Emergency Med Eval

Faculty Chair:

Leandrita Ortega, MD

Contacts:

Gregory Roth, MD

Kerry Stuart, RN

Required Experinces:

Gerald Champion Medical Center Emergency Department

Optional Experience:

1. ATLS, ACLS, ALSO, PALS, NALS

2. Rotation at a trauma center in the University of New Mexico or University Medical Center in El Paso.

3. Wilderness medicine rotation.

4. Assist with NM National Guard combat life support training.

Weekly Schedule:

*Resident will be required to schedule ten 12 hour shifts in the Emergency Department during the 4 week rotation. Two of these shifts should be scheduled on the weekend and 2 should be overnight.

Requirements:

AOA

Emergency Medicine

The program must provide at least eight weeks of training in emergency medicine, including at least four weeks of training during the OGME-1 year.

At a minimum emergency medicine training shall include:

• Didactic and clinical training.
• Triage emergency patients of all ages.
• Certification in ACLS.
• Stabilize and provide initial treatment for medical emergencies.
• Stabilize and provide initial treatment for surgical emergencies.
• Stabilize and provide initial treatment for psychiatric emergencies.
• Stabilize and provide initial treatment for pediatric emergencies.

ACGME

Residents must have emergency department experience. (Core)

Residents must have at least 200 hours (or two months) or 250 patient encounters dedicated to the care of acutely ill or injured adults in an emergency department setting.

Description of Rotation or Educational Experience

Resident will work in the emergency department for 32 hours per week. Residents are encouraged to perform as many procedures as possible such as laceration repairs, intubations, line placement, and thoracentesis. Residents should participate in as many resuscitation efforts as possible, assuming different roles as possible with the final aim at being able to run a code and perform all tasks necessary during ACLS. Residents should also become comfortable doing primary and secondary trauma surveys.

The resident will also become familiar with the throughput of the ED and importance of initial workup of the ED patient and determining the appropriateness of need for admission or discharge with appropriate follow-up.

Expectations:

Residents:

Resident are expected to be prompt, cooperative and behave in a professional manner. If for some reason a shift needs to be changed they need to inform both the ER and Family Medicine staff. They are expected to be cooperative with the ER staff and attendings. The resident are encouraged to be proactive in seeking out procedures and challenging cases. Residents will need to maintain procedure logs.

Faculty:

The family medicine attendings will provide precepting of urgent care patients in the residents continuity clinic. Dr. Roth, other physicians, and mid-level providers will provide precepting during the actual emergency rotation. The preceptors and family medicine faculty are expected to allow the resident to participate and perform relevent procedures. Preceptors are expected to allow time for resident education and questions. Sometimes due to the emergent nature of some cases, the resident teaching may need to occur after the actual event.

Call:

There is no call specific to this rotation.

Patient Care

Goal

Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to:

Competencies

• Demonstrate an ability to rapidly assess and gather information pertinent to the care of patients in an urgent and emergent situation and develop treatment plans appropriate to the stabilization and disposition of these patients. (Patient Care, Medical Knowledge)
• Be able to identify the indication and perform procedures appropriately for the stabilization of the patient in an urgent and emergent care setting. (Patient Care, Medical Knowledge)

Objectives

• Obtain and report developmentally, age and presentation/setting appropriate history
• Perform and report developmentally, age and presentation/setting appropriate physical examination
• Generate an appropriate differential diagnosis
• Make informed decisions about diagnostic and therapeutic interventions based on patient information and preferences, up-to-date scientific evidence, and clinical judgment
• Develop and carry out patient management plans
• Document patient care in appropriate record system and maintain essential components of the patient’s record of care
• Counsel and educate patients and their families in a clear, respectful and culturally conscious manner
• Use information technology to support patient care decisions and patient education
• Perform appropriate procedures, with attention to consent, technique, patient comfort and follow-up
• Cardiopulmonary resuscitation
• Advanced cardiac life support
• Airway control
• EKG interpretation
• Peripheral IV
• Central line
• Intra-osseous fluid access
• Laceration repair
• Splinting/Immobilization
• Incision/Drainage
• Lumbar Puncture
• Gastric lavage
• Nasal packing
• ABG’s interpretation
• X-ray interpretation: CXR, abdominal, C-spine, extremity
• Slit lamp exam
• Wet prep
• Mental status examination

Medical Knowledge

Goal

Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. Residents are expected to:

Competencies

• Demonstrate an ability to rapidly assess and gather information pertinent to the care of patients in an urgent and emergent situation and develop treatment plans appropriate to the stabilization and disposition of these patients. (Patient Care, Medical Knowledge)
• Be able to identify the indication and perform procedures appropriately for the stabilization of the patient in an urgent and emergent care setting. (Patient Care, Medical Knowledge)

Objectives

Knows and applies basic and clinical knowledge in principles of emergency care and emergency medical services

