Seattle, Washington
3rd Year Clerkship - (Peds 665 P)

Schedule and Goal of Medical Student Call
in the Seattle Children's ER

Goal
To provide students with additional exposure to acute pediatrics illnesses

Objectives

Observe a variety of illnesses managed in the pediatric emergency room

Contrast the approach to patients in the ER and outpatient setting

Schedule
Three 6-hour shifts on call in the SCH ER. See Clerkship Manual for specific schedule information

Shift 1

1. Find ED attending in the complex pod and introduce yourself.
2. Do orientation on the computer (40 minutes) that is just outside the physician presenting room.
3. Reconnect with ED attending - for the remainder of the evening stay with ED attending (or their designate, e.g. ED fellow or resident) - listen to resident presentations to the attending and formulation of plans, see patients with the attending or designee (if possible examine patient at same time attending does rather than just observe the exam). Break off from attending or designee only to watch or assist with procedures.
4. Hand ED attending an evaluation form prior to leaving the ED.

Second shift:

1. Find ED attending in the complex pod and introduce yourself
2. Same as #3 and 4 above.

Third shift:

1. Find ED attending and introduce yourself. Tell them this is your third ED shift and that you job is to learn how a resident cares for a patient from start to finish and to see one to two patients on your own.
2. Connect with the Senior Resident to observe patient care from start to finish (including history/exam, presenting to attending or fellow, ordering tests, doing procedures, writing prescription, and discharging using the E-Chart system). You may need to remind the Senior that you are observing them in this situation, not presenting to them..
3. After seeing one or more patients with the ED Senior your goal is to see one to two patients on your own and present directly to the ED attending or ED fellow (this may not be always possible depending on ED flow and patient acuity).
4. Don't sign up for any patient unless you have the OK from the ED attending or fellow.
5. If you find during the shift that you would be better served by shadowing the attending (like you did in the first 2 shifts), just ask the attending if you may shadow them for the remainder of your shift (sometimes preferred as you can see many patients and learning curve is steep).
6. Hand ED attending an evaluation form prior to leaving the ED.

Note: If at any time a code is going on in the resuscitation room (or any room for that matter), we want you to be in the room (no matter how crowded) to observe and assist in any way needed.

Suggested readings to compliment your experience

1. CLIPP cases 12, 16, 19, 24, and 25
2. Yale Observation Scale
3. Write down the diagnosis or major symptoms for each patient you see in the ED (or interesting cases that you hear about). Read a short discussion of that entity in any textbook (one text is recommended below) either during (if there is time) or after your shift.
4. One recommended textbook is entitled "Pediatric Emergency Medicine--A comprehensive study guide" by Strange et al. This book has brief but thorough discussions.

For questions or concerns regarding the ED rotation please contact:

Sherilyn Smith, MD
Associate Director, Medical Student Programs
(206) 987-2008
Email: ssmit1@u.washington.edu

or

Eileen Klein, MD
Attending Physician, Emergency Department
(206) 987-2708
Email: eileen.klein@seattlechildrens.org

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