22101 Moross Rd., Detroit MI 43286

(313) 343-8797 sjhemergency@gmail.com

Medical Student

Welcome Medical Students!

If you are interested in a high-pace experience in Emergency Medicine, consider a rotation at St John Hospital and Medical Center. Our Medical Student Director, Dr. Elizabeth Bascom, offers three rotations; a basic Clerkship, an intensive Subinternship and an Advanced Elective. The attendings and residents who work in our department pride themselves in teaching and including Medical Students in every aspect of the EM experience. For more information, follow the links above.

Apply through your school or St. John Hospital & Medical Center, Medical Education Department, GME Student Program Coordinator 313-343-7843 Please Note: Space is very limited.

OBJECTIVES OF THE EMERGENCY MEDICINE ROTATION:
The student will become familiar with the initial evaluation, assessment, and stabilization of patients who present with urgent and emergent medical problems and trauma.

The student will play an active role in managing acutely ill patients in a timely manner following their emergency department course, and deciding on an appropriate disposition.

Students will become exposed to a variety of invasive and non-invasive procedures that are performed in the emergency department, i.e. arterial lines, arterial punctures, central lines, suturing, chest tubes, resuscitation skills, lumbar punctures, IV lines, nasogastric tubes, Foley catheters and airway management.

The senior student will further enhance his/her basic clinical skills, history and physical exam skills, and learn how to identify any life-threatening process that could be present in all types of patients.

Student will learn the overall organization of the Emergency Department and its ancillary services and personnel.

The student will enhance his/her medical knowledge base on specific topics that will be discussed during the rotation and apply this knowledge to actual patient care.

The student will learn to communicate effectively with all types of patients regarding their medical condition and treatment plan.

Methods of Achieving the Objective Goals:

The senior student will function as a sub-intern in the Emergency Department with responsibility for the initial evaluation of assigned patients, history and physical exam, formulating a differential diagnosis, treatment plan, and determine a disposition for each of their assigned patients. The student will perform these duties under the direct supervision of either attending staff or senior emergency medicine residents.

Students must attend the orientation session at the beginning of each rotation period and gain the basic information needed to begin the rotation and function properly in their assigned areas.

Evaluation Process:

Clinical:

Students are evaluated by the emergency medicine residents and staff attending physicians with whom they have worked during the month. Criteria utilized to evaluate a student’s clinical performance include the following:

Case Presentation
Procedural Skills
History and physical exam skills
Dependability
Patient interpersonal skills
Professional qualities
Initiative and clinical judgment
Attendance/participation at conferences
Ability to formulate a differential diagnosis
Proper utilization of diagnostic studies
Medical knowledge base
Organizational skills
Ability to develop an adequate therapeutic pain
Procedure Log:

Students are required to keep a log of all procedures performed. The attending physician you work with each day must sign all procedures.

Shift Attendance:

You will be required to work 16 shifts. Attendance at all assigned shifts is mandatory!

Specific Guidelines for Senior Medical Students:

The Medical Record:

This is a very important document that must be treated accordingly and the basic format will vary depending on where you are rotating. Students must write legibly, be complete, yet concise and have their charts co-signed by an Emergency Medicine staff attending physician. You are to sign your names in the appropriate space provided on the chart with your school initials next to your name. It is critical to document all pertinent information when evaluating your patients. Remember, “If it isn’t charted, it didn’t happen”! Don’t write down anything you are not sure of or didn’t do. All charts are completed by second or third year Emergency Medicine residents or the Emergency Medicine attending staff once a final disposition is decided upon.

Medical Record Format:

Identify the chief complaint(s):

History of present illness (HPI): include pertinent positive and negatives

Review of Symptoms (ROS): pertinent to the HPI

Past Medical History (PMH): Diabetes, hypertension, TB, sickle cell, asthma, cardiac, kidney, etc.

