Course/Rotation Title: EMERGENCY MEDICINE
Date of Last Review/Update
03/07
Course/Rotation Director
Dr. James Fenn
Location of clinical encounters
Inpatient % time =0
(Check all that apply)
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Wards
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ICU
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Other (please specify)
Outpatient% time = 100%
(Check all that apply)
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Clinic
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Home
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Other: ED
Course/Rotation description with educational purpose/value
The goal of this rotation is to prepare future general internists with the skills and knowledge to
appropriately evaluate and treat patients in an Emergency Department setting. See
Competencies below for further details. This rotation is a mandatory rotation for all internal
medicine residents for at least 1 month prior to graduation. Rotation consists of a minimum of 3
twelve hour shifts (or equivalent) per week. Adequate time off between shifts must be no less
than 10 hours outside of the hospital. Resident will be assigned daily to a specific attending who
has been chosen by the educational coordinator as someone who is interested in and willing to
participate actively in teaching residents.
Types of Clinical Encounters:
Any encounter that occurs in the ED may involve the rotating resident. This is always
supervised by an attending physician. The types of encounters may be guided by the resident’s
abilities, level of training, and interests.
Types of Patients: (PLEASE SPECIFY)
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Adults of all ages
Male
Female
Children < 18 years old
Other (please specify)
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Mix of Diseases:
Any disease process that is encountered in the ED may be seen by the resident including but not
limited to: trauma, orthopedic injuries, lacerations, acute general and vascular surgical cases, all
acute medical cases, acute psychiatric illness, acute obstetric and gynecologic cases, acute
urologic cases, etc.
Types of Procedures: (PLEASE SPECIFY)
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ACLS (senior residents rotate as part of MAYDAY and Medical Emergency Teams)
Abdominal paracentesis
Arterial puncture
Arthrocentesis
Central venous line placement
Lumbar puncture
Nasogastric intubation
Pap smear
Thoracentesis
Endotracheal intubation
Electrical cardioversion
Soft tissue and joint injections
Interpret ECG
Interpret imaging studies (see below)
Describe the level of supervision by faculty
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Attending staff will supervise and precept all patient care activity directly or indirectly.
Attending staff will provide mid rotation feedback
Attending staff will provide end-of-rotation feedback
Other (please specify)
Competency Based Objectives/Expectations. Please see Roman Numeral II
for further details.
Patient Care
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The general goals and practices of Emergency Medicine regarding evaluation, treatment,
arrangement of disposition and follow-up care.
The Basic and Advance Trauma Life Support approach to patients with systemic trauma
including airway management, hemodynamic support, and appropriate evaluative
techniques. (This also falls under competency of medical knowledge).
Management of common wounds, lacerations, abrasions, and sprains.
How to read x-rays and treat fractures and dislocations.
How to evaluate and treat common ophthalmologic emergencies. (This also falls under
competency of medical knowledge).
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How to approach ear, nose, throat and dental trauma and illnesses. (This also falls under
competency of medical knowledge).
How to evaluate head injuries as well as the evaluation and management of headache,
stroke and other neurological emergencies. (This also falls under competency of medical
knowledge).
How to evaluate and treat environmental and toxicological emergencies. (This also falls
under competency of medical knowledge).
How to evaluate and treat allergic reactions and envenomizations. (This also falls under
competency of medical knowledge).
Techniques of pain management and conscious sedation. (This also falls under
competency of medical knowledge).
How to evaluate and treat chest pain, arrhythmias and other cardiac emergencies. (This
also falls under competency of medical knowledge).
The emergency management of shortness of breath and other pulmonologic emergencies.
(This also falls under competency of medical knowledge).
How to manage and treat abdominal pain, gastrointestinal bleeding, and other
gastrointestinal medical and surgical emergencies. (This also falls under competency of
medical knowledge).
How to manage and treat obstetric and gynecologic disorders, as well as treat various
urologic disorders. (This also falls under competency of medical knowledge).
How to evaluate and manage pediatric emergencies. (This also falls under competency of
medical knowledge).
How to evaluate psychiatric emergencies; distinguish organic and functional psychiatric
disorders and assess suicide potential of patients. (This also falls under competency of
medical knowledge).
Evaluate and treat different categories as acute shock; learn the fluid and vasopressor
support for shock situations. (This also falls under competency of medical knowledge).
Assess and suture simple lacerations.
Immobilize and treat sprains and simple fractures.
Use the slit-lamp and evaluate fluorescein staining.
Use of nasal speculum, Frazier suctioning and nasal packing techniques to treat epistaxis,
and remove nasal and aural foreign bodies.
Perform an emergency neurologic exam, and learn indications for emergent diagnostic
imaging.
Learn to perform a lumbar puncture.
Treat toxicologic emergencies with gut decontamination techniques and use of
appropriate antidotal treatments.