• Trauma: initial assessment & stabilization
• Shock
• Toxicologic Emergencies
• Environmental Emergencies
• Sexual assault
• Child abuse
• Chest pain evaluation
• Arrhythmias
• Hypertensive urgencies & emergencies
• Pulmonary edema
• Acute asthma
• Pulmonary embolus
• Pneumonia
• Pneumothorax
• Dyspnea
• Upper airway obstruction/Stridor
• Ketoacidosis
• Hypoglycemia
• Electrolyte Abnormalities
• Acid base abnormalities
• Acute GI bleed
• Diarrhea and dehydration
• Abdominal pain
• Altered mental status & coma
• Headache
• Cerebral vascular accident/TIA
• Meningitis
• Seizures
• Suicidal and homicidal evaluation
• Acute psychosis
• Urinary tract infections
• STDs
• Epididymitis
• Nephrolithiasis
• Pelvic inflammatory disease
• Pregnancy related: ectopic, first or third trimester bleeding
• Strains/sprains/fractures/dislocations
• Septic joint
• Soft tissue injury/infection
• Fever evaluation in an infant
• Red eye evaluation
• Eye trauma
• Epistaxis
• Foreign body: ingestion, eye, nasal
• Dental emergencies

Practice- Based Learning and Improvement

Goal

Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning. Residents are expected to develop skills and habits to be able to:

Competencies

• Participate in the education of patients, families, students, residents and other health professionals, as documented by evaluations of a resident’s teaching abilities by faculty and/or learners
• Demonstrate an ability to learn from experience, utilize electronic-based resources, self-analysis of practice patterns and participate in peer review of practice patterns. (Practice-based Learning, Improvement)

Objectives

• Recognizes his/her own strengths and limitations
• Asks questions as an engaged, critical learner
• Uses information technology to manage information, access on-line medical information, and support their own education

Systems Based Practice

Goal

Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care. Residents are expected to:

Competencies

• Work in interprofessional teams to enhance patient safety and improve patient care quality
• Participate in identifying systems errors and in implementing potential systems solutions
• Acquire the requisite skills in appropriate utilization of the resources available in the urgent and emergent care setting, including laboratory, radiology, ancillary services and consultations with specialists (including transfer to a higher level of care). (Systems-based Practice)

Objectives

• Practices cost-effective health care and resource allocation that does not compromise quality of care
• Advocates for quality patient care and assist patients in dealing with system complexities to minimize discomfort or confusion

Professionalism

Goal

Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles. Residents are expected to demonstrate:

Competencies

• Sensitivity and responsiveness to a diverse patient population, including but not limited to diversity in gender, age, culture, race, religion, disabilities, and sexual orientation
• Appropriately inform, educate and elicit patient and family participation in medicaldecision making in a professional and caring manner with sensitivity to cultural and ethnic diversity. (Professionalism, Interpersonal, Communication Skills)

Objectives

• Accepts responsibility for patient care
• Never misrepresents patient care information
• Consistently performs in a punctual, reliable and collegial manner
• Demonstrates dress, hygiene and manner of speech that consistently reflect appropriate standards

Interpersonal and Communication Skills

Goal

Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. Residents are expected to:

Competencies

• Communicate effectively with physicians, other health professionals, and health related agencies
• Appropriately inform, educate and elicit patient and family participation in medicaldecision making in a professional and caring manner with sensitivity to cultural and ethnic diversity. (Professionalism, Interpersonal, Communication Skills)

Objectives

• Makes organized and effective oral presentations
• Communicates with the patient, family and members of the healthcare team in a timely, developmentally and culturally appropriate manner
• Uses information technology to effectively communicate with all components of the health care team
• Works effectively and respectfully with others as a member or leader of a health care team or other professional group
• Provides appropriate information to consultants or admitting physicians on ED patients.

Teaching Methods

Residents will provide medical care to patients under the direct supervision of the attending physician. They will be supervised on all procedures performed in the hospital. The will participate in weekly conferences. Residents will be assigned specific reading topics to be completed by the end of their month on the service.

Assessment Method (residents)

Direct observation with a final global assessment based on the REDI system. All procedures will be recorded on New Innovations.

Assessment Method (Program Evaluation)

Residents will be provided with an evaluation of their experiences and given the opportunity to provide feedback of the rotation during their quarterly IEP assessments.

Level of Supervision

The resident is directly supervised by the attending physician during all procedures performed in the hospital. An Attending will be available the entire time the resident is on service.

Educational Resources

Readings:

Text Books:

Websites

The American Board of Emergency Medicine http://www.abem.org

The American College of Emergency Physicians http://www.acep.org

The Centers for Disease Control http://www.cdc.gov

The Centers for Disease Control- Emergency Preparedness and Response http://emergency.cdc.gov/