundation the month of _____________. Chairman of ED: Dr. Joseph Guarisco is the Chairman (842-4433). ED Rotation Director: Rebecca Hutchings, MD rhutchings@ochsner.org Orientation: Orientation date will be scheduled based on which half of the month you are rotating. Prior to beginning your first rotation at Ochsner, contact Ester Catalano of the Ochsner GME Department (842-4937) to schedule a time to get your ID and parking cards. You will be required to give a $10 refundable deposit for the cards. You also need to get a yellow sticker for your car. Detailed information concerning orientation and the rotation are in the Ochsner resident handbook you have been given. You will need to call 842-3772 and schedule a time for your picture to get an identification card. It is the Safety and Security Administration Office. They are open Monday-Friday 7a-4p. You will get $100 per month to use in the cafeteria. You must take your Ochsner ID and get money loaded onto it in the Dining Office. This is located down the left hallway right after you pass the Southport Cafeteria on the left. Schedule: Here is the system for putting in your requests for your ED rotation. Remember, you are requesting days you want off, not the days you want to work. Also, if there is something specific like a conference or family function you need to attend, please email Dr. Hutchings. Click below to sign up then you can put in your requests for days off. During a full month you will work 17 ten hour shifts, and for a half month 8-9 shifts. https://my.amscheduler.com/registration/list.bam?id=147&key=0CjuYUZJM3IACaW Directions: 1514 Jefferson Highway New Orleans, Louisiana 70121 Conference: You are required to attend conference and journal club. Extras: All procedures must be recorded in New Innovations. Each month that you work you will be responsible for presenting one evidence based medicine discussion. You will come up with a clinical question based on a patient you have seen, find 3 articles to help answer the question, and then pick a day to present your summary and guidelines to the other residents and staff on shift. You will also be responsible for emailing me the question, article links, and recommendations before the end of the month. I will upload this onto the webpage as an academic resource for all rotating residents. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 152 Supervision: Board Certified EM physicians provide Supervision. Each shift, you will also be required to see 2 pediatric patients, which will be staffed by Board Certified Pediatricians, Emergency Medicine physicians, or Pediatric Emergency Medicine physicians. Evaluations: Compiled and pooled from evaluations by the staff physicians and submitted at the end of the year. You will be asked to evaluate the staff physicians each year as well. LSU Emergency Medicine Residency Program Ochsner Clinic Foundation Hospital Emergency Department Rotation GOALS and OBJECTIVES What follows are the goals and objectives for the Ochsner ED rotation, that will range from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take place at the Ochsner ED. The year of training may include PGY 1-5. The educational goals and objectives for the Ochsner 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, health maintenance organization setting, including 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, PALS and ATLS 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. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 153 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 to evaluate the pediatric patient in the emergency department, including fever of unknown origin and other common pediatric presenting complaints. 12) Learn appropriate use of diagnostic lab and imaging studies for emergency patients and to have basic competence in their interpretations. 13) Learn to use the following diagnostic aids: central venous pressures, pulse oximetry, arterial blood gases, EKG’s. 14) 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. 15) 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. 16) Be able to arrange appropriate follow-up for discharged patients and give adequate discharge instructions. 17) Learn and use the available contributions of the Social Services Dept. to patient care in the ED and for discharge planning. 18) Learn appropriate medical evaluation of mentally disturbed patients including techniques for restraint and control of violent patients. 19) Learn about billing as it pertains to ED patients. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 154 20) Learn about transplant patients. 21) Learn about geriatric presenting complaints. The clinical and didactic experiences used to meet those objectives included daily patient care in the Ochsner 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. This rotation summary has been reviewed and agreed to by the service director and LSU Program Director. Community ED: Specific Competency-based Goals & Objectives, based on Level of Training: PGY1-4 12. 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) LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 155 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) 13. 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) 14. 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) 15. 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) 16. 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. 17. 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) LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 156 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 18. 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) 19. 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) 20. 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) 21. While in the community ED, the resident will demonstrates an understanding of a “SystemsBased 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) 22. 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) LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 157 LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 158 OLOL Pediatric ED Orientation: Orientation to the OLOL Hospital on the first day of the month. Contact person at GME office: Leigh Salvant (leigh.salvan@ololrmc.com) 225-765-7730 Schedule requests: Kyle Fitzgerald (kfitzg3@gmail.com) Schedule: 15 shifts a month, 7a7p, 7p7a or 2p2a. Directions: OLOL Children's Hospital is located at 5000 Hennessy Boulevard within OLOL Regional Medical Center, and can be reached by calling (225) 765-8886. From I-10 west toward Baton Rouge: Take exit 160 for LA-3064/Essen Ln Keep left at the fork, follow signs for OLOL Medical Center and College Turn left at LA-3064/Essen Ln Turn right at Hennessy Blvd Conference: You are required to attend conference. Extras: All procedures must be recorded in New Innovations. Supervision: Provided by OLOL PER faculty. Evaluations: Compiled and pooled from evaluations of the OLOL faculty. Meals: Lunch is provided by OLOL Hospital. Our Lady of the Lake Pediatric Emergency Department Rotation GOALS and OBJECTIVES What follows are the goals and objectives for the OLOL Pediatric ED rotation, that will range from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take place at the OLOL Hospital in the Pediatric ED. The year of training may include PGY 1-5. The educational objectives of the OLOL Pediatric ED rotation are to: 6) Gain expertise in the recognition and management of pediatric emergencies. 