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Emergency Medicine Clerkship

Curriculum

The one-month required clerkship in a hospital Emergency Room setting gives fourth-year medical students direct involvement and experience in emergency medicine.

It is designed to further develop the concepts of diagnosis and management acquired during the OSU-COM pre-clinical course-work and to develop decision-making and cognitive skills related to patient care in an emergency setting.

In addition, this course may include experiences such as:

  • Surgical assistance
  • Labor and delivery
  • Hospital staff and committee meetings
  • Hospital emergency room calls
  • Community and public health functions

Syllabus
CE 9255

  1. General Description
    1. Course Title:  Osteopathic Emergency Medicine Clerkship
      Course Length:  One-month rotation
      Course Format:  Emergency Room - based Clerkship/Rotation
      Student Level:  Fourth Year Osteopathic Medical Students
      Course Coordinator:  William Pettit, D.O.
    2. The Emergency Medicine clerkship gives fourth year medical students direct involvement and experience in a hospital Emergency Room setting. This experience consists of a one-month rotation in an affiliated hospital emergency room designed to further develop the concepts of diagnosis and management acquired during the OSU-COM pre-clinical course-work and to develop decision-making and cognitive skills related to patient care in an emergency room. This course will also provide the student a chance to develop additional clinical psychomotor skills by performing routine basic procedures in a supervised setting. In addition, this course may include experiences such as surgical assistance, labor and delivery, hospital staff and committee meetings, hospital emergency room calls, community and public health functions. The student should be encouraged to observe, evaluate, and participate in the discussions and medical care of patients, at the discretion and under the immediate supervision of an assigned physician through the combined coordination and direction of the OSU-COM on-site supervising physician and the College's Course Coordinator, William Pettit, DO.
    3. William Pettit, D.O. will coordinate the course and will oversee student rotation assignments and course responsibilities in cooperation with the on-site supervising physician. The on-site supervising physician will coordinate daily supervision of the student, assign patient responsibilities, submit a final evaluation of the student's on-site clinical progress, and in coordination with the OSU-COM Clerkship Course Coordinator, will schedule academic presentations.
    4. It is further understood that an on-site physician must be in attendance at all times while the student is in the facility for training purposes. The on-site supervising physician may designate other physicians to meet this requirement.
    5. This practical clinical experience in primary care medicine is designed as an integral part of each OSU-COM clerkship program. The clerkship program is under the direction of the Oklahoma State University College of Osteopathic Medicine, and the courses (rotations) are conducted at affiliated primary care facilities. Successful completion of the course is an OSU-COM requirement for graduation.
  2. Student Responsibilities
    1. Pre-arrival Student Responsibilities and Information
      1. Contact Hospital:
        1. The student is required to contact the hospital contact prior to the beginning of the rotation to obtain hospital orientation and related information.

          Tulsa-OSU Medical Center
          You may receive your schedule by e-mail prior to the first of the month.  If not, please report to the ER at 7:00 a.m. on the first day of the month, in scrubs, in case you are asked to stay and work that day. Someone will meet you there, have a schedule made out for you and give you the reading list for the month. If you cannot be there on the first day, please notify the OSUMC ER and Center for Rural Health Medical Education Office at 918-584-4375.  For questions or concerns contact your OSU NE Regional Coordinator, Xan Bryant, at 918-401-0074 or xan.bryant@okstate.edu

          Oklahoma City-Integris Southwest Medical Center
          Please contact Amber Louch at 405-636-7195 or at Amber.Louch@integris-health.com approximately two (2) weeks prior to starting your rotation to complete paperwork and verify start date, time and location. If you need housing, please contact Anissa Core at (405) 488-0758 as soon as possible. For questions or concerns contact your OSU SW Regional Coordinator, Augelica Burrell-Fleming, at 918-401-0073 or Augelica.burrell@okstate.edu

          Enid-Integris Bass Baptist Health Center
          Please contact your OSU NW Regional Coordinator, Kelly Davie, at 918-401-0274 or kelly.davie@okstate.edu approximately two (2) weeks prior to starting your rotation to verify start date, time, location, housing and instructions. For questions or concerns contact your OSU NW Regional Coordinator, Kelly Davie.

