PACE New Clerkship Proposal: Emergency & Urgent Care Clerkship USF Curriculum Committee Retreat December 16, 2004

Emergency & Urgent Care Clerkship Clerkship Development Subcommittee Members Charlotte Derr, MDEmergency Medicine Charlotte Derr, MDEmergency Medicine Jeff Fabri, MDGME/Surgery Jeff Fabri, MDGME/Surgery Steven Goldin, MDSurgery Steven Goldin, MDSurgery Richard Hoffmann, MDInternal Medicine Richard Hoffmann, MDInternal Medicine Chester Kokseng, MDInternal Medicine Chester Kokseng, MDInternal Medicine Kelly O’Keefe, MDEmergency Medicine Kelly O’Keefe, MDEmergency Medicine David Orban, MDEmergency Medicine David Orban, MDEmergency Medicine Marion Ridley, MDOtolaryngology Marion Ridley, MDOtolaryngology Damian CaraballoMS-II Damian CaraballoMS-II Janelle FauciMS-II Janelle FauciMS-II Brooke ShepardMS-IV Brooke ShepardMS-IV Corinne StobaughMS-II Corinne StobaughMS-II

Emergency & Urgent Care Clerkship Subcommittee Meetings October 7, 2004 October 7, 2004 October 14, 2004 October 14, 2004 October 21, 2004 October 21, 2004 October 28, 2004 October 28, 2004 November 4, 2004 November 4, 2004

Emergency & Urgent Care Clerkship Previous Designations: Special Sites of Care Special Sites of Care Special Sites of Care & Procedures Special Sites of Care & Procedures Sites of Care & Procedures Sites of Care & Procedures Sites of Care Sites of Care Triage & Urgent Care Triage & Urgent Care Triage, Urgent Care & Procedures Triage, Urgent Care & Procedures Emergency Care & Procedures Emergency Care & Procedures

Emergency & Urgent Care Clerkship Brief Summary: A required four-week clerkship for all third-year medical students based on encounters with patients presenting with emergent and urgent complaints and/or symptoms prior to definitive diagnosis, and the development of competence in basic medical procedures.

Emergency & Urgent Care Clerkship Expected Outcomes 1. Ability to perform a symptom-directed history and physical examination of patients upon initial presentation in emergency and urgent care settings. 2. Ability to institute appropriate initial management of emergent and urgent medical problems.

Emergency & Urgent Care Clerkship Expected Outcomes 3. Ability to determine indicated additional testing and/or consultation for definitive care of more complex medical problems. 4. Ability to communicate effectively with the broad spectrum of patients and their families in order to obtain the relevant information necessary to determine an appropriate course of action for the patient’s care.

Emergency & Urgent Care Clerkship Expected Outcomes 5. Ability to perform routine medical procedures: Venipuncture Venipuncture Intravenous line placement Intravenous line placement Obtaining arterial blood Obtaining arterial blood Bladder catheterization Bladder catheterization Endotracheal intubation Endotracheal intubation Nasogastric intubation Nasogastric intubation Lumbar puncture Lumbar puncture Suturing of simple and deep lacerations Suturing of simple and deep lacerations

Emergency & Urgent Care Clerkship Expected Outcomes 5. Perform routine procedures (continued) Fracture splinting Fracture splinting Wound dressing Wound dressing Chest tube placement Chest tube placement Thoracentesis Thoracentesis Paracentesis Paracentesis Pericardiocentesis Pericardiocentesis FAST (focused assessment by sonography in trauma) FAST (focused assessment by sonography in trauma)

Emergency & Urgent Care Clerkship Methods for Attaining Competencies Didactic lectures Didactic lectures Live Live Web-based Web-based Skills laboratories Skills laboratories Cadaver Cadaver Patient simulator Patient simulator Vivarium Vivarium Portfolio development Portfolio development Procedures log Procedures log Written presentations Written presentations Oral presentations Oral presentations Small group discussions/problem-solving sessions Small group discussions/problem-solving sessions

Emergency & Urgent Care Clerkship Portfolio Development 4 written presentations (1/week) on a patient evaluated by the student (1 patient per group) 4 written presentations (1/week) on a patient evaluated by the student (1 patient per group) 1. Abdominal pain 2. Chest pain 3. Musculoskeletal pain/trauma 4. Dyspnea 5. Common infections/fever 6. Change in mental status/coma 7. Headache 8. Major trauma

Emergency & Urgent Care Clerkship Portfolio Development (cont.) Presentations to include patient presentation, interpretations of laboratory tests and imaging, differential diagnosis, and evidence based evaluation and treatment. Presentations to include patient presentation, interpretations of laboratory tests and imaging, differential diagnosis, and evidence based evaluation and treatment. Maintenance of log of: Maintenance of log of: Procedures observed Procedures observed Procedures assisted Procedures assisted Procedures performed Procedures performed Diagnoses of patients evaluated Diagnoses of patients evaluated

Emergency & Urgent Care Clerkship Integrated Longitudinal Curriculum Topics Evidence Based Medicine/Best Practices Evidence Based Medicine/Best Practices End of Life Care End of Life Care Ethics Ethics Pain Management Pain Management Laboratory Medicine Laboratory Medicine Patient Safety & Medical Errors Patient Safety & Medical Errors Professional Communication Professional Communication Radiology Radiology System Based Practice System Based Practice

Emergency & Urgent Care Clerkship Educational Objectives KNOWLEDGE 1. To know the appropriate use of methods and procedures for detection, diagnosis, and treatment of disease states at their initial presentation. 2. To know the theories and principles that govern ethical decision-making in the emergency setting. 3. To know the components of healthcare that influence the organization, financing, and delivery of health care in hospital emergency departments.