7) Gain expertise in pediatric resuscitation, including Pediatric Advanced Life Support, emergent intubation, fluid administration, and drug dosages. 8) Become familiar with the management of non-emergent pediatric conditions which commonly present to the Emergency Department. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 159 9) Gain expertise in the performance of routine procedures such as venipuncture and arterial puncture. 10) Become familiar with pediatric medication dosages. The clinical and didactic experiences used to meet those objectives included daily patient care in the OLOL Pediatric ED, along with bedside teaching. The rotating resident is encouraged to attend lectures available at OLOL pertaining to the care of the pediatric patient. This rotation experience is part of the greater pediatric emergency medicine curriculum, also including PALS 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 pediatrics and emergency medicine. There is a rent free, secure apartment available during the rotation for resident use. The residents will have access to the resources of the hospital including medical texts, medical records 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 pediatric hospital under the supervision of a staff physician. The residents will participate in the initial management of emergency department patients, to include pediatric trauma 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. OLOL PER’s ED: Specific Competency-based Goals & Objectives: PGY 4 1. While in the pediatric ED at OLOL Hospital, the resident will demonstrates skills in “Data Gathering” that includes appropriate focused history and physical exam in the pediatric patient. (* PC, MK, ICS, PR) LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 160 2. While in the pediatric ED at OLOL Hospital, the resident will demonstrate skills in “Problem Solving” that includes appropriate and complete differential diagnosis for an undifferentiated pediatric ED patient. (* PC, MK, PBL) 3. While in the pediatric ED at OLOL Hospital, the resident will demonstrates skills in “Patient Management” that includes initiation of basic treatment plans and timely recognition of complicated pediatric ED patients. (* PC, MK, SBP) 4. While in the pediatric ED at OLOL Hospital, the resident will demonstrate skill in “Medical Knowledge” appropriate for level of training that demonstrates an advancing fund of medical knowledge and the ability to seek the scientific basis for their patient care decisions (*MK, PBL) 5. While in the pediatric ED at OLOL Hospital, the resident will demonstrate technical proficiency in “Procedural Skills” consistent with training PGY3 resident that includes pediatric medical and trauma resuscitations, conscious sedation, intubations, central venous access and arterial access. (*PC) 6. While in the pediatric ED at OLOL Hospital, the resident will demonstrate appropriate “Interpersonal and Communication Skills” that includes effective information exchange with patients, their families, and professional associates. (*ICS, PR) 7. While in the pediatric ED at OLOL Hospital, the resident will demonstrate appropriate “Professionalism” that includes introduces self to patient and/or family. Respectful of patient’s privacy and confidentiality (*PR) 8. While in the pediatric ED at OLOL Hospital, the resident will demonstrates an understanding of a “Systems-Based Practice” that includes understanding basic resources available for care of the pediatric ED patient. (*SBP, PC) 9. While in the pediatric ED at OLOL Hospital, the resident will demonstrate “Practice Based Learning and Improvement” skills that includes use of appropriate information resources (ie, texts, online web sites, etc.) for care of patient (* PBL, PC) This rotation summary has been reviewed and agreed to by the service director and LSU Program Director. OCHSNER ED Dr._________________, You are assigned to Ochsner Clinic Foundation the month of _____________. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 161 Orientation: Report for 7:00 a.m. on the first day of the month to the Emergency department. Dr. Joseph Guarisco is the Director (842-4433). Prior to beginning your rotation, contact Reonda Victor of the Ochsner GME Department (842-4937) to schedule a time to get your ID and parking cards. You will be required to give a $10 refundable deposit for the cards. Detailed information concerning orientation and the rotation are in the Ochsner resident handbook you have been given. Schedule: You will work 15 shifts per month; half of the scheduled residents will work 16 in months with 31 days. Each resident will be required to work one Friday-Saturday night shift each month. Directions: Directions to the hospital are included in the Ochsner resident handbook. Conference: You are required to attend conference and journal club. Extras: All procedures must be recorded and turned in at the end of the month. Supervision: Dr. Guarisco and staff physicians provide Supervision. Evaluations: Compiled and pooled from evaluations by the staff physicians. LSU Emergency Medicine Residency Program Ochsner Clinic Foundation Hospital Emergency Department Rotation GOALS and OBJECTIVES What follows are the goals and objectives for the Ochsner ED rotation, that will range from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take place at the Ochsner ED. The year of training may include PGY 1-5. The educational goals and objectives for the Ochsner 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, health maintenance organization setting, including the following: 22) Perform basic assessment of patients with a variety of moderate and major traumatic conditions. 23) Formulate a differential diagnosis for patients with various kinds of traumatic conditions and mechanisms of injury. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 162 24) Order and interpret appropriate diagnostic laboratory and imaging studies for trauma patients. 25) 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. 26) Demonstrate basic understanding of the principles of ACLS, PALS and ATLS resuscitation as applied to persons in cardio-respiratory arrest. 27) 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. 28) 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. 29) 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. 30) Learn to evaluate and appropriately manage a variety of patient complaints such as chest pain, abdominal pain, dizziness, headache, syncope, etc. 31) 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. 32) Learn to evaluate the pediatric patient in the emergency department, including fever of unknown origin and other common pediatric presenting complaints. 33) Learn appropriate use of diagnostic lab and imaging studies for emergency patients and to have basic competence in their interpretations. 34) Learn to use the following diagnostic aids: central venous pressures, pulse oximetry, arterial blood gases, EKG’s. 35) 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 LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 163 secretions. 36) 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. 37) Be able to arrange appropriate follow-up for discharged patients and give adequate discharge instructions. 38) Learn and use the available contributions of the Social Services Dept. to patient care in the ED and for discharge planning. 39) Learn appropriate medical evaluation of mentally disturbed patients including techniques for restraint and control of violent patients. 40) Learn about billing as it pertains to ED patients. 41) Learn about transplant patients. 