2023-2024 M3/M4 Course Syllabi
Emergency Medicine
COURSE NUMBER:
24 01 03
TITLE:
ELECTIVE AI - EMERGENCY MEDICINE -ICE
Working one-on-one with faculty and senior residents, students will care for patients across the whole spectrum of acuity in the ED. Additionally students will use our simulation center to step into the lead role in the management of critically ill patients and develop team leadership skills. In this course, students learn how to approach the undifferentiated patient and build patient management skills by functioning as interns, formulating their own plans, placing orders, and documenting on all patient encounters.
PREREQUISITES:
26920371 (FAMILY MEDICINE CORE CLKSP), 26931373 (INTERNAL MEDICINE CORE CLKSP), 26940373 (NEUROSCIENCE CORE CLKSP), 26946374 (OBSTETRICS/GYN CORE CLKSP), 26961373 (PEDIATRICS CORE CLKSP), 26963371 (PSYCHIATRY CORE CLKSP), 26980373 (SURGERY CORE CLKSP)

Successful completion of Core Clerkships. 

Student have an opportunity to submit up to two schedule requests (two specific days off) in advance per COM guidelines. Students will receive an email from the Clerkship Coordinator 4 weeks before the rotation start date and have 3 days to respond with any requests, after which no additional requests will be considered. These requests are not guaranteed, but we will do what we can to build them into your schedule. To help us appropriately prioritize the needs of all students, please provide a reason for each request. If you request a day off on a day in which we also have Didactic (Tuesdays from 0800-1000) or Grand Rounds (0800-1300), you still must attend the required academic activity. The clinical schedule will be finalized and distributed to students 1 week before the rotation start date. 
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GENERAL INFORMATION

COURSE YEAR:
M4
CREDIT HOURS:
8
CREDIT WEEKS:
4
DOMESTIC VISITING:
YES
INTERNATIONAL VISITING:
NO
GRADED:
Honors/High Pass/Pass/Fail
COURSE QUALIFICATIONS:
ICE
COURSE TYPE:
Clinical
STATUS:
Full-Time   
OFFERED AS FULL-TIME AND PART-TIME: NO
ALLOWS OVERLAP: NO
COURSE LENGTH:
4 wks
DIRECTOR:
Jason Nagle, MD, MPH
naglejn@ucmail.uc.edu
513-558-5281
MSB, 1553A
ADMINISTRATIVE SUPPORT PERSON:
Paula Klepper
kleppepd@ucmail.uc.edu
513-558-5552
MSB, 1551
SITE(S):
UC Health Medical Center
West Chester Medical Center
MAX ENROLL:
10 
ROTATIONS:
Rotation Dates Max
1 05/29/2023 - 06/23/2023 10
2 06/26/2023 - 07/21/2023 8
3 07/24/2023 - 08/18/2023 8
4 08/21/2023 - 09/15/2023 8
5 09/18/2023 - 10/13/2023 5
6 10/16/2023 - 11/10/2023 0
7 11/13/2023 - 12/08/2023 0
8 12/11/2023 - 01/05/2024 0
9 01/08/2024 - 02/02/2024 0
10 02/05/2024 - 03/01/2024 5
11 03/04/2024 - 03/29/2024 5
12 04/01/2024 - 04/26/2024 6

NOTE: If a rotation is offered in both 2 and 4 week slots, the max capacity is limited to the actual spots offered for the 4 weeks. (ie: the 2 week rotations listed share the max of the 4 week rotation)
WORKING HOURS:
Fourteen 8-12 hour shifts in 4 week block, 4-5 of which will be overnight shifts.
REPORT 1ST DAY:
MSB 1452 at 0800

INSTRUCTION

LEARNING ACTIVITIES:
  • Case-Based Instruction/Learning
  • Clinical Experience - Inpatient
  • Conference
  • Demonstration (description, performance, or explanation of a process, illustrated by examples, observable action, specimens, etc)
  • Lecture
  • Patient Presentation--Faculty
  • Patient Presentation--Learner
  • Research
  • Simulation
LEARNING ENVIRONMENT POLICIES:
UCCOM strives to provide medical students with a learning environment that is conducive to their professional growth. All UCCOM and visiting medical students are encouraged to review the Student Handbook.

