Undergraduate Student Objectives
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The following objectives apply to undergraduate students doing their rotation through the Emergency Department. 

There are eight categories of instructional objectives:  

  • Principles of Emergency Medicine
  • Resuscitation and Management of the Critically Ill/Injured Patient 
  • The Symptom Pursuit Approach to the Undifferentiated Patient
  • System Based Clinical Problems
  • Content Areas Unique to Emergency Medicine Clinical Skills,
  • Interpretations of Tests and Procedures
  • Attitudinal and Professionalism Issues 
  • Societal/Ethical/Legal Issues  
  1. Principles of Emergency Medicine At the end of the rotation the student will be able to:  

    • Discuss the role of the Emergency Department in the health care system. 
    • Demonstrate an understanding of the concept of triage and prioritization of care. 
    • Distinguish seriously ill or injured patients from those with minor conditions. 
    • Discuss the roles of the various providers of pre-hospital care.
    • Appreciate the importance of organizational skills and efficiency in maintaining patient flow.
    • Recognize that assessment and treatment of a patient may occur simultaneously. 
        
  2. Resuscitation At the end of the rotation the student will be able to:  

    • Outline the first-line priorities and treatments of any critically ill/injured patient.
    • Describe the components of a primary and secondary survey in the assessment of a critically ill or injured patient.
    • List the acute life or limb threatening possibilities in a given clinical presentation.
    • Outline the differential diagnosis and initial management of a patient with airway compromise.
    • Outline the differential diagnosis and initial management of a patient who presents in shock.
    • Describe the different methods of monitoring an acutely ill patient. 

  3. The Symptom Pursuit Approach to the Undifferentiated Patient At the end of the rotation the student will be able to:  

    1. Demonstrate the principles of initial evaluation, stabilization and differential diagnosis management of patients with the following symptoms:

    • Shortness of breath Chest pain Shock Altered mental status and coma Headache Syncope Abdominal Pain Fever The 'unwell' patient GI Bleeding Vaginal bleeding Abnormal behavior seizure 
    • Recognize that certain groups of patients require a high index of suspicion for serious illness.
    • Immuno compromised Chronic renal failure Transplant Extremes of Age, i.e. elderly and neonates Intoxicated Diabetes 

  4. System Based Clinical Problems  At the end of the rotation the student will be able to:  
    • Demonstrate the principle of initial evaluation, stabilization and management of patients with the following clinical problems in the Emergency Department.  
    • Respiratory Acute asthma and COPD Pulmonary Embolism Airway obstruction Pneumothorax Pneumonia  
    • Cardiovascular  
    • Acute Coronary Syndromes CHF Cardiac Dysrhythmias Hypertensive urgencies and emergencies Pericarditis Aortic Dissection and Aneurysm  
    • Neurological  
    • Seizures Stroke/Transient ischemic attacks Meningitis Vertigo Cerebral hemorrhages -- subarachnoid, subdural, epidural and intracerebral   Head, Ears, Eyes, Nose & Throat  
    • Corneal abrasion / Foreign body Conjunctivitis Iritic Glaucoma Retinal artery/vein occlusion Retinal detachment Eye trauma Epiglottitis Epistaxis Otitis media Tonsillitis/peritonsillar abscess  
    • Gastrointestinal Disorder  
    • Gastritis/peptic ulcer disease GI bleed ( upper and lower ) Acute cholecystitis, biliary colic, cholelithiasis, cholangitis, pancreatitis Perforated viscus Bowel obstruction Appendicitis   
    • Genito-urinary Disorder  
    • UTI STD/PID Vaginal bleeding - pregnant and non pregnant Sexual assault Ectopic pregnancy Nephrolithiasis Testicular torsion/ovarian tortion Acute and chronic renal failure  
    • Musculo-skeletal Emergencies  
    • Sprains/strains Fractures Septic joints Dislocations Which patients requires orthopedic referral  