          Lawton–Comanche County Memorial Hospital
          Please contact Sarah Hoormann at hoormanns@ccmhonline.com or at 580-355-8620 X3473 approximately two (2) weeks prior to starting your rotation regarding hospital requirements and housing. Please contact J. Michael Fitzgerald, D.O. or at fitzgeraldj@ccmhonline.com or leave a message at 580-355-8620 X3473 to verify your start date, time and location. For questions or concerns contact your OSU SW Regional Coordinator, Augelica Burrell-Fleming, at 918-401-0073 or Augelica.burrell@okstate.edu

        2. Students are required to contact the housing contact as soon as possible if they will NOT be utilizing the housing for any reason. This decreases unnecessary costs to this site and helps maintain these benefits for future students. For more information about housing, contact your OSU Regional Coordinator.

      2. Appropriate Dress:
        1. For students in the Emergency Room, appropriate dress is usually scrubs.  Please verify appropriate dress with your hospital contact.
        2. All students must wear College approved identification and a clean, pressed white clinical jacket.
        3. Men are expected to wear a shirt, tie, and dress trousers.
        4. Women are expected to wear slacks or a dress.
        5. Students are required to bring identification passwords for library resources (i.e. MD Consult), course syllabus, and current references for Family Medicine, Internal Medicine and Obstetrics/Gynecology with them.
    2. Student Responsibilities During the Clerkship
      1. First Week of Rotation:
        1. Attend required hospital orientation.
        2. Meet with your on-site supervising physician for an orientation.
        3. Be prepared to discuss your clinical strengths and weakness relative to the rotation objectives.
        4. We suggest you use the student performance evaluation form as a guide.
      2. During the Rotation:
        1. At all times dress appropriately (as defined above), utilize College approved identification, and identify self as a non-graduate medical student not as a medical graduate or a licensed physician.
        2. View video lectures and take corresponding evaluations. Video lectures are accessible through resource link on OSU-COM Center for Rural Health Emergency Medicine syllabus.
        3. Complete the skills card, get it signed with level of performance.
        4. Provide appropriate patient care under the supervision of the attending physician(s). Demonstrate appropriate indications and techniques in using O.M.M.
        5. Complete all outlined rotation objectives.
      3. Midpoint:
        1. Meet with your attending physician(s) and/or your on-site supervising physician for a verbal evaluation of your clinical performance, areas to improve, and a discussion of your progress on the assigned patient case.
        2. You are responsible for scheduling this meeting.
      1. Final Week:
        1. Meet with your attending physician(s) and your on-site supervising physician at the end of the rotation to review your clinical performance.
        2. Direct the on-site supervising physician to the online evaluation form for completion of the preceptor’s student performance evaluation form
        3. Submit the checklist and video lecture evaluations to ruralhealth.clerkship@okstate.edu. Online site evaluation is due the end of the rotation.
        4. All forms are due within 7 days (postmarked by the 5th day) of the end of the rotation. A grade will not be issued until all the paperwork has been received. If forms are not received within 7 days of the end of the rotation, the student’s grade may decrease one letter grade.
  3. Clerkship Calendar
    1. The student's actual working days and hours shall fall within the clerkship calendar. The specific scheduling of days and hours shall be made by the on-site supervising physician, with approval by the OSU-COM Course Coordinator, and shall generally conform to the following:
      1. Rotation Period:
        1. This clerkship is one month in length.
      2. Date of Arrival:
        1. It is the student's responsibility to report to his or her official rotation site on the date specified.
        2. If there is a reasonable explanation for a delay in reporting (e.g., auto accident, illness, or similar reason), the student is to contact the preceptor, the OSU Regional Coordinator immediately.
      3. Working Day:
        1. A typical working day (or night) is considered to be 12 hours in length; however, there may be instances when the working period may exceed 12 hours especially when accompanying the physician on "out of office" professional duties.
        2. During the one-month rotation, a students schedule will be arranged to provide at least 2 days off out of every fourteen (14) days, as in every other weekend.
      4. Holidays:
        1. Students receive one day off for the Thanksgiving holiday.
        2. Students receive two consecutive days off for the Christmas holiday.
        3. Students are to request approval for specific days off for Thanksgiving and Christmas holidays from their on-site supervising physician.
      5. Travel Time:
        1. Travel time may be taken for rotations requiring travel of more than 50 miles as specified in the student clerkship handbook.
      6. Attendance:
        1. One hundred percent (100%) attendance is required on all clinical rotations.
