Pace new clerkship proposal emergency urgent care clerkship
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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 Jeff Fabri, MDGME/Surgery Steven Goldin, MDSurgery

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PACE New Clerkship Proposal: Emergency & Urgent Care Clerkship

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Pace new clerkship proposal emergency urgent care clerkship

PACENew Clerkship Proposal:Emergency & Urgent CareClerkship

USF Curriculum Committee Retreat

December 16, 2004


Emergency urgent care clerkship

Emergency & Urgent Care Clerkship

Clerkship Development Subcommittee Members

  • Charlotte Derr, MDEmergency Medicine

  • Jeff Fabri, MDGME/Surgery

  • Steven Goldin, MDSurgery

  • Richard Hoffmann, MDInternal Medicine

  • Chester Kokseng, MDInternal Medicine

  • Kelly O’Keefe, MDEmergency Medicine

  • David Orban, MDEmergency Medicine

  • Marion Ridley, MDOtolaryngology

  • Damian CaraballoMS-II

  • Janelle FauciMS-II

  • Brooke ShepardMS-IV

  • Corinne StobaughMS-II


Emergency urgent care clerkship1

Emergency & Urgent Care Clerkship

Subcommittee Meetings

  • October 7, 2004

  • October 14, 2004

  • October 21, 2004

  • October 28, 2004

  • November 4, 2004


Emergency urgent care clerkship2

Emergency & Urgent Care Clerkship

Previous Designations:

  • Special Sites of Care

  • Special Sites of Care & Procedures

  • Sites of Care & Procedures

  • Sites of Care

  • Triage & Urgent Care

  • Triage, Urgent Care & Procedures

  • Emergency Care & Procedures


Emergency urgent care clerkship3

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 clerkship4

Emergency & Urgent Care Clerkship

Expected Outcomes

  • Ability to perform a symptom-directed history and physical examination of patients upon initial presentation in emergency and urgent care settings.

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


Emergency urgent care clerkship5

Emergency & Urgent Care Clerkship

Expected Outcomes

  • Ability to determine indicated additional testing and/or consultation for definitive care of more complex medical problems.

  • 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 clerkship6

Emergency & Urgent Care Clerkship

Expected Outcomes

  • Ability to perform routine medical procedures:

    • Venipuncture

    • Intravenous line placement

    • Obtaining arterial blood

    • Bladder catheterization

    • Endotracheal intubation

    • Nasogastric intubation

    • Lumbar puncture

    • Suturing of simple and deep lacerations


Emergency urgent care clerkship7

Emergency & Urgent Care Clerkship

Expected Outcomes

  • Perform routine procedures (continued)

    • Fracture splinting

    • Wound dressing

    • Chest tube placement

    • Thoracentesis

    • Paracentesis

    • Pericardiocentesis

    • FAST (focused assessment by sonography in trauma)


Emergency urgent care clerkship8

Emergency & Urgent Care Clerkship

Methods for Attaining Competencies

  • Didactic lectures

    • Live

    • Web-based

  • Skills laboratories

    • Cadaver

    • Patient simulator

    • Vivarium

  • Portfolio development

    • Procedures log

    • Written presentations

  • Oral presentations

  • Small group discussions/problem-solving sessions


Emergency urgent care clerkship9

Emergency & Urgent Care Clerkship

Portfolio Development

  • 4 written presentations (1/week) on a patient evaluated by the student (1 patient per group)

    • Abdominal pain

    • Chest pain

    • Musculoskeletal pain/trauma

    • Dyspnea

    • Common infections/fever

    • Change in mental status/coma

    • Headache

    • Major trauma


Emergency urgent care clerkship10

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.

  • Maintenance of log of:

    • Procedures observed

    • Procedures assisted

    • Procedures performed

    • Diagnoses of patients evaluated


Emergency urgent care clerkship11

Emergency & Urgent Care Clerkship

Integrated Longitudinal Curriculum Topics

  • Evidence Based Medicine/Best Practices

  • End of Life Care

  • Ethics

  • Pain Management

  • Laboratory Medicine

  • Patient Safety & Medical Errors

  • Professional Communication

  • Radiology

  • System Based Practice


Emergency urgent care clerkship12

Emergency & Urgent Care Clerkship

Educational Objectives

KNOWLEDGE

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

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

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


Emergency urgent care clerkship13

Emergency & Urgent Care Clerkship

Educational Objectives

SKILLS

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

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

  • To appropriately document patient encounters in the emergency setting.


Emergency urgent care clerkship14

Emergency & Urgent Care Clerkship

Educational Objectives

SKILLS (cont.)

  • To develop an appropriate plan of management and institute therapy in the emergency and urgent care settings.

  • To communicate effectively in the care of patients.

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


Emergency urgent care clerkship15

Emergency & Urgent Care Clerkship

Educational Objectives

SKILLS (cont.)

  • 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 clerkship16

Emergency & Urgent Care Clerkship

Educational Objectives

ATTITUDES

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

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


Emergency urgent care clerkship17

Emergency & Urgent Care Clerkship

Educational Objectives

ATTITUDES (cont.)

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

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

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


Emergency urgent care clerkship18

Emergency & Urgent Care Clerkship

Educational Objectives

ATTITUDES (cont.)

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

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


Emergency urgent care clerkship19

Emergency & Urgent Care Clerkship

Clerkship Components

  • 120 students = 10 students each rotation

  • 2 weeks acute care emergency department (TGH)

    • 5 students

  • 2 weeks urgent care center (VA, community)

    • 5 students

  • ½-day orientation on first day of clerkship

  • 4 eight-hour shifts/week to include day, evening, night and weekend assignments

  • 1 day/week (Friday) lecture, skills lab, conference, oral presentations


Emergency urgent care clerkship20

Emergency & Urgent Care Clerkship

Major Diagnoses/Encounters Required

  • Abdominal pain6 patients

  • Chest pain6 patients

  • Extremity pain/trauma6 patients

  • Dyspnea4 patients

  • Common infections/fever4 patients

  • Change in neurologic status4 patients

  • Headache4 patients

  • Major trauma2 patients


Emergency urgent care clerkship21

Emergency & Urgent Care Clerkship

Procedural Skills Development

  • Venipuncture4 patients

  • Intravenous line placement4 patients

  • Arterial puncture4 patients

  • Bladder catheterization2 ♂, 2 ♀

  • Nasogastric intubation2 patients

  • Endotracheal intubationSkills lab

  • Lumbar punctureSkills lab

  • Suture lacerations8 patients


Emergency urgent care clerkship22

Emergency & Urgent Care Clerkship

Procedural Skills Development (cont.)

  • Fracture splinting4 patients

  • Wound dressing8 patients

  • Chest tube placementSkills lab

  • ThoracentesisSkills lab

  • ParacentesisSkills lab

  • PericardiocentesisSkills lab

  • FAST2 patients


Emergency urgent care clerkship23

Emergency & Urgent Care Clerkship

Measurement of Student Accomplishment

  • Direct observation

    • Patient encounters

    • Procedures performed

    • Oral presentations at weekly conference

    • Preparation and participation in group discussions

  • Evaluation of portfolio

  • Written examination


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