  5. Content Areas Unique to Emergency At the end of the rotation the student will be able to:  
    • Trauma Outline the management priorities in a trauma patient with multiple injuries 
    • Describe the components of a primary and secondary survey in the assessment of a critically injured patient.
    • Outline the principles of assessment and management of patients with a head injury. 
    • Discuss management of wound care and principles of tetanus prophylaxis. 
    • Discuss the general approach to the assessment and management of common fracture, dislocation, soft tissue injuries.   
    • Toxicology  
    • Outline the initial assessment and resuscitation of the poisoned patient
    • Discuss methods of gastric decontamination and methods of enhancing elimination.
    • Differentiate the following toxidromes - anticholinergic, cholinergic, sympathomimetic, opiod. 
    • Outline the general management of patients with substance abuse including both intoxication and withdrawal states. 
    • Discuss the use of antidotes.   
    • Environmental  
    • Outline the principles of management of the following:  Burns  Near drowning  Bites - human, dog, cat  Heat illness Hypothermia/cold injuries 
    • Lightning injuries
    • Diving injuries and Hyperbaric oxygen treatment  
    • Pre-hospital Care  
    • Understand the role of pre-hospital care in Emergency Medicine  
    • Disaster Medicine 

  6. Clinical Skills, Interpretation of Tests, Procedures At the end of the rotation the student will be able to:  

    • Demonstrate a "focused" history and physical examination. 
    • Demonstrate an approach to the interpretation of the following tests:  
      • Oximetry Portable spirometry Arterial blood gases and A-a gradient Anion gaps Osmolar gaps EKGs Radiographs Micro-urinalysis Electrolyte abnormalities  
    • Perform the following skills during their clinical experience in Emergency Medicine. 
      • Competency for each required skill will be documented by the supervising physician in the student's log book.  
      •  Local anesthetic infiltration Application of casts and splints Arterial puncture Urinary catheterization Suturing of minor wounds Intravenous lines Venipuncture Nasogastric tube insertion 
    • Observe and or participate in the following procedures depending on the student's clinical experience.  
      • Tracheal intubation Chest tube insertion
      • Central intravenous lines Intraosseous infusion
      • Pleurocentesis Gastric lavage
      • Reduction of fractures and dislocations Laryngoscopy - direct and indirect Incision and drainage of abscesses
      • ACLS - Defibrillation and Cardioversion Cricothyroidotomy Needle thoracostomy
      • Pericardiocentesis Paracentesis Lumbar puncture Nasal cautery or packing Foreign body removal - various locations Joint aspiration  
    • Toxicology Patient Evaluation:  
      • Resuscitation and supportive care Patient evaluation 
      • Recognize common toxidromes
      • Understand appropriate use of lab tests  
      • Gastric Decontamination and EliminationAntidotal therapy

  7. Attitudinal and Professional Behaviour At the end of the rotation the student will be able to: 
    • Demonstrate effective, empathetic communication with patients and their families. 
    • Establish and maintain effective working relationships with colleagues and other health care professionals. 
    • The importance of honesty, integrity, responsibility and professionalism will be stressed. 
    • Demonstrate an awareness of the underlying psychosocial and social economic problems that may precipitate an Emergency Department visit. 
    • Recognize his or her limitations and know when to ask for help.
    • Have an approach to managing "difficult" patients (e.g. violent patients, drug seekers, alcoholics) 
    • Demonstrate good documentation habits, with concise recording of the pertinent positive and negative findings. 
    • Recognize that Emergency Department care is episodic and therefore that clear follow-up instructions are important. 
    • Understand how and when to consult another specialist. 
    • Understand the advantages and disadvantages of a career in Emergency Medicine.

  8. Societal/Ethical/Legal Issues At the end of the rotation the student will be able to:    
    • Appreciate the significance of ethical decisions made in the Emergency Department (i.e. "DNR", discontinuing resuscitation considerations and the impact of these decisions on the patient, their family and the health care workers involved.
    • Recognize the presentation of physical and sexual abuse and domestic violence.
    • Outline appropriate management for the victims.
    • Recognize the scenarios in which obligatory notification is required by law.
    • Discuss the indications and procedures for certification and involuntary status under the Mental Health Act.
    • Demonstrate an understanding of the principles of informed consent, right of competent patients to refuse treatment and implied consent. 
    • Challenge patients when appropriate on preventative health issues (i.e. smoking cessation, exercise, safe sex, bicycle helmets, seat belts, motorcycle helmets.)