Clinical Rotation

Description

Students work at the level of sub-interns, with senior resident and attending supervision, encountering a wide range of patients, presenting complaints, and levels of acuity. Learning is primarily through direct patient care experience and bedside teaching, supplemented with lectures, directed readings, workshops/labs and simulation experiences.

Objectives

1. Ownership of patients
Students should demonstrate a strong sense of responsibility for the care of their patients from arrival at the emergency department through every aspect of their treatment and evaluation through admission or discharge and follow up. By the end of the clerkship students should be able to:

  1. Describe the full extent and complexities of a patient’s past medical history and current social situation.
  2. Manage timely patient evaluation, treatment, re-examination, and disposition.
  3. Assess patient understanding about workup and treatment, admission or discharge, and when appropriate, follow up and return precautions.

2. Clinical care
Students should integrate the knowledge they have obtained in medical school so far to focus on evaluation and treatment of acute presentations. By the end of the clerkship students should be able to:

  1. Develop an appropriate differential diagnosis for a variety of patient presentations.  At the beginning of patient evaluation this differential should begin broadly in order to ensure comprehensive evaluation, and students should avoid latching quickly onto one diagnosis and closing off other possibilities.
  2. Within the development of a broad differential, list possible diagnoses with particularly significant morbidity and mortality.  Students should then formulate a plan to safely make or rule out these diagnoses prior to disposition of the patient.
  3. Discuss the acute evaluation and treatment of a wide range of symptoms and conditions.

3.  Teamwork
Students should identify and respect the roles of all members of the ED Team.   By the end of the clerkship students should be able to:

  1. Describe the role of pre-hospital providers, appreciating the challenges of pre-hospital evaluation and treatment, and the key communication elements to handoffs from pre-hospital to hospital providers.
  2. Demonstrate a close working relationship with the nursing and medical assistant staff to understand their role and assist in their care of patients.
  3. Demonstrate willingness to help out with any aspect of patient care whenever it is needed.
  4. Demonstrate an appreciation of the job of the social workers and the complex social and societal factors that frequently come into play during an emergency department visit.

4.  Communication
Students should be able to describe the importance of effective communication at all levels for patient care in the ED, and they should be able to demonstrate effective communication skills. By the end of the clerkship students should be able to:

  1. Give a complete yet efficient patient presentation to senior residents and faculty.
  2. Demonstrate a caring bedside manner and provide clear explanations of the medical workup and treatments provided.
  3. Demonstrate elements of effective communication in documentation.
  4. Practice the key elements of efficient and productive communication with consultants.

5. Multitasking
Students should appreciate the clinical challenge of managing multiple patients simultaneously, each at different stages of evaluation and treatment.  They should see as many patients simultaneously as possible, depending on department conditions and experience.  Multitasking skills fall into all other objective categories.