        2. The student is required to inform the on-site supervising physician and the OSU Regional Coordinator of any absence in a timely manner.
        3. If a student needs time off the rotation, make up time may be required.
        4. A student is required to complete an Exception to the Rotation application with the preceptor, Director of Rural Medical Education, and Course Coordinator signatures if he/she is absent for any reason.
      7. Rotation Changes:  Under approved special circumstances only, students may trade rotation assignments by completing a Change of Rotation form. All forms must be forwarded to:
        Sherry Eastman
        OSU-CHS Center for Rural Health
        1111 West 17th Street
        Phoenix Building
        Tulsa, OK 74107
        918-584-4375
        918-582-8938 fax
    2. NOTICE: Emergency Medicine rotations begin on the first day of the month. If travel time is necessary or a holiday falls on the first day of the month, students are encouraged to contact the supervising physician at the new facility to verify date of arrival.
  4. Student Performance Evaluation Procedures
    1. The student's overall performance (grade) will be weighted using the following criteria:
      1. 65% = Student Performance Evaluation
      2. 15% = Procedure/ Skills Card
      3. 20% = Video Lecture Evaluations
    2. All requirements must be passed with a 70 percent or above to pass this clerkship. Letter grades of A, B, C, or U will be assigned according to procedures outlined in the College Catalog.
      1. Student Performance Evaluation:
        1. At the completion of the Emergency Medicine rotation, the on-site supervising physician will evaluate the student's performance on clinical activities of the rotation on the student performance evaluation form.
        2. The final (overall) grade will be determined and issued by the Course Coordinator following the completion of the rotation.
        3. The grade is based on the Student Performance Evaluation, video-lecture post-tests, other required activities, all requirements passed with 70% or more, and the timely receipt (within 7 days) of all the paperwork. If all forms are not received within 7 days of the end of the month( rotation), the student’s grade may be decreased one letter grade.
      2. Performance Reviews:
        1. Students are responsible for scheduling "verbal reviews" and a written evaluation review with their on-site supervising physician.
        2. It is recommended that verbal reviews be conducted at various points throughout each rotation, allowing the on-site supervising physician and student to discuss the student's areas of weakness and plan of action for improvement.
        3. A “verbal review” conference should be scheduled at least once mid-way through each rotation and a written evaluation review on the final day of each rotation.
        4. Students are responsible for scheduling the meeting times.
      3. Paperwork:
        1. Students are responsible for ensuring that all paperwork (student performance evaluation, site evaluation, procedure/skills cardand video lecture evaluations) is completed and received by the OSU-COM Center for Rural Health by the 7th day following the end of each rotation (postmarked by the 5th day)
    3. In addition to an academic grade, all students are held accountable to the non-cognitive academic standards as the standard of professionalism for their conduct. A grade of S (Satisfactory) or N (Needs improvement) is determined by the Course Coordinator based upon evaluation of the student by the on-site supervising physician.
    4. A grade of "I" (Incomplete) will be assigned if:
      1. A student is unable to complete the course requirement of approved 100% attendance.
      2. The Course Coordinator recommends an extension of the student's clerkship, and sets forth reasoning for the recommended extension.
      3. The student fails to submit the required paperwork.
    5. Grievance Authority:  Grievance of a rotation, performance evaluation, or course grade should start with the Course Coordinator. The final grading authority will be with the Course Coordinator.
  5. Program Evaluation
    1. Students are required to complete a site evaluation form at the end of the rotation. This tool is used to evaluate the course curriculum, faculty (attending and on-site supervising physicians), and student experiences. Students are required to complete and return the form to the Center for Rural Health within 7 days of completing the rotation. The Course Coordinator reviews all site evaluations and is responsible for addressing any problems or issues, which are identified in the evaluations. Data will be collated annually. On-site supervising physicians will receive an aggregate report only. The individual site evaluations and responses will remain confidential.
  6. Rotation Objectives
    1. Provide the student practical clinical exposure, knowledge, and additional didactics in a Emergency Medicine setting. Accomplished through a basic structure developed to achieve proficiency in the following areas.
    2. Goals
      1. Supervised patient evaluation, diagnosis and management of general medical maladies.
      2. Application of didactic general medicine principles.
      3. Development & expansion of clinical psychomotor skills.
      4. Gain knowledge and skills in performing procedures commonly done in an Emergency Medicine setting.
Subject/Method Learning Objectives Resources/Assignments
Clinical Psychomotor Skills

