The information below is specific for MUN Medical Students ( Link to the MUM UGME Website) on their Emergency Medicine Elective / Rotation:

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Link to T-RES – electronic evaluation system for Students and Faculty. The T-Res App can also be loaded onto your smart phone

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Clinical Expectations (SJRHEM Version of Dr. Eric Smiths Document)

While on duty, learners are expected to function as an integral part of the ED team, appropriate to their level of training.

• The team – You will always work with a staff ER physician.  You will often also have a resident, usually an EM PGY3, working alongside you with your staff.  You will also be working very closely with the ED nurses.  Each nurse will care for multiple patients in specific rooms; the triage whiteboard will indicate which nurse is assigned to which room.
• How to address your staff – This is often a source of stress for junior learners, but you don’t need to stress out or overthink this.  The cardinal rule is that in front of patients and other physicians, you should refer to your staff as “Dr. [last name].” When you introduce yourself to your staff, they may let you know to call them by their first name when the two of you are talking, in which case you should feel comfortable doing so.  Otherwise, just default to calling them “Dr. [last name]’ when talking to them or anyone else.
• What to wear – All learners must ensure that they wear their ID tags at all times while on shift.  There are a high number of learners rotating through the department and nurses need to be able to quickly identify who they can take orders from.  Scrubs are recommended, closed toed are required (sneakers are fine).  You are welcome to swap scrub pants for your own khakis, but keep in mind the ED can get messy. Jeans are not permitted and lab coats are not necessary.
• When you arrive for a shift – Determine from the schedule and shift time, what unit you’ll be working in that day.  Introduce yourself to one of the nurses, tell them who you are and what shift you’re working; they will direct you to the staff physician on with you that shift.

It’s imperative you show up on time. This is a professionalism expectation and it will also set the tone for the rest of your shift. Aim to be at least 5 minutes early.  If you anticipate that you will be late, you’ll need to call the nursing station of the unit you’ll be working in (call that hospital’s main switchboard and ask the operator for the unit nursing station) and let your staff know.

Once patients have been triaged and placed into a room, their chart will be placed in an area/slot designated for new patient charts.  There is also a slot for charts that have new orders on them, and chart slots for each room once those orders are processed.  On your first shift, at each new unit, ask a nurse or your staff where to find these different chart slots.  If you arrive before your staff, feel free to thumb through the new chart(s) but wait until your staff arrives before seeing your first patient. Your staff may wish to discuss expectations and preferences regarding picking up charts, reviewing patients, orders, etc. before you see a patient.

• Duties on shift – You will be seeing patients of broad spectrums of age, presentation, and acuity. Throughout the day, you will pick up/be assigned new patients for whom you will be expected to obtain a concise and relevant history and physical, document your findings, and devise a plan for investigations/treatment/disposition.  Always pay attention to the triage note and vitals.  You will review all of these with your attending physician (or resident) and will then be expected to follow-up with your patients throughout your shift, keeping an eye on the results of their investigations and reassessing their clinical response to treatments in a timely fashion.  You will generally see and review one patient at a time.  Each physician will have their own approach to diagnosis and management.  Try and learn as much as you can from different approaches.

Charting – work on charting a clear record of the pertinent positives and negatives of the case that lead toward a reasonable plan for investigation and disposition.  Be sure to formulate a plan.  Always leave some room for your staff to record their assessment on the chart as well. 

You will also have the opportunity to observe/assist/perform a number of procedural skills such as laceration repair, casting, lumbar puncture and participating in codes, to name a few. These procedures can often be an enjoyable change of pace in the department. If you are interested in helping out in procedures it is important to let your staff know, as they are more likely to involve you if they know you want to be involved.  Also remember the core procedures you are expected to complete.

When invasive or personal physical exams are indicated, such as male or female genital exams, rectal exams, or female breast exams, please identify the need for the exam in your verbal report to your attending physician but do not perform these exams independently or without discussion with your attending physician.  In most cases we will perform this exam with you in order to avoid the need to duplicate the exam.

At some point during your shift, your staff will likely send you for a meal break, depending on how busy the department is. Aim to return in 20-30 minutes. Before you go on break, let your staff know about any upcoming time-sensitive items for your patient (i.e. “this patient is waiting on a troponin”).  Beverages are permitted in the ED in travel mugs/bottles or cups with lids.  Belongings can be kept in the nursing lounge.

• Expectations of flow – As a clerk rotating through the ED, patient flow is chiefly your staff’s responsibility, not yours.  Your job is to gather a solid history and physical, generate a thoughtful DDx, and try to come up with a concrete plan for investigation and treatment.  Focus on making each clinical interaction you have in the department an excellent one, as opposed to just trying to see as many patients as possible.  That being said, you should avoid the temptation to treat each patient encounter as a formal consult; there simply isn’t enough time to justify spending an hour for the initial patient encounter and there are diminishing returns to be gained by extensively reviewing the patient’s electronic chart before seeing them.  A good goal to aim for is to complete the history/physical/documentation and be ready to present to your staff within 20 minutes of getting the chart.
• Picking up charts – In the last 90 minutes of your shift, you should take extra care to check with your staff before picking up a new chart.  The last 45-60 minutes of your shift are generally reserved for “clean up,” allowing you and your staff to make sure all your remaining patients are appropriately documented with a plan for disposition (consult, further workup or discharge) so that you can leave on time without burdening the incoming team with too many loose ends to tie up after handover.  For this reason, your staff will want to be informed about new patients toward the end of the shift.
• Smart phones – Many staff and patients will assume that by pulling out a smart phone you are indicating that you are no longer interested in being an active participant in the provision of patient care.  Conversely, other staff and patients see smart phones as a powerful tool for accessing clinically relevant information such as drug doses and prognostic score calculators.  The best advice we have is to have good judgment and common sense as to when it is appropriate to use your smartphone and to let your staff know the purpose for which you are using it.  Avoid any use at the bedside.

Discipline of Emergency Medicine – Memorial Clinical Clerk Orientation Letter

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Entrustable Professional Activities (EPAs) for Emergency Medicine

Medical students completing their 2 week Emergency Medicine rotation can be assessed on any of the 13 Entrustable Professional Activities (EPAs).   Please take a few minutes to review the EPAs and their descriptors as they are used as the framework for learning and assessment of core clerks.  It is very helpful to students when comments on their clinic cards are EPA specific.

Download (PDF, 384KB)

 

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Mandatory Procedures

In addition, students are required to complete several mandatory procedures during their core year.  I have attached a card outlining mandatory procedures that students are to complete over the course of the year.  When you have a core clerk on shift with you please help them avail of the opportunity to complete such procedures as they present themselves.

 

 

Mandatory Procedures – Medical Students