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:

  1. Principles of Emergency Medicine
  2. Resuscitation and Management of the Critically Ill/Injured Patient v
  3. The Symptom Pursuit Approach to the Undifferentiated Patient
  4. System Based Clinical Problems
  5. Content Areas Unique to Emergency Medicine
  6. Clinical Skills, Interpretations of Tests and Procedures
  7. Attitudinal and Professionalism Issues
  8. Societal/Ethical/Legal Issues

1. Principles of Emergency Medicine

At the end of the rotation the student will be able to:

  1. Discuss the role of the Emergency Department in the health care system.
  2. Demonstrate an understanding of the concept of triage and prioritization of care.
  3. Distinguish seriously ill or injured patients from those with minor conditions.
  4. Discuss the roles of the various providers of pre-hospital care.
  5. Appreciate the importance of organizational skills and efficiency in maintaining patient flow.
  6. 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:

    1. Outline the first-line priorities and treatments of any critically ill/injured patient.
    2. Describe the components of a primary and secondary survey in the assessment of a critically ill or injured patient.
    3. List the acute life or limb threatening possibilities in a given clinical presentation.
    4. Outline the differential diagnosis and initial management of a patient with airway compromise.
    5. Outline the differential diagnosis and initial management of a patient who presents in shock.
    6. 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 behaviour
      • seizure
    2. Recognize that certain groups of patients require a high index of suspicion for serious illness.
      • Immuno compromized
      • 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
    • Iritis
    • 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

    1. Outline the management priorities in a trauma patient with multiple injuries
    2. Describe the components of a primary and secondary survey in the assessment of a critically injured patient.
    3. Outline the principles of assessment and management of patients with a head injury.
    4. Discuss management of wound care and principles of tetanus prophylaxis.
    5. Discuss the general approach to the assessment and management of common fracture, dislocation, soft tissue injuries.

    Toxicology

    1. Outline the initial assessment and resuscitation of the poisoned patient
    2. Discuss methods of gastric decontamination and methods of enhancing elimination.
    3. Differentiate the following toxidromes - anticholinergic, cholinergic, sympathomimetic, opiod.
    4. Outline the general management of patients with substance abuse including both intoxication and withdrawal states.
    5. Discuss the use of antidotes.

    Environmental

    1. 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:

    1. Demonstrate a "focused" history and physical examination.
    2. Demonstrate an approach to the interpretation of the following tests:
      • Oximetry
      • Portable spirometry
      • Arterial blood gases and A-a gradient
      • Anion gaps
      • Osmolar gaps
      • EKG's
      • Radiographs
      • Micro-urinalysis
      • Electrolyte abnormalities
    3. 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
    4. 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
    5. Toxicology>Patient Evaluation:
      • Resuscitation and supportive care
      • Patient evaluation
        • Recognize common toxidromes
        • Understand appropriate use of lab tests
      • Gastric Decontamination and Elimination
      • Antidotal therapy

    7. Attitudinal and Professional Behaviour

    At the end of the rotation the student will be able to:

    1. Demonstrate effective, empathetic communication with patients and their families.
    2. Establish and maintain effective working relationships with colleagues and other health care professionals.  The importance of honesty, integrity, responsibility and professionalism will be stressed.
    3. Demonstrate an awareness of the underlying psychosocial and social economic problems that may precipitate an Emergency Department visit.
    4. Recognize his or her limitations and know when to ask for help.
    5. Have an approach to managing "difficult" patients (e.g. violent patients, drug seekers, alcoholics)
    6. Demonstrate good documentation habits, with concise recording of the pertinent positive and negative findings.
    7. Recognize that Emergency Department care is episodic and therefore that clear follow-up instructions are important.
    8. Understand how and when to consult another specialist.
    9. 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:

    1. 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.
    2. Recognize the presentation of physical and sexual abuse and domestic violence.
    3. Outline appropriate management for the victims.
    4. Recognize the scenarios in which obligatory notification is required by law.
    5. Discuss the indications and procedures for certification and involuntary status under the Mental Health Act.
    6. Demonstrate an understanding of the principles of informed consent, right of competent patients to refuse treatment and implied consent.
    7. Challenge patients when appropriate on preventative health issues (i.e. smoking cessation, exercise, safe sex, bicycle helmets, seat belts, motorcycle helmets.)