Development & expansion of clinical psychomotor skills

  1. Participate in daily patient rounds and conferences.
  2. Perform clinical workups of patients presenting in the Emergency Room (supervised/critiqued).
  3. Review reading/case presentations related to cases in the Emergency Room.
  4. Review required video lectures and complete evaluations.
  5. Attend/participate in formal clinical presentations by hospital staff and guest presenters.
  6. Receive performance feedback from on-site supervising physician and attending physicians.
  1. Required Internet video lectures: Must review required video-lectures and submit evaluations during rotation. Video-lectures are available via streaming through a resource link on this online syllabus. For Technical Assistance contact your OSU Regional Coordinator.
  2. Required readings and case presentations are determined by on-site supervising physician
Emergency Room Skills
  1. Demonstrate and discuss the principles of clean and sterile technique.
  2. Demonstrate and discuss proper isolation technique.
  3. Demonstrate ability to scrub, gown, glove alone and with assistance, and to maintain proper sterile techniques in an emergency room setting.
  4. Demonstrate knowledge of and proper usage of commonly used instruments.
Required Procedure/Skills Cards:
  1. Complete a procedure/skills card and submit at the end of each month of rotation (2 total).
  2. Must have dates and levels of skills observed, assisted, or performed initialed by physician.
  3. All physicians initialing cards, must include name, MD/DO and contact informtion on back of card.
Emergency Room Procedures
Supervised patient evaluation, diagnosis & management of general medical maladies
  1. Perform specific, assigned medical/surgical case responsibilities.
  2. Perform general medicine assignments.
  3. Obtain a complete and accurate history and physical examination.
  4. Keep adequate and up-to-date medical records.
  5. Identify patient problems utilizing the SOAP format.
  6. Provide patient case presentation to attending physician with appropriate management strategy.
  7. Perform simple procedures (supervised), including but not limited to:
    1. Suturing lacerations and surgical wounds
    2. Removal of sutures and skin staples
    3. Steristrip use in lacerations and surgical wounds
    4. Drainage of abscesses
    5. Surgical dressings
  8. Propose a plan for management of patient, for review by the attending.
    1. Properly indicate the need to perform laboratory or radiographic tests.
    2. Determine appropriate physical activity to be permitted by patient.
    3. Determine type & caloric content of patient's diet.
    4. Determine and recommend appropriate therapeutic measures.
    5. Determine requirement for special precautions or consultation.
  9. Determine appropriate time of patient discharge or release from hospital.
  10. Propose a method for patient follow-up.
  11. Maintain a humane approach, recognizing fears and anxieties of patient and family - understand the impact of patient's background and environmental relationships to his/her illness or trauma.
  12. Apply appropriate Osteopathic Principles and Practice for diagnosis and treatment of patient.
Required Procedure/Skills Cards:
  1. Complete a procedure/skills card and submit at the end of each month of rotation (2 total).
  2. Must have dates and levels of skills observed, assisted, or performed initialed by physician.
  3. All physicians initialing cards, must include name, MD/DO and contact informtion on back of card.
Application of Didactic General Medicine Principles in Emergency Room Cases

