Emergency Department

Educational Purpose:

This rotation is designed to give the Internal Medicine residents exposure to the clinical practice of Emergency Medicine. The resident will have first contact responsibility for an unselected patient population which ranges across adult medicine and surgical illnesses. Each patient will be reviewed with an experienced Emergency Department attending physician.

Goal: Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. 

Residents are expected to:

PGY 1

1. To recognize acutely ill patients in the Emergency Department setting and to initiate initial treatment including assessing airways, respiratory status, and circulation.

2. To appreciate the acute presentation of undifferentiated cardiac, pulmonary, GI and other medical syndromes.

3. To refine focused history and physical examination skills.

4. To learn decision-making skills for determining the need for hospitalization.

5. To learn emergency procedures, including endotracheal intubation, central venous access placement, suturing and repair of lacerations, nasogastric tube placement and Foley catheter placement.

PGY 2 and 3

1. To recognize acutely ill patients in the Emergency Department setting and to initiate initial treatment including assessing airways, respiratory status, and circulation.

2. To appreciate the acute presentation of undifferentiated cardiac, pulmonary, GI and other medical syndromes.

3. To refine focused history and physical examination skills.

4. To learn decision-making skills for determining the need for hospitalization.

5. To learn emergency procedures, including endotracheal intubation, central venous access placement, suturing and repair of lacerations, nasogastric tube placement and Foley catheter placement.

Medical Knowledge Goals and Objectives:

Goal: Residents must demonstrate knowledge of established and evolving biomedical, clinical, epidemiological, and social-behavioral sciences, as well as the application of this knowledge to patient care. 

Residents are expected to:

PGY 1

1. To understand the management of toxic ingestions, intoxication, and drug overdoses.

PGY 2 and 3

1. To understand the management of toxic ingestions, intoxication, and drug overdoses.

Practice-Based Learning and Improvement Goals and Objectives:

Goal: Residents must demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and life long learning.

Residents are expected to develop skills and habits to be able to:

PGY 1

PGY 2 and 3

Systems Based Practice Goals and Objectives:

Goal: Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care.

Residents are expected to:

PGY 1

PGY 2 and 3

Professionalism Goals and Objectives:

Goal: Residents must demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles.

Residents are expected to demonstrate:

PGY 1

PGY 2 and 3

Interpersonal and Communication Skills Goals and Objectives:

Goal: Residents must demonstrate interpersonal and communication skills that result in the effective exchange of information and teaming with patients, their families, and professional associates. 

Residents are expected to:

PGY 1

PGY 2 and 3

Teaching Methods:

The majority of teaching is case-based at the time of the patient encounter. All patients are initially evaluated by the resident and then are reviewed with the attending physician. Salient teaching points are discussed at that time. There are two to four required conferences/lectures each week held at 8 a.m. at change of shift. The resident is expected to participate actively in these while the Emergency Department attending physician is responsible for patient care during that time. These lectures focus on common areas in Emergency Medicine that the resident would not ordinarily be exposed to on other rotations. 

Mix of Diseases and Pathological Material:

Residents care for patients with a wide variety of clinical entities including diabetes, hypertension, hyperlipidemia, coronary artery disease, CVAs, CHF, COPD, asthma, GERD, acute pancreatitis, chronic renal insufficiency, dementia, arthritis, UTIs, bronchitis, and many others.

Patient Characteristics:

Residents care for a diverse patient population with respect to age, ethnicity, and gender. The majority of the patients are older adults, but there are significant numbers of adolescent and young adult patients in some sites. In addition, residents are exposed to trauma patients and OB/GYN patients.

Types of Clinical Encounters:

Residents see patients in an Emergency Room setting for both acute and subacute issues.

Procedures and Services:

Procedural skills that need to be acquired include advanced cardiac life support, arterial puncture, intubation and mechanical ventilation, placement of arterial and central venous lines, paracentesis, thoracentesis, use of point of care ultrasound.The resident will be able to interpret hemodynamic monitoring, pulse oximetry, and telemetry. The trainee needs to know when to order certain tests and have a working knowledge of the meaning of these tests. These include CT of the chest and abdomen, CT and MRI of the brain, coronary angiography, echocardiography, and electroencephalography.

Supervision:

All clinical activities are closely supervised by an attending. There is sometimes a PGY 3 Internal Medicine resident on elective rotation who participates in this supervision. 

Educational Resources to be Used and Reading Lists:

Educational resources for the rotation include the ED syllabus handed out on the first day of the rotation, Emergency Medicine texts on-site, and a complete array of specialty specific texts. Additionally, the MUSC library website is available 24 hours a day with online texts, journals, and search engines.

Method of Evaluation of Resident Competence:

Each patient is checked out to the attending physician on duty. At that time appropriate diagnosis and therapy will be decided upon and recommendations given to the patient prior to their leaving the hospital. The attending will also review chart documentation prior to their signing off on that record. Patient Care is assessed based on direct observation and complete review of all records. Medical Knowledge is assessed through direct questioning and observation. Interpersonal Skills and Communication is assessed by observation of interactions with consulting physicians, patients, and families. The attending physician evaluates Professionalism through direct interaction and observation of the resident. Systems-Based Practice is evaluated based on interactions with the primary team and the ability to provide medical care in the emergency room setting. Practice-Based Learning is evaluated based on the ability to consult the literature and to improve their performance throughout the rotation. At the conclusion of the rotation a consensus evaluation will be generated for that resident based on their interaction with the full-time attending physicians. This evaluation of each competency is entered into the E*Value system.

At the end of the rotation, the resident is sent a letter asking his impressions of the rotation and faculty. Results are reviewed by the Emergency Department Director and feedback then given to each attending as appropriate. Formal evaluation takes place on E*Value.