PACE New Clerkship Proposal: Emergency & Urgent Care Clerkship

PACEPACENew Clerkship Proposal:New Clerkship Proposal:

Emergency & Urgent CareEmergency & Urgent CareClerkshipClerkship

USF Curriculum Committee RetreatUSF Curriculum Committee RetreatDecember 16, 2004December 16, 2004

Emergency & Urgent Care Emergency & Urgent Care ClerkshipClerkship

Clerkship Development Subcommittee Clerkship Development Subcommittee MembersMembers

Charlotte Derr, MDCharlotte Derr, MD Emergency MedicineEmergency Medicine Jeff Fabri, MDJeff Fabri, MD GME/SurgeryGME/Surgery Steven Goldin, MDSteven Goldin, MD SurgerySurgery Richard Hoffmann, MDRichard Hoffmann, MD Internal MedicineInternal Medicine Chester Kokseng, MDChester Kokseng, MD Internal MedicineInternal Medicine Kelly O’Keefe, MDKelly O’Keefe, MD Emergency MedicineEmergency Medicine David Orban, MDDavid Orban, MD Emergency MedicineEmergency Medicine Marion Ridley, MDMarion Ridley, MD OtolaryngologyOtolaryngology Damian CaraballoDamian Caraballo MS-IIMS-II Janelle FauciJanelle Fauci MS-IIMS-II Brooke ShepardBrooke Shepard MS-IVMS-IV Corinne StobaughCorinne Stobaugh MS-IIMS-II


Subcommittee Subcommittee MeetingsMeetings

October 7, 2004October 7, 2004 October 14, 2004October 14, 2004 October 21, 2004October 21, 2004 October 28, 2004October 28, 2004 November 4, 2004November 4, 2004


Previous Designations:Previous Designations: Special Sites of CareSpecial Sites of Care Special Sites of Care & Special Sites of Care &

ProceduresProcedures Sites of Care & ProceduresSites of Care & Procedures Sites of CareSites of Care Triage & Urgent CareTriage & Urgent Care Triage, Urgent Care & Triage, Urgent Care &

ProceduresProcedures Emergency Care & ProceduresEmergency Care & Procedures


Brief Summary:Brief Summary:A required four-week clerkship for all A required four-week clerkship for all

third-year medical students based on third-year medical students based on encounters with patients presenting with encounters with patients presenting with emergent and urgent complaints and/or emergent and urgent complaints and/or symptoms prior to definitive diagnosis, symptoms prior to definitive diagnosis, and the development of competence in and the development of competence in basic medical procedures.basic medical procedures.


Expected OutcomesExpected Outcomes1.1. Ability to perform a symptom-Ability to perform a symptom-

directed history and physical directed history and physical examination of patients upon initial examination of patients upon initial presentation in emergency and presentation in emergency and urgent care settings.urgent care settings.

2.2. Ability to institute appropriate initial Ability to institute appropriate initial management of emergent and management of emergent and urgent medical problems.urgent medical problems.


Expected OutcomesExpected Outcomes3.3. Ability to determine indicated Ability to determine indicated

additional testing and/or consultation additional testing and/or consultation for definitive care of more complex for definitive care of more complex medical problems.medical problems.

4.4. Ability to communicate effectively with Ability to communicate effectively with the broad spectrum of patients and the broad spectrum of patients and their families in order to obtain the their families in order to obtain the relevant information necessary to relevant information necessary to determine an appropriate course of determine an appropriate course of action for the patient’s care.action for the patient’s care.


Expected OutcomesExpected Outcomes5.5. Ability to perform routine medical Ability to perform routine medical

procedures:procedures:• VenipunctureVenipuncture• Intravenous line placementIntravenous line placement• Obtaining arterial bloodObtaining arterial blood• Bladder catheterizationBladder catheterization• Endotracheal intubationEndotracheal intubation• Nasogastric intubationNasogastric intubation• Lumbar puncture Lumbar puncture • Suturing of simple and deep lacerationsSuturing of simple and deep lacerations


Expected OutcomesExpected Outcomes5.5. Perform routine procedures Perform routine procedures

(continued)(continued)• Fracture splintingFracture splinting• Wound dressingWound dressing• Chest tube placementChest tube placement• ThoracentesisThoracentesis• ParacentesisParacentesis• PericardiocentesisPericardiocentesis• FAST FAST (focused assessment by sonography in (focused assessment by sonography in

trauma)trauma)


