Clinical exposure:

• ED shifts: Students will complete at least six 8 hour shifts over the course of their two weeks. These will involve direct patient care as part of a team including an attending physician and a resident physician. In addition, each student will spend one 4 hour block with the ED triage nurse, measuring patients’ vital signs and assessing the acuity of their illness.
• Ambulance shifts: Students will complete at least one 8 hour Emergency Medical Services (EMS) ambulance shift with a paramedic team over the course of their two weeks. This shift will expose patients to the EMS system, principles of scene safety, and field triage and management of patients. Those students rotating at University of Colorado Hospital will ride with Rural Metro EMS, and those rotating at the Children’s Hospital will ride with Denver Health and Hospitals EMS.

Patient Precepting:
Because of the nature of Emergency Medicine, bedside rounds per se do not take place. In some instances, at the end of a shift, or at intervals during the shift, an informal round (“running the board”) will take place involving the outgoing attending, the incoming attending and the charge nurse. Students and residents may be present at these rounds depending on their patient load at the time. The students’ patients will be precepted with the attending, or the senior housestaff. At these times, the student will present their history data, physical examination findings and their thoughts on a potential plan of care. The student may, depending on their needs, accompany the supervising physician back into the room to review any physical findings about which they have questions, or they may discuss the findings and any discrepancies as a learning point. On any patient that is being admitted or on whom a consult is being obtained, the student will learn appropriate behaviors and communication skills necessary to facilitate transition of the patient’s care to another provider. At the end of their shift, each student is expected to perform a sign-out round on any patients that they are following in the ED.

Small groups: (Intrasession activity)
There will be 9 hours of small group didactic sessions distributed across the two week course. Sessions include:

• Initial Assessment of the ED patient: recognizing signs and symptoms of critical illness, clinical implications of vital signs. How to deliver a concise, yet complete, presentation of the patient to a preceptor (1 hour).
• Shock: Pathophysiology of shock, types of shock, recognition of impending and actual shock in adults and children, initial management (1 hour)
• Toxicology: Review of a general approach to the evaluation and management of the poisoned patient (1 hour)
• Disaster Medicine: Small group tabletop exercise in field and hospital-based mass casualty response (1 hour)
• Skills workship: Splinting (2 hours)
• Access to Care: Students will present the results of their access to care project (see below) to their fellow students in a small group setting, with discussion led by a senior resident or attending physician (1 hour)
• Trauma PBL case: case-based review of initial evaluation and management of major traumatic injuries (1 hour)
• Pediatric PBL case: Case-based review of medical and social issues unique to children in the provision of emergency care (1 hour)
• Disaster Medicine tabletop exercise (1 hour)

Project work:
Access to care – Each Student will be required to identify a patient that they see during the first one or two shifts in the ED that they perceive has access to care issues. They will be required to follow up with this patient by phone in order to determine whether the patient was able to re-enter the health care system in an appropriate fashion as discussed during the ED visit, specifically were they able to comply with the follow up instructions. This could include a variety of issues such as “Were they able to get their medications?” “Were they able to obtain a follow up appointment with their PCP in the time frame required?” or “Were they able to obtain specialty care?” and might also encompass addressing how these or other issues may have been affected based on linguistic or cultural issues. Each student will be expected to complete a written discussion of the particular including the students own impressions and feelings about the patients access to care issues and discuss it in a forum with the other students in the course, which will be moderated by one of the course directors or their designate.

Case simulations:
All students must perform at a passing level as determined by a standardized checklist in order to pass the clerkship. However, in this course, the SP performance evaluation will NOT be included in their grade. We expect that each student will use the SP case as a learning tool, and for formative rather than summative evaluation. Any student that is not able to achieve a passing level on the first attempt will receive immediate feedback and will repeat the SP examination until they perform at an acceptable level.

Textbook:
The Emergency Care Block Committee has selected the text An Introduction to Clinical Emergency Medicine (Mahadevan and Garmel, 2006) as a designated resource for the course.

Other didactics:
Students have the option of attending conferences such as M&M, morning report, noontime conferences, grand rounds and any other departmental conferences that are appropriate for their level of learning. Given the brevity of this course, attendance at these conference will not be mandatory.