42) Learn about geriatric presenting complaints. The clinical and didactic experiences used to meet those objectives included daily patient care in the Ochsner 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 LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 164 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. This rotation summary has been reviewed and agreed to by the service director and LSU Program Director. Community ED: Specific Competency-based Goals & Objectives, based on Level of Training: PGY1-4 23. 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) 24. 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) 25. 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) 26. 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) LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 165 d. PGY4: Demonstrates an advanced fund of knowledge and challenges assumptions using problem-based learning techniques. (*MK, PBL) 27. 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. 28. 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 29. 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) 30. 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) 31. 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) 32. While in the community ED, the resident will demonstrates an understanding of a “SystemsBased Practice” that includes but not limited to: LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 166 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) 33. 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) LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 167 OCHSNER ED-Pediatrics Dr._________________, You are assigned to Ochsner Clinic Foundation the month of _____________. Director of ED: Dr. Joseph Guarisco is the Director (842-4433). Pediatric ED Rotation Director: Rebecca Hutchings, MD Rhutchings@ochsner.org Orientation: If this is your first time at Ochsner, report for 7:00 a.m. on the first day of the month to the Emergency department for orientation. Prior to beginning your first rotation at Ochsner, contact Reonda Victor of the Ochsner GME Department (842-4937) to schedule a time to get your ID and parking cards. You will be required to give a $10 refundable deposit for the cards. Detailed information concerning orientation and the rotation are in the Ochsner resident handbook you will be given. Schedule: Residents will work 15 shifts per month from 12noon to 12 midnight; If you have specific requests for your schedule, please contact Hutchings at least 1 month prior to starting, otherwise contact them one week prior to starting the rotation to obtain your schedule. Some of your shifts will be in the Main ER, but the majority with be in the Pediatric ED. Residents will not be scheduled the night of journal club (2nd Thursday of the month) and, in order to avoid duty hour violations, may work a shift either the day before or the day of conference, but not both. Each resident will have two full weekends off each month. Any deviation from this schedule must be approved in advance by Dr. Hutchings and Dr. Haydel. Directions: 1514 Jefferson Highway New Orleans, Louisiana 70121 Conference: You are required to attend conference and journal club. Extras: All procedures must be recorded in New Innovations. Supervision: Board Certified EM physicians provide Supervision. Evaluations: Compiled and pooled from evaluations by the staff physicians and submitted at the end of the year. LSU Emergency Medicine Residency Program Ochsner Clinic Foundation Hospital Pediatric Emergency Department Rotation LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 168 GOALS and OBJECTIVES The educational objectives of the OCHSNER’S Pediatric ED rotation are to: 11) Gain expertise in the recognition and management of pediatric emergencies. 12) Gain expertise in pediatric resuscitation, including Pediatric Advanced Life Support, emergent intubation, fluid administration, and drug dosages. 13) Become familiar with the management of non-emergent pediatric conditions which commonly present to the Emergency Department. 14) Gain expertise in the performance of routine procedures such as venipuncture and arterial puncture. 15) Become familiar with pediatric medication dosages. The clinical and didactic experiences used to meet those objectives included daily patient care in the OCHSNER’S Pediatric ED, along with bedside teaching. The rotating resident is encouraged to attend lectures available at Ochsner pertaining to the care of the pediatric patient. This rotation experience is part of the greater pediatric emergency medicine curriculum, also including PALS 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 pediatrics and emergency medicine. There is a rent free, secure apartment available during the rotation for resident use. The residents will have access to the resources of the hospital including medical texts, medical records 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 pediatric hospital under the supervision of a staff physician. The residents will participate in the initial management of emergency department patients, to include pediatric trauma 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. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 169 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. This rotation summary has been reviewed and agreed to by the service director and LSU Program Director. Ochsner’s ED: Specific Competency Based Goals & Objectives: 10. While in the pediatric ED at Ochsner, the resident will demonstrates skill in “Data Gathering” that includes appropriate focused history and physical exam and ordering and interpretation of ancillary tests (* PC, MK, ICS, PR) 11. While in the pediatric ED at Ochsner, the resident will demonstrate skills in “Problem Solving” that includes appropriate and complete differential diagnosis for an undifferentiated pediatric ED patient. Appropriate organization of data collection in relation to patient management decisions. (* PC, MK, PBL) 12. While in the pediatric ED at Ochsner, the resident will demonstrates skills in “Patient Management” that includes a basic treatment plans and timely recognition of complicated pediatric ED patients. (* PC, MK, SBP) 13. While in the pediatric ED at Ochsner, the resident will demonstrate skill in “Medical Knowledge” appropriate for level of training that demonstrates a basic fund of medical knowledge and the ability to seek the scientific basis for their patient care decisions (*MK, PBL) 14. While in the pediatric ED at Ochsner, the resident will demonstrate technical proficiency in “Procedural Skills” consistent with level of training that includes supervised suturing, abscess I&D, dislocation reductions, ultrasound, pediatric medical and trauma resuscitations,conscious sedation, intubations, central venous access and arterial access. (*PC) 15. While in the pediatric ED at Ochsner, the resident will demonstrate appropriate “Interpersonal and Communication Skills” that includes effective information exchange with patients, their families, and professional associates. Demonstrates appropriate conflict resolution skills. (*ICS, PR) 16. While in the pediatric ED at Ochsner, the resident will demonstrate appropriate “Professionalism” that includes introduces self to patient and/or family. Respectful of patient’s privacy and confidentiality (*PR) 17. While in the pediatric ED at Ochsner, the resident will demonstrates an understanding of a “Systems-Based Practice” that includes understanding basic resources available for care of the pediatric ED patient. (*SBP, PC) LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 170 18. While in the pediatric ED at Ochsner, the resident will demonstrate “Practice Based Learning and Improvement” skills that includes use of appropriate information resources (ie, texts, online web sites, etc.) for care of patient (* PBL, PC) LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 171 SLIDELL ED Orientation: Dr. Lloyd Gueringer is the Director of the Emergency Department at SMH. Please contact him one week before starting your rotation: GUERIN5@AOL.COM 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 11am to 9pm. On conference days, the shift will be 12noon to 9pm. 