The Office of Student Affairs and Admissions is available to all UCCOM and visiting medical students to discuss any concerns/questions related to the learning environment. Please call 558-6796 to access faculty/staff that can assist you.
TEACHING:
90% Attending Physician
10% Senior Resident
FEEDBACK:
ASSESSMENT:
Grading Policy60% Clinical Performance

20% Written Exam

10% Oral Exam

10% Case Presentation




Clinical Performance: For each clinical shift, you will be evaluated using our standardized evaluation form. Our Medical Student Clinical Evaluation Form is based on the National Clinical Assessment Tool for EM (Jung et al, West J EM, 2017). The evaluation is competency-based and assesses entrustability, which is defined as a learner’s ability to perform a specific task independently without supervision. The first section of our evaluation will give you formative feedback on your level of entrustability in six core domains of EM clinical practice. There is a second section on Professionalism with an avenue for preceptors to comment on outstanding or worrisome professional behavior and provide examples. Finally, each preceptor will place you in a Global Assessment category using the same language that appears in the Standardized Letter of Evaluation (SLOE) for EM residency application. 




Written Exam: The Society for Academic Emergency Medicine (SAEM) National EM M4 Exam will be administered on the last day of the rotation, unless you are notified otherwise. The 55 question multiple choice exam will be given over two hours in one of the electronic classrooms on campus. The material on the exam will come from the CDEM readings, and practice exams are available through SAEM. 




Oral Exam: Following your Written Exam, each of you will have 30 minutes to complete a set of standardized patient encounters using the ABEM Oral Boards Examination Format. Each case has defined critical actions. Students will be assessed on their ability to complete a verbal H&P, order appropriate diagnostics and therapeutics, and their communication skills. 




Case Presentation: This is a 30-minute presentation at the end of the rotation in which you present a patient you cared for in the ED, develop a thorough differential diagnosis, discuss their diagnostics and ED course, and ultimately provide a few educational pearls that interest you and are EM-relevant. Depending on the number of students each month, this may be done individually or in small groups.


ASSESSMENT METHODS:
Clinical Performance Rating/Checklist
Exam - Nationally Normed/Standardized, Subject
Exam, Institutionally Developed, Oral
Research or Project Assessment
FINAL GRADE:
GRADE ASSIGNED BY: Course director

OBJECTIVES

Curricular Resources :
All reading is optional, though encouraged in order to succeed in the course. 

1.  Online National EM M4 Curriculum, which is curated by the Clerkship Directors in Emergency Medicine (CDEM): https://cdemcurriculum.com/m4/. This is the curriculum on which the SAEM National EM M4 Exam is based.

2.  Mahadevan SV and Garmel GM. "An Introduction to Clinical Emergency Medicine." 2nd edition. 2012. 

3.  Roberts JR. "Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care." 7th edition. 2018. 

4.  Wald DA. "Emergency Medicine Clerkship Primer: A Manual for Medical Students." 2008. 
Instructional Methods:
  • On-shift experiential learning
  • Didactic lectures
  • Hands-on procedure workshops
  • High-fidelity simulation
  • Small group learning  
  • Peer case presentations
  • Social media (Twitter) based dissemination of learning points based on ED patient cases, offering opportunity to interact with classmates and other emergency physicians around the globe
Knowledge/Skills:
  1. Develop your clinical gestalt for “sick” or “not sick.”
  2. Hone bedside history and physical examination skills.
  3. Discuss the differential diagnosis and develop a management/disposition plan for each patient under your care, focusing on simultaneous diagnosis and management of life-threatening conditions in the undifferentiated patient.
  4. Serve as your patients’ primary provider, performing appropriate procedures, documenting the patient’s ED course in the electronic medical record, and discussing the patient with physicians and consultants from other services. 
  5. Concurrently manage multiple patients across variable levels of acuity and stages of patient progression.  
  6. Practice critical procedures, resuscitation, and team communication using high-fidelity simulation.
Main Course Topics :
  • Airway Management
  • Advanced Cardiac Life Support
  • Resuscitation of Undifferentiated Patient
  • Approach to Trauma
  • Access to Care
  • Resource Utilization
  • Patient Throughput
Procedures:
1.  Primarily perform basic procedures in the ED, including but not limited to laceration repair, incision and drainage, reduction and splinting, regional anesthesia, lumbar puncture, paracentesis, arthrocentesis, diagnostic ultrasound, ultrasound-guided vascular access, and interosseous access. 

2.  Observe, assist, or perform critical procedures including but not limited to intubation and airway management, central venous access, needle and tube thoracostomy, among others on simulated or real patients as appropriate. 

3.  Perform basic and advanced cardiac life support in the ED and in simulation. 
Remediation Plan:
 Remediation Plan will be tailored based on student need/deficiency. Possible methods include additional shifts, SIM lab cases, repeat oral/written exam, and literature discussion.