Emergency & Urgent Care Clerkship Educational Objectives SKILLS 1. To perform a directed history and physical examination in the emergency setting. 2. To identify the indications for and interpret the results of commonly used diagnostic procedures in the emergency setting. 3. To appropriately document patient encounters in the emergency setting.

Emergency & Urgent Care Clerkship Educational Objectives SKILLS (cont.) 4. To develop an appropriate plan of management and institute therapy in the emergency and urgent care settings. 5. To communicate effectively in the care of patients. 6. To assess the level of acuity and initiate appropriate therapy in patients at initial presentation.

Emergency & Urgent Care Clerkship Educational Objectives SKILLS (cont.) 7. To perform routine medical procedures including venipuncture, intravenous line placement, obtaining arterial blood, bladder catheterization, endotracheal intubation, nasogastric intubation, suturing of simple and deep lacerations, fracture splinting, wound dressing, chest tube placement, thoracentesis, paracentesis, pericardiocentesis, and FAST.

Emergency & Urgent Care Clerkship Educational Objectives ATTITUDES 1. To advocate, be compassionate, and ameliorate suffering of patients in emergency and urgent care settings. 2. To demonstrate honesty, integrity, and sensitivity in all interactions with patients’ families, colleagues and other health care providers.

Emergency & Urgent Care Clerkship Educational Objectives ATTITUDES (cont.) 3. To incorporate the relationships of cost, risk, and benefit in patient evaluation and management. 4. To demonstrate a commitment to the ethical practice of medicine. 5. To demonstrate a commitment to collaborate in a team approach for the care of patients.

Emergency & Urgent Care Clerkship Educational Objectives ATTITUDES (cont.) 6. To demonstrate a commitment to the provision of care to all patients including the underserved and to promote the health of the public. 7. To work with patients and their families in making shared treatment and health care decisions.

Emergency & Urgent Care Clerkship Clerkship Components 120 students = 10 students each rotation 120 students = 10 students each rotation 2 weeks acute care emergency department (TGH) 2 weeks acute care emergency department (TGH) 5 students 5 students 2 weeks urgent care center (VA, community) 2 weeks urgent care center (VA, community) 5 students 5 students ½-day orientation on first day of clerkship ½-day orientation on first day of clerkship 4 eight-hour shifts/week to include day, evening, night and weekend assignments 4 eight-hour shifts/week to include day, evening, night and weekend assignments 1 day/week (Friday) lecture, skills lab, conference, oral presentations 1 day/week (Friday) lecture, skills lab, conference, oral presentations

Emergency & Urgent Care Clerkship Major Diagnoses/Encounters Required Abdominal pain6 patients Abdominal pain6 patients Chest pain6 patients Chest pain6 patients Extremity pain/trauma6 patients Extremity pain/trauma6 patients Dyspnea4 patients Dyspnea4 patients Common infections/fever4 patients Common infections/fever4 patients Change in neurologic status4 patients Change in neurologic status4 patients Headache4 patients Headache4 patients Major trauma2 patients Major trauma2 patients

Emergency & Urgent Care Clerkship Procedural Skills Development Venipuncture4 patients Venipuncture4 patients Intravenous line placement4 patients Intravenous line placement4 patients Arterial puncture4 patients Arterial puncture4 patients Bladder catheterization2 ♂, 2 ♀ Bladder catheterization2 ♂, 2 ♀ Nasogastric intubation2 patients Nasogastric intubation2 patients Endotracheal intubationSkills lab Endotracheal intubationSkills lab Lumbar punctureSkills lab Lumbar punctureSkills lab Suture lacerations8 patients Suture lacerations8 patients

Emergency & Urgent Care Clerkship Procedural Skills Development (cont.) Fracture splinting4 patients Fracture splinting4 patients Wound dressing8 patients Wound dressing8 patients Chest tube placementSkills lab Chest tube placementSkills lab ThoracentesisSkills lab ThoracentesisSkills lab ParacentesisSkills lab ParacentesisSkills lab PericardiocentesisSkills lab PericardiocentesisSkills lab FAST2 patients FAST2 patients

Emergency & Urgent Care Clerkship Measurement of Student Accomplishment Direct observation Direct observation Patient encounters Patient encounters Procedures performed Procedures performed Oral presentations at weekly conference Oral presentations at weekly conference Preparation and participation in group discussions Preparation and participation in group discussions Evaluation of portfolio Evaluation of portfolio Written examination Written examination