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. Gueringer 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. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 172 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. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 173 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. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 174 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 34. 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) 35. 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) 36. 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) 37. 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) LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 175 d. PGY4: Demonstrates an advanced fund of knowledge and challenges assumptions using problem-based learning techniques. (*MK, PBL) 38. 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. 39. 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 40. 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) 41. 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) 42. 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) LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 176 d. PGY4: Models and teaches verbal and written documentation skills to lower level residents. (*PC, ICS) 43. 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) 44. 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, ICS-Interpersonal 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. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 177 PEDIATRIC INTENSIVE CARE UNIT ROTATION- Childrens Faculty: Bonnie Desselle, MD Gary Duhon, MD Costa Dimitriades, M.D. Amy Creel, MD Janet Rossi Goal: Develop competency in pediatric intensive care medicine Learning Objectives: 1. Understand how to rapidly resuscitate and stabilize the critically ill child in the PICU setting. a. b. c. Explain and perform steps in resuscitation and stabilization, particularly airway management and resuscitative pharmacology. Describe the common causes of acute deterioration in the previously stable PICU patient. Function appropriately in codes and resuscitations as part of the PICU team. 2. Understand how to evaluate and manage common signs and symptoms seen in critically ill children, including when to transfer to an intensive care setting. 3. Understand how to manage certain common diagnoses in the PICU setting. 4. Develop case management skills on complex multi-problem patients under high stress situations, under the supervision of an intensivist, using principles of decision-making and problem-solving and understanding one’s own limits. 5. Understand how to provide comprehensive and supportive care to PICU patients and their families. 6. Become familiar with ethical and medical-legal considerations in the care of critically ill children. 7. Understand key aspects of cost control in the PICU. 8. Understand how to maintain accurate, timely and legally appropriate medical records on complex and critically ill children. Curriculum Content: 1. For each of the following signs and symptoms which may herald the onset of serious or lifethreatening events in infants, children or adolescents: a. b. c. d. Rapidly recognize the signs or symptoms as heralding the onset of disease or injury and perform a directed pertinent history and physical exam. Formulate an age appropriate differential diagnosis. Discuss indications for admission to and discharge from the PICU, and indications for emergent interventions, as well as procedures for stabilization prior to transport to the PICU. Devise a plan for stabilization, further evaluation and definitive management, and be able to describe the physiologic basis for therapies. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 178 Signs and symptoms: 1. 2. 3. 4. 5. 6. 2. Cardiovascular: bradycardia, tachycardia, cardiopulmonary arrest, hypertension, hypotension, rhythm disturbances, poor capillary perfusion. GI: abdominal distension, acute gastrointestinal hemorrhage, peritoneal signs, vomiting. Hematologic: petechiae, purpura, polycythemia, anemia, neutropenia. Neurologic: altered mental status, coma, delirium, encephalopathy, seizures, thermoregulatory abnormalities, acute weakness, tetany. Renal: anuria, hematuria, oliguria, polyuria. Respiratory: tachypnea, dyspnea, apnea, cyanosis, increased or decreased respiratory effort, poor air movement, stridor, wheezing, pulmonary edema. For each of the following diagnoses which may require PICU monitoring and management: a. b. c. d. Discuss the pathophysiologic basis of the disease or injury. Discuss the indications for admission to and discharge from the PICU. Discuss stabilization, further work-up and management. Explain potential acute and long-term consequences and complications of the disease, and treatment and be able to evaluate prognosis. Common conditions: 1. 2. 3. 4. 5. 6. 7. General: submersion injury, shock (cardiogenic, hypovolemic, septic, toxic), burns (thermal, electrical), common intoxications. Cardiovascular: congestive heart failure, pericardial effusion, cardiac tamponade. Fluids, electrolytes, metabolic: severe dehydration, diabetic ketoacidosis, syndrome of inappropriate secretion of antidiuretic hormone, diabetes insipidus. GI/surgery: stress ulcer, massive GI bleeding, abdominal trauma (blunt/penetrating), acute abdomen, pre-op and post-op management. Hematologic: disseminated intravascular coagulopathy. Neurologic: head injury acute increased intracranial pressure, cerebral edema, status epilepticus. Pulmonary: adult respiratory distress syndrome, respiratory failure/impending respiratory failure, status asthmaticus, pneumothorax, upper airway obstruction (infectious, structural, foreign body). Skills Acquisition: 1. Laboratory and diagnostic tests: a. Explain the indications and limitations and be aware of age appropriate normals. b. Interpret abnormalities in the context of specific physiologic derangement. c. Discuss therapeutic options for corrections when appropriate. List of laboratory tests: 1. 2. 3. 4. 5. 6. 7. CBC, differential, platelets, indices Blood chemistries: electrolytes, calcium, magnesium, glucose Tests of liver function and damage Renal function tests Arterial blood gases Coagulation studies, platelets, PT/PTT, fibrinogen, FSP, D-dimers, “DIC screen” Urinalysis LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 8. 9. 10. CSF analysis Cultures and other diagnostic tests for infectious agents Drug levels and toxicologic studies List of imaging studies: 11. 12. 13. 14. 2. Chest x-ray Abdominal survey Cervical spine films CT scans Perform procedures: a. b. c. d. e. f. Intubation Arterial lines Central lines Lumbar punctures Pleuracentesis Chest tubes Reading Materials: Provided by faculty. Rotation Requirements: 1. 2. 3. 