Application of didactic general medicine principles in the following areas:

  1. Cardiovascular
    1. Myocardial infraction
    2. Acute dysarrhythmias
    3. Cardiac arrest
    4. Cardiac tamponade
    5. Penetrating and non-penetrating cardiac injuries
    6. Hypertensive emergencies
    7. Thoracic-abdominal aneurysm
    8. Basic life support techniques
    9. Principles of advanced life support
    10. Recognition and treatment of different types of shock
  2. Tracheal foreign bodies
  3. Acute injuries
    1. Simple-compound fractures
    2. Pneumothorax
    3. Burns
    4. Head and neck injuries
  4. Psychiatric emergencies
    1. Acute psychosis
    2. Depression – suicide
    3. Paranoia
    4. Delirium tremens
  5. Medical emergencies
    1. Pulmonary edema
    2. Heart blocks
    3. Intractable angina/MI
    4. Hypoglycemia
    5. Status epilepticus
    6. Overdose patient
    7. Anaphylactic shock
    8. Acute endocrine emergencies
      • Thyroid storm
      • Hypertensive emergency
      • Insulin shock
      • Acute Adrenal insufficiency
    9. CVA
  6. Acute emergencies of hematology
    1. Hemophiliac conditions
    2. Sickle cell crisis
    3. ITP
  7. Urological emergencies
    1. Renal trauma (penetrating and non-penetrating)
    2. Acute urinary tract infections
    3. Testicular torsion
    4. Urethral, ureteral, bladder injuries
  8. Care of acute infections and prevention
    1. Meningitis – encephalitis
    2. Tetanus
    3. Endocarditis
    4. Fulminating pneumonia
  9. Abdominal emergencies
    1. Blunt – penetrating injuries
    2. Upper GI hemorrhage
    3. Upper – lower GI foreign body
    4. Perforated viscus
    5. Intestinal obstruction
    6. Acute appendicitis
    7. Acute pancreatitis
    8. Diverticulitis
    9. Incarcerated hernia
    10. Acute cholecystitis
  10. Acute electrolyte imbalances
    1. Hyponatremia – hypernatremia
    2. Hypokolemia – hyperkolemia
    3. Hypocalcemia - hypercalcemia
  11. Eye emergencies
    1. Penetrating – blunt eye trauma
    2. Acute glaucoma
    3. Corneal injuries
    4. Chemical injuries
    5. Intraocular foreign bodies
    6. Hyphema
    7. Acute iritis
    8. Acute conjunctivitis
  12. Pediatric emergencies
    1. Cardiac
    2. Pulmonary
    3. Endocrine
    4. Overdoses
    5. Trauma
  13. Dental emergencies
    1. Post extraction hemorrhage
    2. Root abscess
    3. Tooth fracture/avulsion
  14. Gynecological emergencies
    1. PID
    2. Ectopic pregnancy
    3. Ovarian torsion
    4. Ruptured ovarian cyst
  15. ENT emergencies
    1. Epitaxis
    2. Foreign body removal from ear canal
    3. Foreign body removal from nose
    4. Ruptured TM
    5. Labrinthitis
  16. Wound care
    1. Proper wound preparation
    2. Hemostasis
    3. Suture techniques
  17. Environmental emergencies
    1. Insect bites
 
OMM
Hands-on
Demonstrate appropriate techniques and indications in the use of OMT, as applicable to patient care.