SAMPLE WEEK

Monday:
7:00AM 7:30AM Rounding in ED
7:30AM 8:00AM Morning Report
8:00AM 6:00PM Emergency Dept 8 am - 7 pm (12 hrs)
Tuesday:
7:00AM 7:30AM Rounding in ED
7:30AM 8:00AM Morning Report
8:00AM 10:00AM Didactic
10:00AM 6:00PM Emergency Depart 10 am - 7 pm (12 hr)
Wednesday:
8:00AM 1:00PM Grand Rounds
1:00PM 6:00PM Emergency Dept 1 pm - 7 pm (12 hr)
Friday:
10:00AM 4:00PM Emergency Dept Minor Care (6 hrs)
SCHEDULE NOTE:

14 Clinical Shifts in total:

10 shifts of 8-12hour duration, divided among various pods in the ED, with one-on-one faculty or senior resident supervision. In general 4 of these shifts will be overnights, though this is variable. 

2 Minor Care shifts, 5-7 hours in length, with one-on-one faculty or senior resident supervision

1 Ultrasound shift, 6 hours in length, with Pattie Smith RDMS or faculty member of the Ultrasound division 


In general, students can expect to have one weekend (Saturday-Sunday) off, one weekend in which you work one day (Saturday or Sunday), and one weekend in which you work both days. Students may request days off in advance for academic or personal reasons, but please allow at least 3 weeks notice and keep requests to a reasonable minimum. If necessary, students can swap shifts among each other once the clinical schedule is released, though all trades must be approved by the Clerkship Director to ensure shift distributions remain equal and duty hours are obeyed. 


Other Required Events (required unless post-overnight):

Didactic/Simulation: Tuesdays from 0800-1000

Grand Rounds: Wednesdays from 0800-1300

Morning Report: Every morning (except Wednesday) from 0730-0800 while working 7am day shift in ED


Other Optional Events:

Coffee Talk: Every other Wednesday from 0700-0800

Journal Club: Monthly on Wednesdays from 1800-2100, dates vary

ATTENDANCE AND ABSENCE POLICY

 

Session Attendance for M4 Students

  • Students may miss no more than two days of planned excused absences on a four week rotation without being required to make-up the work, at the discretion of the clerkship/elective/course director or his/her designee.
  • Non-AI Rotations - Per the Student Duty Hours Policy, an average of one day (24 hours) in every seven must be free of clinical responsibilities (including seminars, clinic, rounds, lectures) averaged over a four week period. These days off are assigned by the clerkship director to best align with the site schedule. Students may request to schedule 1 or more of these 4 days for planned absences that fall under 1 of the categories listed below for excused absences during non-AI rotations, in consultation with the course/elective director, who may or may not approve such planned absences.
  • AI Rotations - Per the Student Duty Hours Policy, an average of one day (24 hours) in every seven must be free of clinical responsibilities (including seminars, clinic, rounds, lectures) averaged over a four week period. These days off are assigned by the course director to best align with the site schedule. Students may request to schedule 1 or 2 of these days for planned absences that fall under 1 of the categories listed below for excused absences during AI rotations, in consultation with the course director, who may or may not approve such planned absences. Students must avoid scheduling Step 2 examinations during an Acting Internship.
  • Excused Absences - The following will be considered excused absences:
    • Diagnostic, preventative, and therapeutic health services (e.g. doctor appointments, physical therapy, counselling, etc).
    • Personal illness, accident or a major catastrophic event
    • Death or serious illness of immediate family members. Immediate family members, as defined by UC, are Grandparents, Brother, Sister, Brother-in law, Sister-in-law, Daughter-in-law, Son-in-law, Father, Mother, Mother-in-law, Father-in-law, Step-sister, Step-brother, Step-mother, Step-father, Spouse or domestic partner, Child, Grandchild, legal Guardian or other person who stands in place of parent (in Loco Parentis)
  • Whenever possible, planned absences should be requested a minimum of six weeks in advance of the start of the clerkship/elective/course in which the absence will occur; this enables the clerkship/course/elective to help plan for educational event scheduling (e.g. a known appointment could be scheduled around with enough notice and the student might not have any required coursework to make up). Absences requested less than 1 week prior to the planned absence may not be considered for a possible excused absence unless extenuating circumstances prevented the student from providing timely notification per the policy. Students should first submit their request for a planned absence to the clerkship/elective/course director using the online MSSF. All planned/excused absences for any reason should be documented on the MSSF.
  • The COM abides by the UC Religious Observance Policy that respects the religious diversity of its students by providing opportunities, where possible, for accommodation in cases where conflicts exist between students’ religious beliefs/practices and educational activities. In clinical settings, such accommodations must honor the primacy of a commitment to patient care and avoid unduly burdening faculty, staff and the general student population involved in the affected educational and/or patient care activity.
  • The following items are explained in detail in the Medical Student Handbook:
    • Excused/unexcused/unplanned absence, religious holidays, jury duty, and make-up work

See Attendance and Absences Policy, Religious Observance Policy, Medical Student Handbook.




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