Harborview Medical Center
Amy Baernstein, MD, Associate Professor, Medicine/GIM
OVERALL EDUCATIONAL PURPOSE
PRINCIPAL TEACHING METHODS
Case discussion and review
There is a daily case-based review of every patient seen in the Emergency Trauma Center facilitated by the Director of the Emergency Trauma Center.
DidacticsPrior to the start of the rotation each resident must attend a mandatory 4 hour didactic/orientation session and complete two rides with Medic One.
Mix of Diseases
Patients presenting to the Emergency Trauma Center are frequently brought in by Medic unit or Airlift with the following acute medical problems: toxic ingestions, coma, stroke, myocardial infarction, septic shock, respiratory failure, subarachnoid hemorrhage, and vascular emergencies such as aortic dissection. Obstetric/gynecologic problems frequently encountered include vaginal bleeding, ectopic pregnancy, and pelvic inflammatory disease. Infectious disease affects many patients, including TB, complications of AIDS, and infections in patients from Asia, Africa, and Central America.
Patients presenting to the Emergency Trauma Center represent a full socio-economic spectrum. Many of our patients belong to our “Mission Population:” patients who are indigent, homeless, incarcerated, immigrant, affected by substance abuse, and those with sexually transmitted diseases.
Types of Clinical Encounters
Clinical encounters include:
Procedures performed during this rotation include central line insertion, paracentesis, lumbar puncture, endotracheal intubation, arthrocentesis, arterial puncture, phlebotomy, peripheral IV insertion, urinary catheterization, and placement of nasogastric tubes.
Harborview Medical Center is owned by King County and operated by the University of Washington. Harborview is the region’s only Level 1 trauma center and has a full range of services which include:
Rotation Specific Schedule
Call and Weekend Responsibilities
Residents are assigned approximately 23 12-hour shifts a month. Residents work either nights or days with a minimum of twelve hours off between shifts.
Principle Educational Materials Used
The residents have access to reference books in the ER. Multiple computers with connections to various clinical resources are available on-site. Additionally, Harborview Medical Center has a library.
METHODS OF EVALUATING RESIDENT AND PROGRAM PERFORMANCE
The Director of the Emergency Room provides feedback to the residents during case-based discussions. At the end of the rotation, the resident is evaluated via computer by the attendings that he or she has interacted with most. The evaluator rates the resident on a nine-point scale in each component of clinical competence (i.e., patient care, medical knowledge, practice based learning improvement, interpersonal and communication skills, professionalism, system based learning, educational attitudes, leadership, overall clinical competence).
The resident is given the opportunity to evaluate via computer the quality of the curriculum and the extent to which the educational goals and objectives of the rotation have been met. The resident also evaluates the teaching competence of each attending with whom s/he has interacted for a significant amount of time.
LINES OF RESPONSIBILITY
EXPLICIT LINES OF RESPONSIBILITY FOR CARE OF PATIENTS ON THIS SERVICE
The director of the Emergency Trauma Center and medicine attendings supervise residents and medical students. The residents also provide supervision to the students.
The residents are responsible for the evaluation and treatment of all patients who are “triaged to medicine” in the Emergency Trauma Center. Residents present all patients to a medicine attending, who then sees the patient.