4. Residents will care for their patients under the supervision of an intensivist. Residents will pre-round on their patients daily and when on call. Residents will take call every fourth night. Residents will perform procedures with the supervision of faculty. 179 LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 180 TOXICOLOGY Orientation: There is a mandatory orientation for this rotation. Dr. Tuckler is the director of the toxicology rotation. Contact him one week prior to starting the rotation. Orientation occurs on the first day of each month. Vacation and time off are not allowed during the rotation. There is an exit interview on the last day of the rotation that you must attend. All required materials are due at that time. Scheduling: The majority of your time on this rotation will be spent performing consults, taking call, attending lectures, and giving lectures. When you meet with Dr. Tuckler, you will be given a list of lectures and persons giving you those lectures. It is your responsibility to contact each lecturer and schedule the date and time of each lecture. Responsibilities: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Daily rounds on all toxicology patients in the MER, ICUs and wards. Responding to all ED and in house toxicology consults. Giving intern and resident lectures. Giving one conference lecture. Attendance to the Trauma Conference. Presenting at M & M conference. Attending all emergency medicine conferences and journal club. Availability for Disaster call. Completing a "toxicology case of the month". Report due at the end of the month. Completing one toxicology oral board scenario case. Completing a set of “written board” toxicology questions. Attending an interactive review session of past toxicology cases. Goals, objectives and responsibilities will be given to you during orientation. Meeting with Dr. Tuckler for toxicology teaching. Conferences: You must attend all conferences. Extras: All consults and required paper work must be turned in to Dr. Tuckler on the last day of the month. Supervision: Per Dr. Tuckler Evaluation: Compiled and pooled from all faculty and Dr. Tuckler. LSU Emergency Medicine Residency Program LSU Toxicology Rotation GOALS and OBJECTIVES LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 181 What follows are the goals and objectives for the LSU Toxicology rotation, that will range from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take place at the LSU University Hospital. The year of training is assigned in the PGY4 year but may include PGY 1-5. Toxicology is a core component of the Emergency Medicine curriculum mandated by the Residency Review Committee. 1. ROUNDS and CALL at LSU The most important part of your rotation will be DAILY ROUNDS as a stimulus to further your education in emergency toxicology. You are expected to make rounds with the interns and emergency medicine residents caring for poisoned patients. These rounds should be geared to educate the residents and interns as to the appropriate evaluation, treatment, and disposition of the patient, as well as the pathophysiology of the agent or agents causing the overdose. You should be available to the residents to answer questions that may arise regarding treatment of overdoses and perform consults on those patients admitted. Document these rounds by having the ESU staff sign your daily round sheet. Also, document the date, patient's name, hospital number, type of overdose, and location of all patients seen. In addition YOU WILL BE ON CALL (24 hour call). A schedule will be provided. You will be required to round with the toxicology staff when they ask you to round with them. You will consult with the staff when you are called for a consult. You will be required to follow patients admitted to the hospital. DAILY PROGRESS NOTES need to be written and placed in the patient’s chart. You will also be made familiar with the HAZMAT disaster protocol and you and the staff will be called to come to the hospital in the event of a citywide HAZMAT incident. NO VACATION TIME SHOULD BE PLANNED DURING YOUR TOXICOLOGY MONTH. YOU ARE REQUIRED TO ATTEND ALL RESIDENT CONFERENCES. NO EXCUSES!!! You will be required to LECTURE TO THE INTERNS AND RESIDENTS IN THE ED. The subjects of these lectures will be given to you at the beginning of the month. You should also PREPARE A HANDOUT for the interns covering the lecture material. Please provide copies of the lectures to Dr. Tuckler when you check out at the end of the month. The date, time, and subject of these lectures should be documented on the toxicology rotation checklist provided with this packet. You will be REQUIRED TO HAVE A TOXICOLOGY LECTURE LOG SIGNED by all persons attending your lecture. ONE LOG SHEET PER LECTURE LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 182 2. MEETINGS: Toxicology meetings will be held with members of the faculty who have a interest in toxicology, namely, Drs. Keith Van Meter, and Victor Tuckler. You will be provided with a Topics Form, which will list the topics and designate which the faculty will discuss each topic with you. It is your responsibility to establish the time and place with each faculty member. Please do not wait till the end of the month to have these lectures. These meetings will provide one-on-one interaction and allow the discussion of varied issues in toxicology. 3. LECTURE: Each resident is expected to give a hour long lecture to the Emergency Medicine residents. The lecture is to be given on the Last Wednesday of the month at 11:00 a.m. The topic of your lecture will be assigned on the first day of the month so that adequate preparation time is available. HANDOUTS AND SLIDES ARE REQUIRED FOR THIS LECTURE. FIVE BOARD TYPE QUESTIONS REGARDING YOUR LECTURE ARE REQUIRED. Please provide a copy of the handout in a floppy disk to Dr. Tuckler. A copy of the handout will be added to the toxicology file. Please meet with the toxicology staff prior to your presentation to review your presentation and discuss possible changes. 4. QUESTIONS: One hundred well documented questions of a national board type are required to be handed in at the end of the rotation. These questions will be discussed at the end of the month with Dr. Tuckler during your check out meeting. 5. PATIENT LOG: YOU WILL NEED TO KEEP A LOG OF ALL PATIENTS SEEN DURING THIS ROTATION. PLEASE LIST THEM ON THE PROVIDED CHECKLIST. Use extra sheet if needed. At the end of the rotation please place all materials to Dr. Tuckler. 6. TOXICOLOGY ORAL BOARD SESSION AND WRITTEN EXAM REVIEW: You will have one oral board scenario practice session with Dr. Tuckler. Please arrange the date and time with Dr. Tuckler. You will also have a review session with Dr. Tuckler over written exam topics and questions. 7. TOXICOLOGY CASE OF THE MONTH You will have one toxicology case to solve during the month. The case will be provided to you at the beginning of the month by Dr. Tuckler. Please answer all the questions, provide a diagnosis, and explain why you reached the diagnosis that you did. 8. TOXICOLOGY CASES REVIEW: You will review toxicology cases with Dr. Tuckler and will be asked to discuss and answer questions regarding toxidromes and pathophysiology. 10. HAZMAT/DISASTER MEDICINE Please contact Dr. Aiken and Dr. Hardy to help with teaching Hazmat and attending Hazmat drills. 11. MONTHLY EVALUATIONS: A final evaluation of your performance and completion of all the above requirements are submitted to Dr. Haydel/Avegno to be put in your file. You are required LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 183 to turn in to Kathy a copy of your lecture, case of the month answers, a copy of the one hundred questions, patient log, sign in sheets, and lectures attended. For any concerns or questions call Dr. Tuckler at 664-5383. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 184 TRAUMA ICU Dr.______________________, You are scheduled for LSU Trauma ICU from______________to _______________. Schedule: Contact the LSU Surgery chief resident 2-3 weeks prior to your rotation to receive your schedule and /or submit a schedule request. All schedule requests should be directed to the Chief Residents. Responsibilities: Care of LSU Trauma Surgery Patients. Conference: You must attend conference. Extras: All procedures must be recorded and turned in at the end of the month. Supervision: Provided by LSU Surgery faculty and senior level residents. Evaluations: Compiled by LSU faculty and senior level residents at the completion of the rotation. The resident is responsible for delivering the evaluation forms to the appropriate faculty or chief resident at the completion of the rotation. Meals: available at University Hospital. LSU Emergency Medicine Residency Program LSU Trauma Surgery Rotation GOALS and OBJECTIVES What follows are the goals and objectives for the LSU Surgery rotation, that will range from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take place at the LSU University Hospital. The year of training is assigned in the PGY2 year. OBJECTIVES: Gain expertise in the management of surgical emergencies. Learn the priorities and procedures of trauma resuscitation. Become an integral part of the trauma team and respond to all trauma resuscitations along with junior, senior and staff surgeons. Gain exposure to OR sterile techniques and surgical techniques. GOALS: Participate in daily teaching rounds Evaluate Surgical patients in the Emergency Department LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 185 Participate in Surgical Procedures, both in the OR and on the floor Participate in the routine care of Surgical patients Participate in consults to the Surgical Service Follow inpatient surgical patients through discharge, including discharge planning The clinical and didactic experiences used to meet those objectives included daily patient care of the LSU Surgical Service Patients, along with bedside teaching. The rotating resident is encouraged to attend lectures available at LSU pertaining to the care of the surgery patient. This rotation experience is part of the greater emergency medicine curriculum, also including 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 surgery and emergency medicine. The residents will have access to the resources of the hospital including call rooms, the LSU Medical Library, Hospital medical texts, medical records and the cafeteria. The clinical experiences, duties and responsibilities the resident will have on the rotation: Residents will act as a part of the Surgery team under the supervision of a staff physician. The residents will participate in the initial management of surgery patients, to include pediatric and adult trauma and general surgery 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 Surgery faculty daily and prior to patient discharge. Duty hours for this rotation will not exceed an average of 80hrs/week, call not longer than 24 consecutive hours and will include 1 in 7 days off. This rotation summary has been reviewed and agreed to by the service director and LSU Program Director. Specific Competency Based Goals & Objectives: 1. While in the TICU, the resident will demonstrates skill in “Data Gathering” that includes appropriate focused history and physical exam and ordering and interpretation of ancillary tests (* PC, MK, ICS, PR) LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 186 2. While in the TICU, the resident will demonstrates skill in “Problem Solving” that includes appropriate and complete differential diagnosis for an undifferentiated patient. Appropriate organization of data collection in relation to patient management decisions. (* PC, MK, PBL) 3. While in the TICU, the resident will demonstrates skill in “Patient Management” that includes a basic treatment plans and timely recognition and appropriate emergency stabilization of the unstable patients. (* PC, MK, SBP) 4. While in the TICU, the resident will demonstrate skill in “Medical Knowledge” appropriate for level of training that demonstrates a basic fund of medical knowledge and the ability to seek the scientific basis for their patient care decisions (*MK, PBL) 5. While in the TICU, the resident will demonstrates technical proficiency in “Procedural Skills” consistent with level of training that includes supervised intubations, central venous access, chest tubes and trauma resuscitations. (*PC) 6. While in the TICU, the resident will demonstrate appropriate “Interpersonal and Communication Skills” that includes effective information exchange with patients, their families, and professional associates. Demonstrates appropriate conflict resolution skills. (*ICS, PR) 7. While in the TICU, the resident will demonstrate appropriate “Professionalism” that includes introduces self to patient and/or family. Respectful of patient’s privacy and confidentiality (*PR) 8. While in the TICU, the resident will demonstrates an understanding of a “Systems-Based Practice” that includes understanding basic resources available for care of the TICU patient. Utilizes the consultation process appropriately. Assists in appropriate bed triage decisions. Assists in appropriate step-down and transfer decisions. (*SBP, PC) 9. While in the TICU, the resident will demonstrate “Practice Based Learning and Improvement” skills that includes use of appropriate information resources (ie, texts, online web sites, etc.) for care of patient (* PBL, PC) (* denotes core competency area: PC-Patient Care, MK-Medical Knowledge, ICS-Interpersonal and Communication skills, PRProfessionalism, SBP-Systems Based Practice, PBL-Practice Based Learning and Improvement). LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 187 VA URGENT CARE CENTER Dr.__________________________, You are assigned to the VA URGENT CARE CENTER from__________________ to ________________________. Orientation: Email Dr. Campisi (Michele.Campisi@va.gov) at least one week prior to the start of the rotation to obtain your schedule. Make sure you have your fingerprinting done at least 1 month prior to your rotation; it is necessary in order for you to receive clearance (it takes at least 2 weeks for processing before you can receive your ID or computer access). Richell Richardson (Richell.richardson@va.gov) is your contact for your ID as well as your computer access, her office number is 504-565-4940. Responsibilities: Interns and Residents are expected to manage their individual patients under the direct supervision of the Urgent Care faculty. Conference: All resident are expected to attend EM conference and journal club. Procedures: All procedures must be recorded in New Innovations. Supervision: You will be supervised by board certified Emergency Medicine physicians. Evaluations: Monthly evaluations via New Innovations. Meals: Resident Responsibility. What follows are the goals and objectives for the Urgent Care rotation, that will range from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take place in the VA Urgent Care Center. The year of training may include PGY 1-5. LSU Emergency Medicine Residency Program Southeast Louisiana Veterans Health Care System Urgent Care Rotation GOALS and OBJECTIVES What follows are the goals and objectives for the VA Urgent Care rotation, that will be a 1 month rotation, as assigned by the Program Director. The rotation will take place at the SLVHCS Urgent Care Clinic. The year of training may include PGY 1-5. General Schedule below, specific schedule from Dr. Campisi. