Community Emergency Medicine - Thomas Memorial Hospital
LOCATION: Thomas Memorial Hospital, 4605 MacCorkle Ave, Charleston, WV
PRECEPTOR: Anthony Steratore, MD and Andrew Morgan, DO
DURATION: 2 or 4 weeks
OFFERED: Continuously
MAXIMUM ENROLLMENT: 2
STATUS: Elective
OBJECTIVES:
Emergency medicine is a broad specialty and this rotation aims to expose students to the wide variety of acute, undifferentiated patients presenting for care in community based emergency departments. The intention is that this rotation will eventually be offered at multiple WVU Emergency Medicine affiliated sites throughout the state, it will be piloted at Thomas Memorial Hospital initially. This rotation will help students assimilate information gained in all of their clinical clerkship to care for undifferentiated patients and will expose them to a wide variety of procedures--from endotracheal intubation and resuscitation of critically ill patients to laceration repair and incision and drainage of abscesses. Although students currently have the opportunity to rotate in tertiary, academic settings, the majority of emergency care is delivered in community settings. This rotation seeks to expose both EM bound and non EM bound students to community based settings where there is less availability of in-person consultative services and students are able to directly interface with attending physicians. This rotation is also intended to fulfill the requirements for a Community Based/Rural Experience.
Patient Care:
1. Perform focused history and physical examinations relevant to the presenting complaint in the wide variety of undifferentiated patients presenting to the ED for care.
2. Describe an initial approach to evaluation and assessment of critically ill patients presenting in various forms of shock.
3. Demonstrate the ability to conduct a primary and secondary trauma survey on patients presenting with acute traumatic injuries.
4. Identify patients at risk for acute decompensation and appropriately involve attending physicians in those circumstances.
Medical Knowledge:
1. Interpret unstable and stable vital signs as well as recognizing emergent vs. benign medical conditions.
2. Demonstrate an understanding of basic life support, advanced cardiac life support, pediatric advanced life support, and advanced trauma life support.
3. Identify patients at risk for clinical deterioration by demonstrating an understanding of when patients require admission to the hospital and appropriate consultation of specialty physicians.
4. Discuss commonly used emergency department risk stratification tools utilized by emergency physicians (i.e. PECARN criteria, Canadian Head and C-Spine criteria, PERC rule, HEART score, etc.).
5. Describe ECG findings concerning for ischemia and how those findings impact decision making in the emergency department
Practice-Based Learning:
1. Discuss principles behind evidence based medicine with supervising physicians and use data from major studies in emergency medicine to formulate diagnostic and treatment plans for individual patients.
2. Participate in departmental quality improvement initiatives during the elective rotation.
3. Incorporate formative feedback provided in the clinical setting into daily practice going forward.
4. Engage effectively in shared decision making with patients and their families by assimilating and communicating the best available evidence for the patient's situation and using this as a framework to guide the patient and their family to the most appropriate situation that incorporates the evidence and the patient's beliefs and values.
Communication Skills:
1. Communicate effectively with the wide variety of acutely ill, undifferentiated patients presenting to the emergency department, including the involvement of family members and surrogate decision makers in instances where the patient is unable to provide any information.
2. Demonstrate the ability to communicate effectively with all members of the interprofessional healthcare team.
3. Collate data obtained from the history, physical examination, laboratory and imaging data and incorporate this information into concise presentations to effectively communicate pertinent information to supervising attending physicians, families, and consulting teams.
Professionalism:
1. Maintain confidentiality of patient information and comply with all relevant host hospital policies regarding patient privacy and patient information.
2. Demonstrate respect for all members of the healthcare team, regardless of training background.
3. Demonstrate respect for autonomy and privacy while providing compassionate care to all patients presenting for emergency care.
Systems-Based Practice:
1. Collaborate with community based primary care physicians to effectively identify patients who may safely continue their care in an expedited outpatient setting.
2. Collaborate with a wide variety of interdisciplinary team members to provide high quality, evidence based medical care within the constraints of the resources available in the local community
METHODS TO ACHIEVE OBJECTIVES:
Students will evaluate undifferentiated acutely ill and injured patients under the direct supervision of emergency medicine faculty. Students completing a 2 week elective will work six 12 hour shifts and those completing the four week option will work twelve 12 hour shifts. Students will receive bedside teaching during each shift and will also complete online SOLE modules and recorded lectures that will outline the core content in emergency medicine, based upon the Clerkship Directors in Emergency Medicine national curricular model.
Formative Assessment:
Students completing the rotation will be given daily verbal and written feedback at the end of each clinical shift. Written feedback will be obtained via completion of a QR code based survey, which will be uploaded into E-value and utilized to inform the mid-rotation feedback session with the site director. The mid-rotation meeting will be completed on a one on one basis by the site director either in person or virtually using video conferencing--this session will inform the student of their areas of strength as well as any opportunities for improvement during the remainder of the rotation.
Summative Assessment:
Evaluation data from the daily evaluations and end of rotation examination (SAEM standard examination) will be utilized to both craft the final narrative evaluation and provide the final grade for the rotation. Clinical evaluation will comprise 85% of the final grade while the examination score will comprise 15% of the final evaluation. The final narrative evaluation will be filed with the Dean's Office within 20 working days as is required by the SOM.
PRIOR TO THE FIRST DAY OF THE ROTATION:
Contact Dr. Anthony Steratore, afsteratore@hsc.wvu.edu at least two weeks before the rotation start date.