OUTLINE FOR DESCRIPTION OF ROTATION

ROTATION: Emergency Room/Department

PRECEPTORS: Dr. Michael Sore & ER Physicians

DURATION: One Month

1. GOALS/OBJECTIVES OF ROTATION:

--- Develop knowledge and skills needed to recognize and treat emergency situations.

--- Develop skills in resuscitation including intubation, central lines, chest tube placement, CPR, and ACLS.

--- Develop suturing techniques for common lacerations.

--- Learn a family practitioner's role in the Emergency Department

--- Improve skills of interpreting radiologic films

--- Learn a family medicine approach to assessing and intervening with psychological and social issues that commonly present in the ER.

2. EXPECTATIONS OF ROTATION:

--- Spend 15 days per month working shifts in the ER, shifts vary:

--- (1) Friday or Saturday night from 9:00 p.m. to 6:00 a.m.

--- (9) weekday shifts 9:30 a.m. to 7:30 p.m.

--- (3) weekend shifts from 10:00 a.m. to 9:00 p.m.

--- (2) night shifts 6:00 p.m. to 3:00 a.m.

*See call section for scheduling details (item #9)

--- Document each shift and provide a summary of all shifts done to the ER physician doing your evaluation and to the faculty liaison doing your evaluation (include shift times; number, age/sex, major diagnosis of patients).

--- See patients, order appropriate studies, formulate a diagnosis and plan, and then staff with the attending ER physician.

--- For patients being admitted, if you are asked to contact a medical staff member by phone, tell the physician that:

--- You are a resident on the ER rotation;

--- You are calling concerning an admission and that the case has been reviewed with an ER physician. Then present the case and state the reasons why admission is thought to be necessary.

--- Take an active role in codes and other emergency situations under the supervision of ER physician.

--- Check in daily with Logician for patient care issues. Evening sign-out to the Family Practice Resident On Call for family practice patients is permitted.

--- Present one topic of choice for one Morning Report or Educational Conference, see suggested list, case-based is preferred. Any other interesting or challenging case is also acceptable.

3. SUGGESTED PREPARATION/REFERENCES:

--- Practice suturing skills prior to starting rotation. Review ACLS and all of the algorithms prior to starting rotation. Review treatment of status asthmaticus, treatment of coma, status epilepticus, treatment of chest pain, triage of multiple trauma and assessment of domestic violence prior to starting rotation. Curriculum Coordinator will put the syllabus in your mailbox approximately two weeks prior to rotation; meet for orientation with ER liaison faculty (Dr. Michael Sore, or his designate) prior to the first day of the rotation. This is critical to arrange in advance, since the day you start there may not be time to orient you if things are busy. You should discuss how to keep the ER flow running smoothly.

4. TYPICAL DAY/WEEK:

--- Will see patients throughout the shift as they arrive - you will usually be busy. As trauma or other emergency patients arrive, you should become involved in their care. Work out with ER attending and triage nurse types of patients you want to pick up.

5. WORKUPS/WRITEUPS:

--- All patients must be staffed with an ER attending. All orders should be reviewed with an ER attending before handing them off to nursing. This includes any important medications for which you give a verbal order. Nursing has been instructed to verify all verbal orders with an attending physician.

-- Responsible for writing up the ER chart thoroughly and efficiently and then having ER attending co-sign your note.

6. PROCEDURES:

--- Oral and nasotracheal intubation, managing codes, placing central lines, fine-tuning suturing skills. Will reduce simple dislocations, and learn splinting and casting. The attached procedure documentation list gives examples of procedures with which you should try to obtain some experience.

--- Document all procedures done in the ER and then add them to New Innovations.

7. AVAILABLE EDUCATIONAL EXPERIENCES/CONFERENCES:

--- You are expected and encouraged to attend all regular morning conferences and Wednesday educational conferences. You MUST attend any required PGY-1 conferences. You are encouraged to research and discuss a theme topic with the ER attending each shift and document in shift summary. You should also try to read and review as much of the ER syllabus packet as possible during the rotation.

8. IMPACT OF OFFICE SCHED/CONFERENCES/FAMILY PRACTICE MORNING ROUNDS:

--- Generally able to easily make all FP scheduled meetings, clinics, etc.

9. CALL AND SHARED CALL:

--- Residents will make out their own schedules, present them well in advance to Dr. Douglas for review; they will then be forwarded to the Curriculum Coordinator. Please note: No three consecutive 12 hour shifts; minimum 9 hours between shifts. Avoid scheduling shifts that overlap into Wednesday afternoon conferences or PGY-1 lectures unless this is absolutely unavoidable.

--- When two residents are rotating on the ER rotation in the same block, AVOID OVERLAPPING scheduled shifts. This has been specifically requested by the ER physicians in order to maximize supervision and your educational experience.

10. WEEKEND REQUIREMENTS:

--- (4) Four shifts. (see above)

11. VACATION/TIME OFF:

--- May take one week vacation with reduction of total shifts to twelve (three of which are weekend shifts).

12. STRENGTHS:

--- Busy emergency room with many procedures available. Preceptors easy to work with

--- They allow much participation. Evaluations of preceptors have shown eagerness to teach. Your eagerness to perform procedures will be rewarded with more procedure experience.

13. WEAKNESSES:

--- When busy, finding time for didactics may be challenging. Preceptors may have different styles of practice.

--- Some allow more independence than others.

Revised: 6/1/05 – LOD:lmc

Suggested Theme Topics

for Emergency Room Experience

· Chest Pain

· Shortness of Breath

· Headache

· Febrile Infant

· Lacerations

· ACLS

· ATLS

· Fractures

· GI and GYN

· Bleeding

· Cough

· Poisoning

· PID

· Eye Complaints

· Epistaxis

· Abdominal Pain

· Arrhythmia’s or Palpitations

· Hypertensive Crisis

· Change in Mental Status or Altered Consciousness

· Alcohol Overdose and Withdrawal Symptoms

· Seizure

· Allergic Reaction

· Endocrine Emergencies

· Burns

· Radiology

· Near Drowning

· Acute Back and Neck Strain

· Dentistry in the ER

· Insulin Therapy - Acid Base Management - Fluid Replacement - Electrolyte Therapy - Steroid Therapy

· Psychiatry - Depression, Suicide, Acute Psychosis, Drug Reactions, Acute Anxiety, Hyperventilation; State Statutes and Transfer

· Domestic Violence - Assessment and Intervention

· Child Abuse - Assessment and Intervention

· Sexual assault

· The role of drugs and alcohol intoxication and injury

· Inappropriate use of the ER – malingering, psychosomatic, and non-emergent problems

LRM:ejb

Revised: 09/06/2001 LOD

Reviewed: 6/1/05 – LOD:lmc