1. Course Requirements
Welcome to your Emergency Medicine rotation. This is meant to be a summary of what is expected during your rotation here. We have tried to design this course so that both students interested in Emergency Medicine and those interested in something else will have a good experience here. You are receiving this packet ahead of time so you will have an idea of what to expect in your rotation month. You will be able to schedule your ride-alongs (explained below) before you begin your rotation so you will have some advance knowledge of your schedule. If you have any questions or concerns, you will be able to discuss them with Dr. Ledrick before beginning your rotation.

On the first day of your scheduled rotation, come to the residency office. You will receive your reading material and a schedule. Be sure to leave a reliable phone number where you can be reached. You might not be scheduled to work clinically that day. You can use the time to organize your procedure day and ride-alongs. Feel free to come over and visit the Emergency Department. The reality is that no matter how you are oriented, the first four hours of your first shift are going to teach you more about Emergency Department function than any tour can.

During your rotation, you will be expected to do twelve (12) eight-hour shifts. These will be scheduled for you. You may switch shifts with your classmates; but these changes must first be approved by the faculty ( David Ledrick). In addition to these shifts, you will do two (2) eight-hour ride-along shifts with Lucas County EMS and two (2) four-hour procedure shift.  You may schedule these shifts yourself.

You will have time that is protected for educational reasons. Every Tuesday morning between 7 am - Noon, you will be expected to come to Emergency Medicine Grand Rounds. In addition to this, you will also have scheduled Wednesday lectures with the Emergency Medicine residents. (These will be announced at the beginning of the rotation.) If you are scheduled for a shift at the same time, you are released from your clinical duties and will be expected at the lecture, as attendance is REQUIRED. Also, Journal Club is held once a month. You can pick up the articles and get the date from Jan Fuller in the Residency office. Finally, students rotating on Pediatric Emergency Medicine should go to the pediatric code lecture. This is scheduled on a variable basis.  Jan Fuller has this schedule also.

2. Reading List
You will receive several texts when you show up for your first day of rotation. The yellow, soft-bound, home-made text is yours to keep. The written test will come from this source and the green text book edited by Hamilton. You will only need to read the following chapters by Hamilton: Orientation to Emergency Medicine:  Pages 1-75   Acute Abdominal Pain: Pages 77-97    Chest Pain:  Pages 131-154   Anaphylaxis:  Pages 209-217    The Poisoned Patient:  Pages 259-286    Febrile Infants:  Pages  439-454    Acute Low Back Pain:  Pages 485-503    Multiple Blunt Trauma:  Pages 693-723.

All told, this amounts to about 10 pages per day. Pace yourself.

You are welcome to check out the other texts in the office. You will be expected to return the Rund text and any others at the conclusion of your rotation. You will not receive a grade from this rotation until they are all returned.

3. Shift Work
The nature of Emergency Medicine is learning how to work as a team and how to work different shifts. You will receive an orientation to your shift work and a schedule on your first day. One of our priorities is scheduling the students throughout the day so that we don't have overlapping student shifts. 

We also want the students to experience all shifts, which include days, evenings, and nights. Some shifts will be designated as pediatric shifts (PEDS). These shifts are in the Pediatric Emergency Department from 3 pm - 11 pm. Some shifts may be designated as Fast-Track (FT) shifts. These will be from 3 pm - 11 pm in the Fast-Track area of the Emergency Department. You should see the patients as they are placed in rooms and present to a RESIDENT. After you and the resident come up with a plan for the patient, you should talk to the ATTENDING.  Often the Resident is also assigned to flight duty, and another resident should be involved with each case.

If you see a patient who you think is unstable or has the potential to become so, tell a resident or attending immediately. You will continue to care for the patient, but it is important that you have back up.

4. Night Shifts.
Part of Emergency Medicine is working nights. At times, the night shifts are EXTREMELY busy. If this is the case, the resident may ask you to work as their expediter. This may mean shadowing the resident to act as a scribe, order writer, discharge writer, and following up on labs and x-rays. Yes, there is a component of scut work to this; but by the same token, you will see more patients and can ask the resident questions about each. There is teaching value in this. If you feel you are getting only scut work without any educational benefit, please tell Dr. Ledrick.

5. Ride-alongs
You will be given information on how to schedule your ride-along shifts. You will need to turn in your logs as a completion requirement for the course. You have great flexibility in doing this. Just get two 8-hour shifts in sometime during the month.

6. Procedure Day
You may do your procedure day on any day and at any time you like (provided you are not on shift). The purpose of this is for you to get a feel for what the nurses do and give you a chance to do blood draws, start IVs, and do NG tubes. Let both the residents and the charge nurse know that you are in the Department for a procedure day. They will try to get you as many procedures as possible. The residents, for instance, are likely to give you a laceration to sew. The nurses will give you plenty of opportunities to start IVs. You will have a procedure log to fill out.  Have the charge nurse sign it after your procedure day.

7. Lectures
The Wednesday lectures are given at noon. These are done by Emergency Medicine residents. Since the rotations of the students don't match those of the residents, these will be announced at the beginning of each rotation.

8. Grand Rounds
Grand Rounds are required and are from 7 am - Noon every Tuesday. Food is usually served. If you are working a morning shift that day, you are excused to go to Grand Rounds. You should go back to the Department after the lectures.

9. Written Exam
A written exam will be given at any time during the month that you request it. You may take it once. Your final grade will be approximately 30% based on the written exam. This exam is available in the office where you picked up your orientation material. It is a closed-book exam and is to be taken in the library and returned the same day you receive it.

10. Grading
Your grade will come primarily from your clinical performance. You will receive another 30% from your written exam.  Ultimately, the attendings are grading you, but we will take input from the residents.

You will also keep patient logs. These are evaluation sheets with room for the stickers of each of your patients. Place a sticker of each patient you see on the sheet; and upon disposition of the patient, place a diagnosis. At the end of your shift, turn your sheet in to the resident or attending you worked most closely with; and they will fill out your evaluation at the end.

We will use the daily evaluations as a part of your grade. We use the patients and numbers to track the experience you are having. We want to improve the rotation over time and need to know what sort of patients the students are seeing. The number of patients you see is irrelevant. Residents are for moving patients, NOT students. Your grade will be dependent on how well you manage your patients, not how many you see.