Emergency Medicine Elective Curriculum

Department:  Emergency Medicine
 
Faculty Director: Ramano Sprueil, M.D
 
Hospital: Texas Health Presbyterian Hospital Dallas
 
Offered: All
 
Length of Rotation: 4 weeks
 
Maximum number of residents: 1 (PGY-2 or PGY-3)
 
First Day Contact: Ramano Sprueil - (972) 567-6782
 
First Day Time: To be arranged. (Review Orientation Notes)
 
First Day Place: Presbyterian Hospital Emergency Room

1. Course Description:

The resident will work in the Emergency Room of Texas Health Presbyterian Hospital Dallas.  The resident will be responsible for first-line evaluation, management and disposition of patients in the emergency room. The resident will be exposed to a diversity of cases, which will provide the resident with a wide experience in Emergency Medicine.  The resident will have constant supervision and communication with the emergency room attending.  The ACGME duty hour requirement will be strictly followed.

2. Course Goals and Objectives: (based on ACGME competencies for resident education and modified for medical student education)

Patient Care: Residents are expected to provide care that is compassionate, appropriate and effective for the promotion of health, prevention of illness, treatment of disease and at the end of life.

Objectives:

• Gather accurate, essential information from all sources, including medical interviews, physical examinations, medical records and diagnostic/therapeutic procedures.  Examples: The resident will perform a problem-based history and physical and make appropriate diagnostic and therapeutic decisions on a patient in the emergency room.
   
• Make informed recommendations about preventives, diagnostic and therapeutic options and interventions that are based on clinical judgment, scientific evidence, and patient preference.  Examples: In the emergency room setting, the resident will make decisions about admission or discharge, will educate patient regarding signs or symptoms for which to return to the ER or how to get appropriate follow-up after discharge from the ER.  The resident will need to apply his/her clinical judgment to the efficient and effective management of the patient.  In the ER, the resident will need to be sensitive to cross-cultural issues and religious preferences when it comes to evaluation and treatment.
    
• Develop, negotiate and implement effective patient management plans and integration of patient care.
  Example:  See above.
  
  
• Perform competently the diagnostic and therapeutic procedures considered essential to the practice of internal medicine. Examples: In the ER the resident should perform ACLS, airway management, lumbar puncture, thoracentesis, paracentesis, arterial puncture, central line placement, joint aspiration, nasogastric tube placement, cervical smear and culture for infection.
  
  

Medical Knowledge: Residents are expected to demonstrate knowledge of established and evolving biomedical, clinical and social sciences, and the application of their knowledge to patient care and the education of others.

Objectives:

• Apply an open-minded, analytical approach to acquiring new knowledge.  Examples: In the ER, the resident will be exposed to areas outside of Internal Medicine, including trauma, pediatrics, obstetrics and gynecology, surgery.  He/she should learn the important disease states that present to the ER in these areas, the method of evaluation and emergency management of these areas.
   
• Access and critically evaluate current medical information and scientific evidence.  Examples:  In the ER, the resident should assess the literature regarding current guideline management of chest pain, asthma exacerbation, syncope, coma, abdominal pain, delirium, headache, stroke, hypertensive emergency, hypotension due to hypovolemeia, sepsis syndrome, cardiac arrest, ACLS protocol for unstable rhythms, pain, hip fractures, stabilization of the trauma patient.
  
  
• Develop clinically applicable knowledge of the basic and clinical sciences that underlie the practice of internal medicine. Examples: In the ER, the resident should understand the cardiovascular physiology in order to understand the pathophysiology of hypotension or hypertenison, understand the physiology of pain and the pharmacology of the drugs used to manage pain in order to relive pain, etc.
  
  
• Apply this knowledge to clinical problem-solving, clinical decision-making, and critical thinking. Examples:  Management of shock, hypertesnive emergency, pain from a fractured hip, etc.