Participate in Advanced Cardiac Life Support in cardiac arrest resuscitations. (This also
falls under competency of system-based practice).
Perform supervised gynecologic examinations.
Evaluate and institute treatment for emergency patients and review each with attending
emergency physician. (This also falls under competency of interpersonal communication
skills).
Medical Knowledge
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See above under Patient care
Please see BMC general core competencies under Roman Numeral II
Practice-Based Learning
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Perform an adequate emergency medical assessment, including ordering of necessary
tests, and institution of appropriate treatment modalities.
Didactic lectures; presentation of interesting cases and review commonly seen
problems/issues (see attached list). (This also falls under competency of interpersonal
communication skills).
Please see BMC general core competencies under Roman Numeral II
Interpersonal and Communication Skills
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Perform appropriate treatment and evaluation of the emergency patient/communication
with attending physician in Emergency Department and referring physician.
See above under patient care
Please see BMC general core competencies under Roman Numeral II
Professionalism
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Please see BMC general core competencies under Roman Numeral II
System-Based Practice
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How and when to institute home care resources for needful and elderly patients.
Please see BMC general core competencies under Roman Numeral II
Check Any Methods Used For Teaching and Assessment:
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Ambulatory Clinic (feedback written & verbal)
Annual In-service Exam (feedback written)
Attending Rounds (feedback written & verbal)
Board Review (feedback written examination)
Cancer Conference
Case Management Evaluation (360 degree written evaluation)
Chart Stimulated Recall & Feedback (feedback verbal)
Direct Observation and Feedback (feedback written & verbal)
GME Core Curriculum
Interns Report (feedback written & verbal)
Journal Club (feedback written & verbal)
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Medical Record Review (feedback written & verbal)
Mentor Feedback (feedback written & verbal)
Monthly End of Elective Exam (feedback written)
Monthly Mini CEX (feedback written & verbal)
Monthly Competency Based Written Evaluation
Morning Report (feedback written & verbal)
Multidisciplinary Rounds Feedback (feedback verbal)
Nursing Evaluation (360 degree written evaluation)
Patient Evaluation (360 degree written evaluation)
Patient Management Discussions (feedback written & verbal)
Procedure Logs
Performance improvement Multidisciplinary Morbidity and Mortality
(feedback written & verbal)
Semi Annual Program Director Feedback (feedback written &
verbal)
Student Evaluation (feedback written & verbal)
Supervised Sign-In Rounds (feedback written & verbal)
Supervised Sign-Out Rounds (feedback verbal)
Other _______________________________
Other _______________________________
Other _______________________________
Other _______________________________
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Other Policies
The Course Director recognizes that the trainee is accountable to all BMC Residency and GME
Personnel Policies and Procedures. The Course Director recognizes that the residents are
expected to attend all continuity clinics and mandatory educational conferences unless excused
by the Program Director or Chief Medical Resident with advanced notice.
Check The Educational Materials Used (beyond direct patient care)
[X] Reading List:
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Department of Emergency Medicine Orientation Manual.
Case-related emergency medical articles (located in Emergency Department).
A Practical Approach to Emergency Medicine, Little, Brown & Company, 1994.
Abnormal EKG and x-ray file.
ACLS: Advanced Cardiac Life Support, Principles and Practice; American Heart
Association, Cummings, Richard O., Ed; This is the manual of the certification course of
how to manage a variety of life threatening cardiac emergencies.
ATLS: Advanced Trauma Life Support; American College of Surgeons. This is the
manual for the certification course of how to manage trauma from pre-hospital to the
operating room. Emphasis is on evaluation and treatment in the emergency department.
PALS: Pediatric Advanced Life Support; or APLS: Advanced Pediatric Life Support;
Essentially ACLS for pediatrics
Emergency Medicine; Rosen and Barkin; The “Bible” of Emergency medicine; in depth
reviews; three volume set – not for the weak.
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Emergency Medicine, a Comprehensive Study Guide; Tintinalli, et al. Excellent source
for fairly quick yet thorough reviews.
Clinical Procedures in Emergency Medicine; Roberts and Hedges; Every procedure you
could possibly need in the ED with clear instruction and diagrams.
Emergency Medicine Procedures; Reichman and Simon; Similar to above
Emergency Wound Care, Principles and Practice; Zakin and Simon; The best and
concise review of wounds, suturing and more. My personal copy available upon request.
Anyone, Anything, Anytime, A History of Emergency Medicine; Zink; How Emergency
Medicine became a specialty. Good for insomnia; my personal copy available upon
request.
[X]Review of Appropriate Radiology Images:
 Review personally any imaging studies ordered in PACS and if needed review with oncall radiologists
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Review of Appropriate Laboratory Data:
Review personally all Lab Data ordered and interpret with attending physician to allow
for proper plan and disposition of patient
Articles from the Literature (Please Specify):
Annals of Emergency Medicine
Other (Please Specify):
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