Medications: includes prescribed and non-prescribed, over-the-counter medications

Allergies: (i.e. medications, contrast dyes, Iodine)

Social History: intravenous drug abuse (IVDA), smoker (ppd), alcohol abuse, crack or other illicit drugs

Family History: cardiac, MI’s, hypertension, diabetes, etc.

Tetanus update: especially in cases of abrasions or lacerations

Physical Exam:

General appearance, distress and pain assessment of the patient

Vital signs (temp, pulse, blood pressure, respiratory rate, pulse ox)

Head, eyes, ENT exam, neck, lungs, heart, abdomen, include rectal exam, pelvic, genitourinary exam, back, extremities, neurological and skin exams

Procedural Notes:

Should be written on the chart for any procedure performed i.e. suturing, lumbar puncture, chest tube, central lines

Differential Diagnosis:

All students will develop an initial diagnosis/impression list on each assigned patient and discuss this with the supervising physician.

Evaluation and management plan:

What treatment needs to be started and why; what diagnostic testing needs to be done and why?

Diagnostic/Laboratory Results:

Each student is expected to review all the radiological studies done on their patients, interpret any lab results, record them on the chart and discuss them with the supervising physician

Treatment plan/Disposition:

You are to discuss these plans with the attending staff on each assigned patient.

Length of Evaluations:

Your initial encounter with the patient should focus on the degree of possible life threat based on the patient’s complaint and general appearance, vital signs, and initial history and physical exam. Plan on presenting your patient to your supervising physician within 20 minutes after the patient arrives. You will be learning to evaluate patients quickly, and accurately, and should be able to see a minimum of 5-6 patients per shift worked. Of course, this will vary depending on the site you are assigned to, time of day, and overall patient volume.

Diagnostic Studies:

After developing a treatment plan for your patients, you will be expected to be able to determine what diagnostic studies are necessary, if any, and justify the clinical necessity of the studies. All orders should be written on the appropriate physician order sheet and co-signed by your supervising physician before they are initiated. Make certain that the lab data you have retrieved from the computer and documentation on the chart is the data from the present visit.

Therapeutic procedures/Medication orders:

Any therapeutic procedure (i.e. central line insertion, lumbar puncture) anticipated must be performed under the direct supervision of your attending staff. All medication orders must be written on the physician order sheet, and co-signed by your supervising physician. No verbal orders will be accepted! Do not administer any medication yourself!

Patient Disposition/Discharges:

All patients seen in the Emergency Department will have a final disposition plan once their emergency care has been completed. Patients may expire, be admitted to a general floor, intensive care unit, or operating room. They may be transferred to other facilities, or be discharged home. It is important to be able to insure that adequate follow-up instructions are given to any patient discharged home from the Emergency department. All patients are given some type of instructions regarding their medical condition, diagnosis, medications, and a follow-up doctor’s appointment upon discharge. It is necessary to contact any identified primary care physician regarding a patient’s follow-up. No patient is to be discharged without the attending physician’s signature on the sheet.

Attire:

Professional dress is expected at all times. Clean laboratory coats, with identification badges, and a complete set of scrubs are required.

Attendance:

Promptness is critical. Any unexcused tardiness or absence will prevent your successful completion of this rotation. If you have an unpreventable situation that may necessitate you being late or absent, contact the Emergency Medicine Medical Student Coordinator during business hours (leave a voicemail if necessary). Students are allowed a maximum of (2) schedule switches and these can only be done with the approval of the site coordinator.

Conduct:

You will be expected to be professional and personable in sometimes hectic, stressful situations in the Emergency Department. Your patience may be tested many times during the month, and your interpersonal skills will be further developed as you communicate with patients, colleagues, family and ancillary personnel. Address all patients as Mr., Mrs., Ms., and NOT BY THEIR FIRST NAMES. Please be sensitive to a patient’s privacy in the department and close doors, or pull curtains when examining them. A good way to overcome interpersonal conflicts is to “treat others as you would like to be treated”, and provide them with the best care you can.

