Rotation Curriculum

University of Florida Health Science Center/Jacksonville Department of Emergency Medicine 4th Year Rotation Curriculum

Goals ➢ To introduce rotating students to the assessment, stabilization, and resuscitation of patients with emergent medical and surgical problems ➢ To teach the fundamentals of patient triage and prioritization of medical care ➢ To give rotators the opportunity to be involved in the initial presentation and early management of emergent and urgent medical problems, and to be involved in the disposition of these patients ➢ To provide exposure to a variety of primary care problems with involvement in the assessment, management, and the provision of proper follow-up within the University of Florida System ➢ To familiarize rotators with the scope of health care and social issues confronting emergency departments

Objectives ➢ Application of resuscitation and stabilization modalities ○ Airway management including bag-valve-mask and intubation techniques ○ Familiarization with pulse oximetry and carbon dioxide monitoring ○ Provide an introduction to intravenous access including central line access and venous cut down techniques ➢ Application of Advanced Cardiac Life Support protocols ○ Cardiac dysrhythmia recognition ○ Pharmacotherapetic and electrical treatment of dysrhythmias ➢ Application of Advanced Trauma Life Support protocols ○ Cervical spine immobilization and radiography interpretation ○ Primary survey ○ Secondary survey ○ Tetanus immunization protocols ○ Wound management including wound cleansing and suturing ○ Orthopedic evaluation including basic splinting techniques

➢ Introduction to managing toxic ingestion ○ Recognition of toxidromes ○ Impart an understanding of skin, ocular, and GI decontamination, including:  The indications of ipecac, gastric lavage, and/or use of activated charcoal  Alkalization  Whole bowel irrigation ○ Introduction of specific antidotes ○ Management of specific ingestion with an emphasis on the alcohol, cocaine, tricyclics, salicylates, and acetaminophen ➢ Provide as comprehensive an experience as possible in evaluation and managing common complaints that present to the emergency department, including a focus on patient disposition. Partial lists of entities addressed are: ○

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Chest pain—develop a differential diagnosis of chest pain including cardiac, pulmonary, vascular, and GI causes. Gain experience in the management of unstable angina, acute MI, pulmonary embolus, and aortic aneurysms Asthma—management of acute reactive airway disease Hypertensive urgencies and emergencies Evaluation and management of patients with fever and/or hypotension with a focus on sepsis Acute management of diabetic ketoacidosis Evaluation and management of seizure disorders including first time seizure, convulsive and non-convulsive status epilepticus Evaluation and management of acute abdominal pain, including acute GI bleeds and pain in the pregnant patient with an emphasis on the diagnosis of ectopic pregnancy Evaluation and management of basic OB/GYN complaints Evaluation and management of basic dental complaints Evaluation and management of basic ophthalmologic complaints To teach the judicious use and interpretation of laboratory, radiographic and the ancillary tests within the practice of emergency medicine To introduce rotators to the community’s use and abuse of the emergency department and the emergency department’s role in trying to meet its patients’ primary health care needs

Implementation ➢ Direct supervision of patient care in a high patient volume environment by senior emergency medicine residents and/or faculty with case discussion and management plan formulation. ➢ Self-study—rotators will be provided with two text resources. “Ma etal” functions as a pocket reference fo ruse during shifts. “Mitchell and Medzon” provides a more readable recource meant for directed self-studey. In addition students are encouraged to encouraged to utilize texts available on line and through the Borland Library to supplement their information base and help in the management of their patients. ➢ Monthly journal conference is held the last Wednesday of the calendar month to review recent literature pertaining to the specialty. Rotators will be provided with PDF files of the paper being discussed and encouraged to attend the conferences. ➢ Didactic teaching provided at weekly departmental conference, which consists of grand round presentation, resident topic presentation, faculty lectures, and morbidity & mortality case presentations. (Thursdays 7:30 am – 12:00 pm). ➢ Department rounds with attending physician held daily at 7:00 am, 3:00 pm, and 11:00 pm in the ED. ➢ Log—all rotators will be required to maintain a log (sheets attached to daily evaluation forms) during their rotation which records the patients seen, presenting complaint, and specific learning points garnered from the clinical encounter (ex: tests performed, procedures done, discharge/admitting diagnosis, and follow-up information including response to treatment). ➢ Self-directed self-improvement. Each daily evaluation form should contain a directed suggestion from the day’s supervising attending or resident designed to direct the student toward improvement in one of the specific ACGME core-competencies. ➢ Case presentations. At the midpoint of the rotation students will meet as a group (case-presentation workshop) to present cases and work on case presentation skills. Case reports will be critiqued by both faculty and fellow students.

Assessment (**Grade will remain incomplete until all components completed) ➢ Written evaluation of performance in the ED by EM2 and EM3 residents and/or ED faculty.

➢ Review of patient log entries (shift summary evaluation) and case discussions with the rotation director. ➢ Performance on case presentation workshop (including improvement during the course of the rotation) ➢ Multiple choice examination at the end of the rotation including a discussion of the answers with the faculty rotation director