Methods for Attaining CompetenciesMethods for Attaining Competencies Didactic lecturesDidactic lectures

LiveLive Web-basedWeb-based

Skills laboratoriesSkills laboratories CadaverCadaver Patient simulatorPatient simulator VivariumVivarium

Portfolio developmentPortfolio development Procedures logProcedures log Written presentationsWritten presentations

Oral presentationsOral presentations Small group discussions/problem-solving Small group discussions/problem-solving

sessionssessions


Portfolio DevelopmentPortfolio Development 4 written presentations (1/week) on a 4 written presentations (1/week) on a

patient evaluated by the student (1 patient evaluated by the student (1 patient per group)patient per group)

1.1. Abdominal painAbdominal pain2.2. Chest painChest pain3.3. Musculoskeletal pain/traumaMusculoskeletal pain/trauma4.4. DyspneaDyspnea5.5. Common infections/feverCommon infections/fever6.6. Change in mental status/comaChange in mental status/coma7.7. HeadacheHeadache8.8. Major traumaMajor trauma


Portfolio Development (cont.)Portfolio Development (cont.) Presentations to include patient Presentations to include patient

presentation, interpretations of presentation, interpretations of laboratory tests and imaging, laboratory tests and imaging, differential diagnosis, and evidence differential diagnosis, and evidence based evaluation and treatment.based evaluation and treatment.

Maintenance of log of: Maintenance of log of: Procedures observedProcedures observed Procedures assistedProcedures assisted Procedures performedProcedures performed Diagnoses of patients evaluatedDiagnoses of patients evaluated


Integrated Longitudinal Curriculum Integrated Longitudinal Curriculum TopicsTopics

Evidence Based Medicine/Best PracticesEvidence Based Medicine/Best Practices End of Life CareEnd of Life Care EthicsEthics Pain ManagementPain Management Laboratory MedicineLaboratory Medicine Patient Safety & Medical ErrorsPatient Safety & Medical Errors Professional CommunicationProfessional Communication RadiologyRadiology System Based PracticeSystem Based Practice


Educational ObjectivesEducational ObjectivesKNOWLEDGEKNOWLEDGE

1.1. To know the appropriate use of methods and To know the appropriate use of methods and procedures for detection, diagnosis, and procedures for detection, diagnosis, and treatment of disease states at their initial treatment of disease states at their initial presentation.presentation.

2.2. To know the theories and principles that To know the theories and principles that govern ethical decision-making in the govern ethical decision-making in the emergency setting.emergency setting.

3.3. To know the components of healthcare that To know the components of healthcare that influence the organization, financing, and influence the organization, financing, and delivery of health care in hospital emergency delivery of health care in hospital emergency departments.departments.


Educational ObjectivesEducational ObjectivesSKILLSSKILLS

1.1. To perform a directed history and To perform a directed history and physical examination in the emergency physical examination in the emergency setting.setting.

2.2. To identify the indications for and To identify the indications for and interpret the results of commonly used interpret the results of commonly used diagnostic procedures in the diagnostic procedures in the emergency setting.emergency setting.

3.3. To appropriately document patient To appropriately document patient encounters in the emergency setting.encounters in the emergency setting.


Educational ObjectivesEducational ObjectivesSKILLS (cont.)SKILLS (cont.)4.4. To develop an appropriate plan of To develop an appropriate plan of

management and institute therapy management and institute therapy in the emergency and urgent care in the emergency and urgent care settings.settings.

5.5. To communicate effectively in the To communicate effectively in the care of patients.care of patients.

6.6. To assess the level of acuity and To assess the level of acuity and initiate appropriate therapy in initiate appropriate therapy in patients at initial presentation.patients at initial presentation.


Educational ObjectivesEducational ObjectivesSKILLS (cont.)SKILLS (cont.)

7.7. To perform routine medical procedures To perform routine medical procedures including venipuncture, intravenous line including venipuncture, intravenous line placement, obtaining arterial blood, placement, obtaining arterial blood, bladder catheterization, endotracheal bladder catheterization, endotracheal intubation, nasogastric intubation, intubation, nasogastric intubation, suturing of simple and deep lacerations, suturing of simple and deep lacerations, fracture splinting, wound dressing, chest fracture splinting, wound dressing, chest tube placement, thoracentesis, tube placement, thoracentesis, paracentesis, pericardiocentesis, and paracentesis, pericardiocentesis, and FAST.FAST.