Supervision:

HCFA has mandated that all procedures are directly supervised by an attending physician. All lacerations must be explored with the attending physician. Suturing must be done under the direct supervision of the attending physician. All procedures must be done with direct attending physician supervision e.g. lumbar punctures, central line placement, joint dislocation reduction, joint aspiration, etc.

Parking/Lockers:

You will be given information about parking and availability of lockers from Medical Education. All of your belongings must be placed in your locker before you come to work.

PREREQUISITES

Student must have successfully completed years 1-3 of their medical school education

DESCRIPTION

The Emergency Medicine Sub-I Clerkship is a fourth year medical student rotation offered at St John Hospital and Medical Center in Detroit, MI. The clerkship is offered monthly throughout the academic year. Each month-long rotation runs from the first weekday to the last calendar day of the month. Students rotating in the Emergency Department are expected to attend a mandatory orientation on the first weekday of their assigned month, work a minimum of 14 scheduled 8-hour shifts at varied times throughout the month including days, afternoons, evenings and nights, become a part of a complex team that provides the highest quality emergency health care to all our visitors 24 hours a day, 7 days a week. Approximately 10 Medical Students will participate in each clerkship month.

THREE MAIN EDUCATIONAL GOALS FOR THE SUB-I EM CLERKSHIP
Review and refine pertinent basic and advanced emergency procedures and the indications, contraindications, and complications for each procedure
Review the key aspects of the core curriculum of emergency medicine, including:
Patient care
Medical knowledge
Practice-based learning and improvement
Interpersonal and communication skills
Professionalism
Systems based practice
Review and application of knowledge ascertained in medical education course work and previous rotational experiences.
OBJECTIVES BY THE CONCLUSION OF THE EM SUB-I CLERKSHIP
By the conclusion of the Emergency Medicine (EM) Clerkship, the medical student will be able to:

Be familiar with the initial evaluation, assessment, and stabilization of patients presenting to the Emergency Department with urgent and emergent medical and traumatic conditions.
Obtain a focused, developmentally appropriate, biomedical and psychosocial history of a patient’s illness in the acute care setting.
Perform a physical examination that focuses on a patient’s acute complaint(s), with attention to and respect for a patient’s privacy and dignity, recognizing the limitations of the Emergency Department.
Organize information gathered from the interview, physical examination, and diagnostic work-up to appropriately formulate reasonable hypotheses and differential diagnoses.
Formulate management strategies that: are consistent with the acuity of a patient’s illness; incorporate the patient’s interests, needs, and preferences; and are mindful of resource utilization.
Verbally present clinical case presentations to attendings, residents, and consultants in a concise and coherent manner.
Formulate safe, appropriate, and evidence-based disposition plans for a wide range of clinical conditions common to the practice of Emergency Medicine.
Utilize a range of communication and interpersonal skills to respond to a patient’s concerns and needs, so as to establish a trusting relationship, and inform, educate, and enlist the patient to participate in his/her health care decision.
Perform a variety of invasive and noninvasive procedures that are commonly practiced in the Emergency Department. These procedures include: intravenous catheter placement (with and without ultrasound guidance); lumbar puncture; orthopedic splinting; simple laceration repair with suturing.
Apply EM-based medical knowledge and skills taught during all available weekly didactic, procedural, and simulation sessions throughout the rotation while assisting the Emergency Department team with patient care.
Be familiar with the overall organization of the Emergency Department and its flow, and work closely with ancillary personnel.
Practice interprofessional teamwork that is essential to patient care and patient safety in the Emergency Department.
Be familiar with the training pathway for the physician pursuing Emergency Medicine as a career option.
KEY RESPONSIBILITIES OF THE STUDENT WHILE ON ELECTIVE
Students will work under close supervision by the attending faculty and senior residents.
Mandatory attendance for all activities, including clinical shifts in Emergency Department and all available didactic lectures, ultrasound workshops, SIM sessions and conferences.
Students will be scheduled for a variety of shifts 8 hours in length and will be rotated a clinical schedule of days, evenings, nights and weekends in order to experience the full range of case types that are typical of each type of shift.
METHOD OF EVALUATION