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 Monday Tuesday UC UC Wednesday Thursday Friday 7:30am 7a11a VA Dental Clinic Conference 2901 N. Causeway Dr. McDonald(Dental Rotation Director) Dr. Sobota 8am VA ENT Clinic Gravier St. Old VA Hosp 9th floor 9Red Dr. Aslam & Fazakas (ENT Rotation Directors) 8am VA Optho Clinic 1515 Poydras 6th fl (subway building) Mr. Cory Dickson (coordinater) Dr. Metzinger (Ophto Rotation Director) UC UC UC UC 188 The educational goals and objectives for the VA Urgent Care rotation are to provide residents with an opportunity to experience and learn about the initial evaluation and management of walk-in veteran patients, including the following: 1) Perform basic assessment of patients with a variety of mild to moderate 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 minor to moderate 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, lumbar puncture, splinting of fractures and sprains, spinal immobilization. 5) Demonstrate basic understanding of the principles of ACLS and ATLS 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 Urgent Care for care. 7) Learn proper methods for stabilization of patients prior to transfer to an emergency department with life threatening conditions such as sepsis, respiratory failure, acute MI, CHF, status epilepticus, status asthmaticus, cardiac arrhythmias, severe GI bleeds, and overdose. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 189 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: pulse oximetry, arterial blood gases, EKG’s. 13) Perform the following procedures with basic competency and to know indications and contraindications: insertion of a Foley catheter, thoracentesis, paracentesis, lumbar puncture, wet prep of vaginal secretions. 14) Become familiar with common medico-legal problems which present in urgent care practice such as: consent, desertion, AMA, restraints, impaired patients, 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 and Mental Health Depts. 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 VA patients. 19) Learn about transplant patients. 20) Learn about geriatric presenting complaints. The clinical and didactic experiences used to meet those objectives included daily patient care in the VA Urgent Care, 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). LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 190 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 VA Library services, including current texts in emergency medicine. The clinical experiences, duties and responsibilities the resident will have on the rotation: Residents will act as a part of the Urgent Care team under the supervision of a staff physician. The residents will participate in the initial management of urgent care patients, to include trauma, psychiatric, obgyn, 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 supervision while on the rotation. All patient care and medical charts will be reviewed and signed by the VA Site Director or other staff physician prior to patient discharge. Duty hours for this rotation will be an average of 50hrs every two weeks. The VA Urgent Care is open from 8a-8p Monday through Friday. It is closed on weekends and Federal holidays. The residents will initially follow the monthly schedule of the VA Site Director until other emergency medicine faculty are credentialed at the facility. This rotation summary has been reviewed and agreed to by the service director and LSU Program Director. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 191 VA Hospital Dental Clinic Dr.______________________________, You are assigned to rotate through the VA Dental Clinic for the month of____________________. Orientation: If this is your first rotation at the VA hospital, email Dr. Campisi (Michele.Campisi@va.gov) at least one month prior to the start of the rotation to arrange for computer access and your schedule. Schedule: The Dental Clinic starts at XX O’clock, on the first xxx of the month. You will need to contact Dr. McDonald Georgia.McDonald@va.gov one week prior to starting your rotation. You will attend Clinic every XXX. Clinic is located at XXXXXX. Conference: You are to attend EM conference on Wednesdays, 7a11a, and Journal Club at 7pm on the second Thursday of each month. Extras: All EM procedures must be recorded in NewInnovations. Evaluations: Global Rotation evaluation, via NewInnovations. Supervision: You will be supervised by the Dental Faculty and upper-level Dental residents on this rotation. Meals: The resident’s responsibility. VA Hospital Dental Rotation: GOALS and OBJECTIVES The year of training is typically PGY 1. OVERALL OBJECTIVES: The EM Resident will gain experience and knowledge of the anatomy, physiology, and pathophysiology of dental patients pertinent to the practice of Emergency Medicine. The EM Resident will demonstrate a basic understanding of the nature and principles of common dental emergencies. The feedback mechanisms and methods used to evaluate the performance of the resident include an end of rotation global evaluation on NewInnovations. Immediate feedback may also be given to the resident, and any significant problems will be discussed during the rotation with the LSU EM program director, Dr. Haydel mhayde@lsuhsc.edu LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 192 The resources and facilities in the institution that will be available to each resident include computer access to Up To Date and the LSU and VA Library services. The clinical experiences, duties and responsibilities the resident will have on the rotation: Residents will act as a part of the Dental Clinic team, under the direct and indirect supervision of the Dental Faculty. 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 faculty prior to patient discharge. Duty hours for this rotation will not exceed an average of 80hrs/week, do not include call, and will include 1 in 7 days off. This rotation summary has been reviewed and agreed to by the service director and LSU Program Director. Dental Service: Specific Competency Based Goals & Objectives 1. While on Dental service, the resident will demonstrates skill in “Data Gathering” that includes appropriate focused history and physical exam and ordering and interpretation of ancillary tests (* PC, MK, ICS, PR) 2. While on Dental, the resident will demonstrate skills in “Problem Solving” that includes appropriate and complete differential diagnosis for an undifferentiated patient. Appropriate organization of data collection in relation to patient management decisions. (* PC, MK, PBL) 3. While on Dental, the resident will demonstrates skills in “Patient Management” that includes a basic treatment plans and timely recognition of complicated Dental patients. (* PC, MK, SBP) 4. While on Dental, the resident will demonstrate skill in “Medical Knowledge” appropriate for level of training that demonstrates a basic fund of medical knowledge and the ability to seek the scientific basis for their patient care decisions (*MK, PBL) 5. While on Dental, the resident will demonstrate technical proficiency in “Procedural Skills” consistent with level of training that includes local and regional anesthesia. (*PC) 6. While on Dental, the resident will