Practice-Based Learning and Improvement: Residents are expected to be able to use scientific evidence and methods to investigate, evaluate, and improve patient care practices:

Objectives:

• Identify areas for improvement and implement strategies to enhance knowledge, skills, attitudes and processes of care. Examples: In the ER, the resident should identify a process of care that could be improved with improved knowledge and use of personnel in the ER such as the cost effective, evidence based management of delirium; the cost-effective, evidence based management of acute abdominal pain, etc.
  
  
• Analyze and evaluate practice experiences and implement strategies to continually improve the quality of patient practice. Examples:  See above.
  
  
• Develop and maintain a willingness to learn from errors and use errors to improve the system or processes of care. Examples: In the ER, the resident should review carefully missed or incorrect diagnoses, inappropriately ordered tests or treatments and review the literature to improve his/her knowledge in those areas.
   
• Use information technology or other available methodologies to access and manage information, support patient care decisions and enhance both patient and physician education.  Examples: Use of electronic information system available in the ER to all residents.
  
  

Interpersonal and Communication Skills : Residents are expected to demonstrate interpersonal and communication skills that enable them to establish and maintain professional relationships with patients, families and other members of health care teams.

Objectives:

• Provide effective and professional consultation to other physicians and health care professionals and sustain therapeutic and ethically sound professional relationships with patients, their families, and colleagues.  Examples: The resident in the ER will maintain a professional relationship with his/her attending, communicating important medical information to him/her on an ongoing basis; the resident will communicate with the patient's primary care physician, the admitting physician, and/or the consultant to facilitate the patient care; the resident will maintain professional behavior at all times when dealing with the patient in the ER.
  
  
• Use effective listening, nonverbal, questioning, and narrative skills to communicate the patients. Examples: The resident will have ample and repeated opportunity to practice these skills in the ER.
  
  
• Interact with consultants in a respectful, appropriate manner.  Examples: See above.
  
  
• Maintain comprehensive, timely, and legible medical records.  Examples:  Maintenance of ER record in an ongoing fashion during the patient’s stay in the ER.

Professionalism:  Residents are expected to demonstrate behaviors that reflect a commitment to continuous professional development, ethical practice, an understanding and sensitivity to diversity and a responsible attitude toward their patients, their profession, and society.

Objectives:

• Demonstrate respect, compassion, integrity, and altruism in relationships with patients, families, and colleagues.  Examples: See above.
  
  
• Demonstrate sensitivity and responsiveness to the gender, age, culture, religion, sexual preference, socioeconomic status, beliefs, behaviors and disabilities of patients and professional colleagues. Examples: See above.
  
  
• Adhere to principles of confidentiality, scientific/academic integrity, and informed consent. Examples: See above.
  
  
• Recognize and identify deficiencies in peer performance.

Systems-Based Practice: Residents are expected to demonstrate both an understanding of the contexts and systems in which health care is provided, and the ability to apply this knowledge to improve and optimize health care.

Objectives:

• Understand, access and utilize the resources, providers and systems necessary to provide optimal care. Examples:  The ER provides an environment where working with team members, including nursing, respiratory therapy, and social work to facilitate the care of the patient is of utmost importance.  The efficient response of other departments is also important including radiology and laboratory.
  
  
• Understand the limitations and opportunities inherent in various practice types and delivery systems, and develop strategies to optimize care for the individual patient.  Examples: The resident in the ER will learn how to arrange follow-up for all patients seen, understanding how to access the limited resources available to the patient without insurance or without a primary care physician.
  
  
• Apply evidence-based, cost-conscious strategies to prevention, diagnosis, and disease management.
  Examples: See above.
  
  
• Collaborate with other members of the health care team to assist patients in dealing effectively with complex systems and to improve systematic processes of care.  

III. Methods of instruction:

1. Didactic (schedule, topic, faculty)

Daily residents conference 12:00-1:00 p.m. - IM Training Room
Wednesday mornings 7:30-8:00 a.m. - Clinical Ground Rounds - IM Training Room
Wednesday afternoons 12:15-1:00 p.m. - Internal Medicine Update - Haggar Hall


2. Clinical

Residents are assigned to an Emergency Medicine physician. The resident is expected to work with the physicians. Residents are expected to attend every noon conference, except when they are working night shifts.