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 weekly 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 weekly 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.
Each week, 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. |