Educational ObjectivesEducational ObjectivesATTITUDESATTITUDES

1.1. To advocate, be compassionate, and To advocate, be compassionate, and ameliorate suffering of patients in ameliorate suffering of patients in emergency and urgent care settings.emergency and urgent care settings.

2.2. To demonstrate honesty, integrity, To demonstrate honesty, integrity, and sensitivity in all interactions and sensitivity in all interactions with patients’ families, colleagues with patients’ families, colleagues and other health care providers.and other health care providers.


Educational ObjectivesEducational ObjectivesATTITUDES (cont.)ATTITUDES (cont.)

3.3. To incorporate the relationships of To incorporate the relationships of cost, risk, and benefit in patient cost, risk, and benefit in patient evaluation and management.evaluation and management.

4.4. To demonstrate a commitment to the To demonstrate a commitment to the ethical practice of medicine.ethical practice of medicine.

5.5. To demonstrate a commitment to To demonstrate a commitment to collaborate in a team approach for collaborate in a team approach for the care of patients.the care of patients.


Educational ObjectivesEducational ObjectivesATTITUDES (cont.)ATTITUDES (cont.)

6.6. To demonstrate a commitment to the To demonstrate a commitment to the provision of care to all patients provision of care to all patients including the underserved and to including the underserved and to promote the health of the public.promote the health of the public.

7.7. To work with patients and their To work with patients and their families in making shared treatment families in making shared treatment and health care decisions.and health care decisions.


Clerkship ComponentsClerkship Components 120 students = 10 students each rotation120 students = 10 students each rotation 2 weeks acute care emergency 2 weeks acute care emergency

department (TGH)department (TGH) 5 students5 students

2 weeks urgent care center (VA, 2 weeks urgent care center (VA, community)community) 5 students5 students

½-day orientation on first day of clerkship½-day orientation on first day of clerkship 4 eight-hour shifts/week to include day, 4 eight-hour shifts/week to include day,

evening, night and weekend assignmentsevening, night and weekend assignments 1 day/week (Friday) lecture, skills lab, 1 day/week (Friday) lecture, skills lab,

conference, oral presentationsconference, oral presentations


Major Diagnoses/Encounters RequiredMajor Diagnoses/Encounters Required Abdominal painAbdominal pain 6 patients6 patients Chest painChest pain 6 patients6 patients Extremity pain/traumaExtremity pain/trauma 6 patients6 patients DyspneaDyspnea 4 patients4 patients Common infections/feverCommon infections/fever 4 patients4 patients Change in neurologic statusChange in neurologic status 4 patients4 patients HeadacheHeadache 4 patients4 patients Major traumaMajor trauma 2 patients2 patients


Procedural Skills DevelopmentProcedural Skills Development VenipunctureVenipuncture 4 patients4 patients Intravenous line placementIntravenous line placement 4 patients4 patients Arterial punctureArterial puncture 4 patients4 patients Bladder catheterizationBladder catheterization 2 ♂, 2 ♀2 ♂, 2 ♀ Nasogastric intubationNasogastric intubation 2 patients2 patients Endotracheal intubationEndotracheal intubation Skills labSkills lab Lumbar punctureLumbar puncture Skills labSkills lab Suture lacerationsSuture lacerations 8 patients8 patients


Procedural Skills Development (cont.)Procedural Skills Development (cont.) Fracture splintingFracture splinting 4 patients4 patients Wound dressingWound dressing 8 patients8 patients Chest tube placementChest tube placement Skills labSkills lab ThoracentesisThoracentesis Skills labSkills lab ParacentesisParacentesis Skills labSkills lab PericardiocentesisPericardiocentesis Skills labSkills lab FASTFAST 2 patients2 patients


Measurement of Student Measurement of Student AccomplishmentAccomplishment

Direct observationDirect observation Patient encountersPatient encounters Procedures performedProcedures performed Oral presentations at weekly conferenceOral presentations at weekly conference Preparation and participation in group Preparation and participation in group

discussionsdiscussions Evaluation of portfolioEvaluation of portfolio Written examinationWritten examination

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PACE New Clerkship Proposal: Emergency & Urgent Care Clerkship

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