The fourth year elective in Emergency Medicine is a popular and sought after clinical opportunity available to UNC medical students and to a limited number of qualified and highly motivated students from other medical schools. The UNC ED clerkship is valued by our medical students for a number of reasons, including the clinical environment, the opportunity to work one on one with attending physicians, the flexible clinical schedule, and our recently completed addition of monthly emergency simulation laboratory training.
During the UNC EM clinical electives, medical students see patients with undifferentiated medical conditions and get the first opportunity to evaluate and diagnose a variety of medical conditions under the direct supervision of our experienced Emergency Medicine attending physicians.
Emergency medicine is exciting because patients present to the emergency department with a collection of signs and symptoms but not a definitive diagnosis. Often, the emergency department is the first place the patient gets seen with a new medical condition.
The fun of medicine comes from bonding with the patient and then solving the diagnostic puzzles and providing the treatment that can improve or even save their lives. It often seems to students in medical school that their role is to watch residents and attendings work through this process. But in the UNC 4th year ED elective, medical students act as the primary provider for the patient with the close supervision of the ED attending physician. The medical student interviews and examines the patient, and then they have an opportunity to use the knowledge that they gained in the first 3 years of medical school to come up with a differential diagnosis and plan for initial management of the patient. After discussing and refining the differential diagnosis and plan with the attending physician, the medical student continues to function as the patient’s primary provider during their emergency department stay. This format allows for valuable one on one teaching from the attending physician and a chance to experience the joys of bonding with the patient and their family members, to interact directly with consultants, and to evaluate and make decisions based on the patient’s laboratory, EKG, and radiologic test results.
The high stakes but sometimes low frequency, unstable emergency cases are exciting and addictive to all of us in emergency medicine. We have recently added a monthly simulation laboratory curriculum to allow medical students to learn and practice the skills required to manage unstable patients. These skills are essential to emergency medicine but will be used by students who begin their internship the next year in almost all specialties.
Once during a monthly rotation, the medical students meet with Dr. Jones and a resident physician in the simulation lab to practice two patient scenarios and an essential emergency procedure skill. The patient scenarios are played out using a high fidelity patient simulator and the same equipment that we use in the emergency department. As the month progresses the weekly cases get more complicated and build on skills learned the previous weeks. The procedural skills, such as intubation, chest tube placement, placement of central lines, and lumbar puncture are practiced with models made to realistically approximate the real procedures.
Please keep in mind that there are sometimes violent patients in the ED. If you encounter a patient that may be violent or makes you feel uncomfortable, please retreat to a safer area and notify your attending or the nursing staff. Always take another staff member with you when you go in to see a patient in the locked area for psychiatric patients. Patients in the psychiatric area are rarely violent but it is better to be safe. If a patient needs to be restrained, please do not attempt to assist with the restraint. In that situation the medical student can be very helpful by going to the computer and gathering information about the patient to report to the attending and ED staff. Helpful information includes allergies, medications, past psychiatric history, and past medical history.
1. Where do I go for orientation?
Orientation is held on the first day of the course in the small conference room on the 1st floor of the Physicians Office Building. This is the floor where the UNC Department of Emergency Medicine offices are located. You will receive an email at least one week prior to the beginning of the course confirming the time for the course orientation meeting.
2. Which procedures are required on the procedure cards?
The procedure cards are guides to help you see a variety of patients in the ED and to help you to have the opportunity to get a variety of procedures completed. You most likely won’t have an opportunity to participate in some of the types of patient encounters and procedures listed. The goal is to see 80% of the patient presentations listed (e.g. Abdominal pain, Chest pain, Altered Mental Status…) and as many of the procedures as you can do. The procedures that have “Min” written beside them are required procedures and you should do at least the minimum number listed. For example “IV starts 4 Min” means you should start at least 4 IV’s during the month. Points will be deducted for any of the required procedures that are not completed.
3. How should I prepare for Sim Lab?
Each week , Sim Lab covers a different general topic. Review the following:
- When Sim Lab is covering cardiac emergencies, review ACLS and cardiac rhythms
- When Sim Lab is covering respiratory emergencies, review rapid sequence induction and airway anatomy.
- For the trauma Sim, review the primary and secondary survey for trauma patients.
4. How should I study for the end of course exam?
The end of course exam is covers a variety of common EM topics. During the month you should read about the common presenting complaints in emergency medicine in the copy of the Tintinalli Handbook that we will provide to you. The presenting complaints listed on your procedure card are a good guide to the topics that you may want to read about. Also be sure to read up on complaints related to patients that you see in the ED. A good way to practice for EM tests is with practice questions. There are 800 practice EM questions that you can do on the Access EM website, available through the UNC health sciences library portal.