The final evaluation will be completed by the SJH EM Clerkship Director, using the format provided by the student’s school and based upon:

Successful completion of a minimum of 14 eight-hour required shifts
A minimum of 8 shift evaluations must be returned to the Clerkship Director by month end
100% Participation in available conferences and lectures
SCHEDULING INFORMATION
MONTHS OFFERED: YEAR-ROUND, SPACE IS LIMITED
Mandatory Orientation attendance on the first weekday of the rotational month

Month runs from the first weekday to the last calendar day

Prior to orientation you will receive orientation details and rotation guidelines via email

Apply through your school or St.John Hospital & Medical Center, Medical Education Department, GME Student Program Coordinator 313-343-7843

Prerequisites

Students may register for the Advanced EM Elective, if they have permission from their medical program and meet the following criteria:

Intend to apply for an Emergency Medicine residency
Successful completion of a prior EM rotation
Have not failed any medical school course
Passing score on Step-1 exam first attempt
Must be in the final year of medical school education
DESCRIPTION
The Advanced Elective in Emergency Medicine is a critical care experience for students applying for an Emergency Medicine residency. There is an emphasis on critical care “resuscitation” shifts, and opportunities to participate in the following:

Medical Critical Care Cases
Pediatric Critical Care Cases
Trauma Cases
Detroit EMS Ride-Along
Advanced Procedures such as:
ABG
Ultrasound Guided-IV
Ultrasound FAST exam
Intubation
Central Line placement
Trauma Code procedures
Chest Tube Insertion
This Elective will expose the student to the diverse spectrum of clinical problems encountered in the Emergency Department. The student will gain experience in the evaluation and treatment of various acute medical and surgical and traumatic disorders. The student will work closely with the senior residents and faculty of the Emergency Department in developing expanded differential diagnosis and management of both critically and non-critically ill patients. In addition to the patient care responsibilities, there are opportunities to participate in some of the following: didactic lectures, workshops, conferences and the opportunity to spend a shift riding with Detroit EMS.

OBJECTIVES OF THE ELECTIVE
Development of critical thinking and patient care management skills in a large urban Emergency Department setting.
The ability to function effectively within the context of complexity and uncertainty in medical care
Management of more than one patient simultaneously, devise and implement expanded differential diagnosis and management of critically ill patients, and see them through to disposition.
The student will learn advanced procedures.
The student will gain experience with End-of-life care and decisions, bereavement and family stress management.
Content Theme Integration
Critical Decision Making
Ethics
Violence/Abuse
Geriatrics
Pain Management
Substance Abuse
Effective communication under stress conditions
KEY RESPONSIBILITIES OF THE STUDENT WHILE ON ELECTIVE
Students will have direct patient management responsibility under close supervision by the attending faculty and senior residents.
Mandatory attendance for all activities, including clinical shifts in Emergency Department and all available didactic lectures, ultrasound workshops, SIM sessions and conferences.
Students will be scheduled for a variety of shifts 8 hours in length and will be rotated a clinical schedule of days, evenings, nights and weekends in order to experience the full range of case types that are typical of each shift.
METHOD OF EVALUATION

The final evaluation will be completed by the SJH EM Clerkship Director, using the format provided by the student’s school and based upon:

Successful completion of a minimum of 14 eight-hour required shifts
A minimum of 8 shift evaluations must be returned to the Clerkship Director by month end
100% Participation in available conferences and lectures
SCHEDULING INFORMATION

Months Offered: August-November, space is limited

Mandatory Orientation attendance on the first weekday of the elective month

Month runs from the first weekday to the last calendar day

Prior to orientation you will receive orientation details and rotation guidelines via email

Apply through your school or St. John Hospital & Medical Center, Medical Education Department, GME Student Program Coordinator 313-343-7843 Please Note: Space is very limited.