demonstrate appropriate “Interpersonal and Communication Skills” that includes effective information exchange with patients, their families, and professional associates. Demonstrates appropriate conflict resolution skills. (*ICS, PR) LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 193 7. While on Dental, the resident will demonstrate appropriate “Professionalism” that includes introduces self to patient and/or family. Respectful of patient’s privacy and confidentiality (*PR) 8. While on Dental, the resident will demonstrates an understanding of a “Systems-Based Practice” that includes understanding basic resources available for care of the Dental patient. (*SBP, PC) 9. While on Dental, the resident will demonstrate “Practice Based Learning and Improvement” skills that includes use of appropriate information resources (ie, texts, online web sites, etc.) for care of patient (* PBL, PC) (* denotes core competency area: PC-Patient Care, MK-Medical Knowledge, ICS-Interpersonal and Communication skills, PRProfessionalism, SBP-Systems Based Practice, PBL-Practice Based Learning and Improvement). LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 194 WEST JEFFERSON ED Schedule: Contact the director of the rotation ED, Dr. Mayer 2-3 weeks prior to your rotation to submit a schedule. All shifts must be covered, unless a resident is scheduled to be on Vacation that month. Each resident will be assigned 15-16 shifts a month; 12noon to 12midnight. No more than one resident per shift. Send a copy of your schedule to Kathy Whittington. Responsibilities: You will be responsible for the care of individual patients in the ED. Conference: You must attend conference. Extras: A patient list must be maintained and turned in with your procedure log at the end of the month. Supervision: You will be supervised by board certified Emergency Medicine physicians. Evaluations: Daily evaluations. Meals: provided in the West Jefferson cafeteria and doctor’s lounge. GOALS and OBJECTIVES The following are the goals and objectives for the West Jefferson ED rotation, which will range from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take place at the West Jefferson ED. The year of training may include PGY 1-5. The educational goals and objectives for the West Jefferson 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. Prehospital emergency medical services 2. Multicasualty incidents and disasters 3. Legal aspects of emergency care 4. Emergency procedures 5. Emergency department consultation 6. Billing LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 195 The clinical and didactic experiences used to meet those objectives included daily patient care in the West Jefferson 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. This rotation summary has been reviewed and agreed to by the service director and LSU Program Director. WEST JEFFERSON PEDIATRIC ED & FASTTRACK You are scheduled for West Jefferson ED: Pediatric & FastTrack for the month: Orientation: Contact Kacy Petit in their GME office kacy.petit@wjmc.org (504) 349 – 1897) two weeks prior to starting if this is your first rotation at West Jefferson Medical Center to be oriented to the electronic medical records system prior to starting. Schedule: Two weeks prior to starting, contact the director of the rotation ED, Dr. Andy Mayer for your schedule. You will do 12-hour shifts: Monday, Tuesday, Thursday & Friday. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 196 Responsibilities: You will be responsible for the care of patients in the Pediatric ED, and if the volume is low in the PED, you will see patients in the FastTrack. Conference: You must attend conference and Journal Club. Extras: A patient list must be maintained and turned in with your procedure log at the end of the month. Supervision: You will be supervised by board certified Emergency Medicine physicians. Evaluations: Monthly evaluations. Meals: provided in the West Jefferson cafeteria and doctor’s lounge. GOALS and OBJECTIVES What follows are the goals and objectives for the WJ Pediatric ED rotation, that will range from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take place at the West Jeff Hospital in the ED where you will see pediatric and fast track patients. The year of training will typically include PGY 1 residents only. The educational objectives of the West Jefferson Pediatric ED rotation are to: 1) Gain expertise in the recognition and management of pediatric emergencies. 2) Gain expertise in pediatric resuscitation, including Pediatric Advanced Life Support, emergent intubation, fluid administration, and drug dosages. 3) Become familiar with the management of non-emergent pediatric conditions which commonly present to the Emergency Department. 4) Gain expertise in the performance of routine procedures such as venipuncture and arterial puncture. 5) Become familiar with pediatric medication dosages. The clinical and didactic experiences used to meet those objectives included daily patient care in the Pediatric ED, along with bedside teaching. The rotating resident is encouraged to attend lectures available at West Jefferson pertaining to the care of the pediatric patient. This rotation experience is part of the greater pediatric emergency medicine curriculum, also including PALS LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 197 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 pediatrics and emergency medicine. There is a rent free, secure apartment available during the rotation for resident use. The residents will have access to the resources of the hospital including medical texts, medical records 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 pediatric hospital under the supervision of a staff physician. The residents will participate in the initial management of emergency department patients, to include pediatric trauma 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. This rotation summary has been reviewed and agreed to by the service director and LSU Program Director. Community ED: Specific Competency-based Goals & Objectives, based on Level of Training: West Jefferson Medical Center PGY1-3 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: LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 198 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: LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 199 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 “SystemsBased 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) LSUHSC Emergency Medicine Residency Policies and Rotation Guide 2013-14 200 ELECTIVE Dr.__________________________________, You are scheduled for Elective from ________________to_______________. Schedule: As required by your rotation. The program director and program coordinator must be informed of your selected elective 2 weeks prior to starting the rotation. Responsibilities: As required by the rotation. Obtain these from the director of the elective rotation you take. Conference: You are expected to attend conference. Extras: All procedures must be recorded and turned in at the end of the month. Available Electives: -Radiology -ENT -Ophthal -OMFS -Hyperbarics -Research -Critical Care -Pathology (autopsy) -EMS -Toxicology -Teaching -International EM -Dermatology -Board Preparation *Note, all electives must be approved by the residency program director, 2 weeks prior to start of the elective or you will default to University ED. Evaluations: Responsibility of resident to identify supervising faculty for rotation and obtain summative evaluation sheet.
