UCHSC Core Clerkship in Emergency Care
Finally….The UCHSC School of Medicine has incorporated a required clerkship into its medical school curriculum! This is our opportunity to introduce these students to EM early in their clinical careers, at a point when they are beginning to think about choosing a specialty. We hope the experience will be fun and rewarding for the students, the residents, and the faculty. Who knows, maybe we’ll meet some of our future residents…..
Here’s what the teaching team should expect from the students:
There will be three to four MSIII students rotating at a time for a two week block in the ED.
Students will work 8 hour shifts with the teaching team during the week. Each student works one weekend shift. During the weekend shift, the student will spend 6 hours seeing patients under the supervision of the senior resident. The final two hours of their 8 hour shift will be spent with the triage nurse.
The resident is primarily responsible for the patient, not the student. That means the residents should evaluate the patient, start the workup, etc. Remember, these are MSIII students, not sub-Is. They will not yet have the ability to generate a rapid differential and management plan. The students will be expected to follow 1-2 patients at a time. You may decide which patient(s) you think will provide good learning material for the students, and direct the student to do their own H&P and follow that patient. The student can present the patient to either you or the attending. Students should be included in sign out rounds.
Students are expected to enter a “medical student note” in Ibex on EVERY patient they sign up for. In general, they should sign up for 2-3 patients per shift. Residents should document in the chart just as you would if you were seeing the patient primarily. Attendings should document as you normally would. Students will NOT have the ability to order meds, labs, radiographs, beds etc. in Ibex. Therefore, you must still order any studies or treatments.
Here’s what the students will expect of the teaching team:
1. Brief orientation on their first shift
Take a few minutes to give the students a tour of the department—where the ambulance bay and waiting rooms are, how patient flow happens, where are the utility rooms, bathrooms, etc. Then, show them the short video module about how to use Ibex. This video is on the flash drive with all the other teaching modules
2. Formal didactics
There are two objectives to the formal didactic sessions. The first is for the students to be taught three modules which are part of the required curriculum of the clerkship. The second is for the teaching resident to gain experience presenting interactive lectures in the small group setting, and to receive immediate feedback on his or her performance from both the attending and the students. The three modules are:
Altered mental status (usually the first Tuesday at 1:00pm)
Splinting workshop (usually the first Friday at 1:00pm)
Intro to toxicology (usually the second Tuesday at 1:00pm)
Please note that these modules are part of the required curriculum for the students and will be covered on their final course exam. Students who are rotating at both UCH and TCH are expected to attend these at the scheduled times. As such, these modules cannot be skipped, rescheduled or substantially changed.
A schedule of which module will be taught on which day will be posted in the doc box. Copies of the modules are available on the DHMC intranet, the Emed drive on the Safari server, in the Clerkship reference folder in the doc box. You can present these using the Division laptop and projector if you wish—just let Marybeth know in advance. The ED conference room is reserved for you for these sessions.
3. Bedside teaching
Core Learning objectives for medical students: this is where to focus your bedside teaching
Sick or not sick…that is the question. Is this patient sick or not sick? How can you tell in one minute or less?
1) Vital signs
i) Obtain them, recognize age appropriate values, correlate them with clinical condition of patient
2) Shock
i) Pathophysiology, clinical presentation, initial management
3) Trauma
i) Initial evaluation and management
4) Altered mental status
i) Initial evaluation and management
5) The poisoned patient
i) Approach to toxicologic emergencies
6) Serious bacterial illness
i) Age-appropriate presentation and management
7) Access to health care
i) Barriers to accessing care, role of the ED in providing care
8) Communication
i) Concise ED H&P (not a comprehensive Internal Medicine H&P)
Try to spend time observing a student perform an H&P, and listen to the student present the case. Please read their notes in Ibex. Then take time to give the student specific, constructive feedback on their work. Expect your students’ case presentations to be:
l Brief, focused
l 2 – 3 minutes in length
l Directed opening statement: chief complaint and pertinent PMH
l Description of the HPI, pertinent ROS
l Additional medical history, etc.
l Physical examination
l Differential diagnosis
l Diagnostic and treatment plan
Encourage students to participate in critical resuscitations in the department, even if they are not following the patient primarily. Be on the lookout for other learning opportunities too—an interesting physical exam finding or radiograph, a possible procedure, etc. and encourage the student to learn from these.
4. Evaluations
As the teaching team, you will likely be asked to evaluate the students’ clinical performance. Half their grade in the clerkship is made up of your evaluations, so please take this responsibility seriously. Within two weeks after the end of the clerkship, you will receive an email from New Innovations telling you that you have been asked to evaluate the student. Your evaluation will be easier for you and more meaningful for the student if you complete it as soon as possible, while the details are fresh in your mind. A brief document on how to write a meaningful assessment of the medical student is located on the DHMC Intranet, on the Emed drive on Safari Server, and in the Clerkship folder in the doc box.
Students will be asked to evaluate both faculty and residents at the end of their clerkship. If you would like an evaluation from a particular student, consider giving them your business card at the end of a shift so they will remember who you are.
If you have concerns about a student’s performance, please do not hesitate to contact the Clerkship Director (Lynne Yancey) directly. I would much rather know early if a student is struggling, while there is still time for me to work with the student. Call my cell at 303-916-0164, or page me at 266-2635.