SELECT SIEMA - Acting Internship Emergency Medicine

1. Knowledge of the fundamental principles of medicine
2. Understanding of the fundamental concepts and skills learned in the 3rd year clerkships
3. Basic knowledge of the pathophysiology, clinical presentation, assessment and treatment and interpretation of diagnostic tests of major and common disease problems presenting to the emergency department
4. Skills of medical history taking and general physical examination
5. Foundation for continuing education and lifelong learning skills

• Initial evaluation (history and physical examination) of a patient presenting to the ED with undifferentiated non-urgent, urgent or emergent illness or injury.
• Basic steps of resuscitation and stabilization of patients
• Development of a differential diagnosis for common presenting complaints in the ED setting such as:
  • Chest pain
  • Fever
  • Shortness of Breath
  • Dysuria
  • Dizziness
  • Hematuria
  • Headache
  • Vomiting
  • Abdominal pain
  • Sore throat
  • Minor trauma
  • Altered mental status

Specific Objectives:

1. Students will provide primary contact with patients under direct faculty supervision.
   • Students will be under the supervision of ED faculty who are always present in the Emergency Care Center
   • The history, physical examination and differential diagnosis will be presented to the faculty at each patient encounter. This will establish a teaching dialogue between faculty and student.
2. Medical history and physical examination skills will be improved.
   • The opportunity for bedside teaching regarding history-taking and physical examination skills will be avail- able at each student/patient encounter.
3. Students will learn to perform a focused history and physical examination pertinent to what is needed for their patients.
   • The concept of a focused history and physical examination as it relates to the “Chief Complaint” is integral to the practice of Emergency Medicine and will be taught to all students.
   • Students will be taught to perform a rapid but thorough physical examination.
4. General medical knowledge and disease-specific information for common and major medical problems treated :
   • Students will utilize a variety of resources including standard texts and computer-based resources to enhance their knowledge of specific disease processes as they are encountered.
   • Hands-on workshops will be presented covering a variety of Emergency Medicine topics:
     • “Wound care and suturing techniques”
     • “Basic Splinting”
     • “Intubation and Emergency Airway Skills”
     • “Cervical Spine Evaluation”
     • “Emergency Procedures”
     • “Medical Record Documentation”
   • Students will also attend the weekly department lecture series covering Core Emergency Medicine topics
     • Altered Mental Status
     • Approach to Poisoning
     • Approach to Trauma
     • Chest Pain
     • Shock
     • Respiratory Failure
     • Common Infections
     • Emergency Psychiatry
     • Abdominal Pain in the Emergency Department
     • Gynecologic Disorders and Emergencies
     • Medical-Legal Aspects of Emergency Medicine
     • ENT & Dental Emergencies
     • Urologic Disorders and Emergencies
     • Pediatric Emergencies
     • Dermatology in the Emergency Department
5.  Students will learn about aspects of preventative medical care.
   • The student will be educated on follow-up instructions and patient education regarding their disease process at the conclusion of each patient encounter.
   • The importance of immunization status and recommendations regarding rabies, tetanus and influenza will be emphasized during the rotation.
   • Breaking the Cycle of Domestic Violence - awareness, recognition and prevention of intimate partner abuse, child abuse and elder neglect/abuse will be highlighted during this rotation
6. Learn documentation requirements.
   • In addition to the documentation workshop, each student chart will be reviewed by a faculty member prior to disposition of the patient from the Emergency Department.
7. Exposure to effects of social, cultural and societal problems and issues on health.
   • During the rotation the student will interact with various organizations:
     • LSUHSC Social Services
     • LSUHSC Pastoral Care
     • Adult and Child Protective Services
     • YWCA Spouse Abuse and Domestic Violence Program
     • The Rape Crisis Center
     • STEPS Chemical Dependency Detox Program
     • Animal Control Center
     • Louisiana Poison Control Center
     • Shreveport/Bossier Rescue Mission
     • Alcoholic’s Anonymous

• Emergency Department Clinical Area
• Small group workshops
• Library
• Conferences
• One-on-One Faculty Interaction

• All Emergency Department Faculty Attendings

Texts:

• Study Guide of Emergency Medicine- Judith Tintinalli.
• Emergency Medicine- Concepts and Clinical Practice- Peter Rosen.
• 5-Minute Emergency Medicine Consult.
• e-Medicine, web-based emergency medicine text- Adler and Plantz. (This peer reviewed, web-based text will be utilized at the bedside at the time of each patient encounter. This will foster the development of lifelong learning skills in the student.)

Workshops:

• “Wound care and suturing techniques” - will provide students with the basic skills required for management of routine wounds seen in the ED setting.
• “Basic Splinting” - will teach students how to apply splinting material and manage many common orthopedic injuries.
• “Intubation and Emergency Airway Skills” - this workshop will teach students to recognize situations of potential airway compromise and develop the motor skills required to obtain a secure airway in the emergent situation.
• “Cervical Spine Evaluation” - will explore physical examination findings, mechanisms of injury and radiographic evaluation of the cervical spine in the trauma setting.
• “Emergency Procedures” - will teach indications, contraindications, risks, complications, techniques and landmarks for several emergency procedures including central venous access, lumbar puncture, thoracostomy and arterial access.
• “Medical Record Documentation” - this workshop will introduce the student to the computerized documentation system utilized in the ED and emphasize important medical/legal aspects of ED charting.
• Lumbar puncture workshop

Hands-on Experience:

• Bedside supervision of physical examinations and simple procedures will be provided by the Faculty after the student has shown proficiency in the practice workshops.

Directed Readings:

• Emergency Medicine: A comprehensive Study Guide - Companion Handbook, David Cline (recommended)

Self-Directed Learning:

• Each student will be required to demonstrate independent life-long learning skills by presenting a brief case-based, oral presentation to a faculty member prior to completion of the rotation.

• A skills completion form will be maintained and checked as the student masters each required skill in the workshops listed above.
• Subjective - a comprehensive faculty evaluation form will be completed for each student at the conclusion of the selective.