Rotation Specific Objectives - Emergency Medicine

 

 

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Introduction:

 

With the introduction of the PGYI Residents to the Orthopaedic Program the Orthopaedic Surgery Residency Training Committee felt it was important to include Emergency Medicine. This rotation demonstrates the importance of learning adult resuscitation skills and provides an overview in all areas of Emergency Medical Management.

 

The experience will vary widely from one period to another but in the two blocks assigned to this rotation the resident will have some exposure to both surgical and non-surgical conditions.

 

 

Rotation Specific Objectives:

 

1. Medical Expert:


1.1. Some of the objectives, which will not necessarily be included on other rotations include:

1.1.1. Fever (Infections)

1.1.2. Trauma

1.1.3. Poisoning

1.1.4. Anaphylactic Reaction

1.1.5. Diabetes Mellitus

1.1.6. Chest Pain

1.1.7. Dyspnea

1.1.8. Syncope

1.1.9. Cyanosis

1.1.10. Palpitations

1.1.11. Shock

1.1.12. Haemoptysis

1.1.13. Abdominal Pain Acute

1.1.14. Vomiting

1.1.15. Hematuria

1.1.16. Pelvic Pain

1.1.17. Ear, Nose and Throat Problems

1.1.18. Dermatologic Problems

1.1.19. Ocular and Neurologic Problems

1.1.20. Psychiatric Problems

1.2. Core objectives in surgery that will be included in this rotation:

1.2.1. Establish emergency treatment priorities and effectively perform the immediate management of the following life threatening conditions:

1.2.1.1. Airway Obstruction

1.2.1.2. Shock And Overt Haemorrhage

1.2.1.3. Pneumothorax

1.2.1.4. Haemothorax

1.2.1.5. Cardiac Tamponade

1.2.1.6. Trauma, Burns

1.2.1.7. Immobilization of The Fractured Cervical Spine

1.2.2. Perform physical examination of the trauma patient once the patient is stabilized

1.2.3. List the appropriate diagnostic procedures for conditions identified during a detailed physical examination

1.2.4. List and describe the baseline parameters which should be assessed and monitored in the head injured patient

1.2.5. Outline the appropriate diagnostic procedures and the management principals of conscious and unconscious patients with traumatic head injury

1.2.6. Elicit and interpret the clinical feature of spinal, paraspinal and cord injuries

1.2.7. Order and interpret the appropriate investigations required to diagnose the type of spinal injury

1.2.8. List the appropriate initial measures for the management of a patient with a spinal injury

1.2.9. Identify the nature and extent of facial and cervical injuries and plan the appropriate investigation and the basic initial management

1.2.10. Identify those injuries requiring the attention of a specialist and outline the principles of treatment of such injuries

1.2.11. Diagnose and perform the initial management of:

1.2.11.1. Tension Pneumothorax

1.2.11.2. Open (sucking) Pneumothorax

1.2.11.3. Massive Coagulation

1.2.11.4. Flail Chest

1.2.11.5. Cardiac Tamponade

1.3. Diagnose and describe the initial management of pulmonary contusion, aortic rupture, tracheobronchial tree injuries, diaphragmatic rupture, and esophageal rupture

1.4. Outline the initial management of non-life threatening chest injuries

1.5. Determine on the basis of history and physical examination whether significant abdominal injuries exist and provide a differential diagnosis of the type of injury

1.6. List and interpret the results of the initial diagnostic procedure for blunt or penetrating abdominal trauma

1.7. Elicit the clinical signs essential in the diagnosis of arterial and venous injuries and differentiate between the various types of vascular injuries

1.8. Outline priorities in the assessment and management of the injured extremity

1.9. Identify, order the appropriate investigations and interpret the results of investigations in the following life threatening extremity injuries:

1.9.1. Major Pelvic Fractures

1.9.2. Major Femoral Fractures

1.9.3. Traumatic Amputations

1.9.4. Outline the basic emergency care of fractures and join injuries including open wound care, immobilization, pain control and tetanus prophylaxis

1.9.5. Diagnose and treat compartment syndrome

1.10. Describe the principles and outline a management plan for of urinary tract injury

1.11. Estimate the burn surface area

1.12. Identify first, second and third degree burns on a clinical and anatomical basis

1.13. Interpret symptoms and signs of respiratory tract burn injury

1.14. Construct a plan for the local and systemic treatment of major burns

1.15. Shock

1.15.1. Define and classify shock

1.15.2. Construct and justify a patient management plan based on a differential diagnosis formulated by the performance and/or interpretation of a relevant history and physical examination and interpretation of ancillary diagnostic tests

1.16. Medical Problems in Surgery

1.16.1. Diagnose, recognize surgical complications of and outline emergency treatment plans for:

1.16.1.1. Anemia

1.16.1.2. Coma

1.16.1.3. Diabetes

1.16.1.4. Bleeding Disorders

1.16.1.5. Chronic Obstructive Pulmonary Disease

1.16.1.6. Coronary or Valvular Heart Disease

1.16.1.7. Renal, Hepatic Disease

1.16.1.8. Hypotensive and Hypertensive Disease

1.16.1.9. Psychiatric Disorders

 

 

2. Communicator:

2.1. establish therapeutic relationships with patients and families

2.2. obtain and synthesize a relevant history from patient, families and communities

2.3. listen effectively

2.4. discuss appropriate information with patients and families and the health care team

 

 

3. Collaborator:


3.1. consult effectively with other physicians and health care professionals

3.2. interact effectively with interdisciplinary team activities

 

 

4. Manager:


4.1. utilize resources effectively to balance patient care, learning needs, and outside activities

4.2. work effectively and efficiently in the healthcare organization

4.3. allocate finite health-care resources wisely

 

 

5. Health Advocate:


5.1. identify the important determinants of health affecting patients particularly those with spinal cord injuries, amputations, chronic debilitating diseases

5.2. Have knowledge of community services available for these patients

 

 

6. Scholar:


6.1. critically appraise sources of medical information

6.2. contribute to the development of new knowledge

 

 

7. Professional:


7.1. Deliver highest-quality care with integrity, honesty and compassion

7.2. Exhibit appropriate personal and interpersonal professional behaviors

7.3. Practice medicine ethically consistent with obligations of the physician

 

 

Conditions of Learning

 

Junior level – two-month rotation in Emergency Room

 

 

Methods of Instruction/Learning

 

Patient interaction in Emergency Room

Self-directed/ cognitive apprenticeship

 

 

Evaluation:

 

Evaluation daily (each shift) by supervising preceptorFinal aggregate in training evaluation by Department of emergency medicine.