Syllabus

Here is the syllabus for this course, EMD 703: Emergency Medicine. Please read through this and refer to it as needed throughout the rotation. Click on the links to get more information. If you have any questions, please feel free to contact your site director or site coordinators. There are some paper forms you’ll need to download, and these are all collected on the downloads page.

  1. What are the requirements I need to fulfill to complete this rotation?
    • You need to complete 13 clinical shifts
    • You need to enter at least one patient into OASIS per shift.
    • You must complete a patient log for each shift you work. You are required to turn these forms in to the rotation coordinator at the end of the rotation.
    • For each of those patients you’ve entered into Oasis, you need to complete a note (EPIC, CERNER or paper – whatever is done at your site).
    • You need to complete a shift eval before the end of each shift
    • You’ll need to completed one faculty observed history and physical and turn in the form. Here is the definition of Rush Medical College Faculty.
    • Prior to the end of the rotation, you’ll present an evidence-based self-directed learning project
    • You’ll need to complete a mid-rotation feedback session with the clerkship director approximately midway through the rotation
    • At the end you’ll take the NBME Shelf Exam (or equivalent exam for visiting students)
    • After your test, you’ll be asked to complete an evaluation of the rotation
  2. These components go into calculating your grade (including professionalism)
  3. What is my role as a student during the shift?
  4. Is there a required textbook for this course?
  5. What happens if I’m going to be sick or late? And what about interviews?
  6. What’s the dress code?
  7. What is Rush’s policy on academic honesty?
  8. What can I do if I feel like I am being treated unfairly?
  9. What if I’m being evaluated by a doctor who once took care of me?
  10. What if I get stuck with a needle or something in my eye?
  11. How can I get safely to my car?
  12. Do you have any other helpful advice?
  13. Who are the course administrators?
  14. Other important phone numbers

Clinical Shifts

You’re expected to do thirteen 8-hour shifts over the course of the four week rotation. Of these:

  • At least four evening shifts
  • At least three night shifts
  • At least two weekend shifts
    • Only shifts which begin on a Saturday or Sunday count as weekend shifts
  • You should have at least 10 hours off in between shifts.
  • You cannot work more than 80 hours a week — that would be 10 shifts a week, which is not possible anyway

The available shifts differ based on site. Please note some of the Pod C shifts are not available on weekends.

Rush County
  • 6 am to 2 pm Pod B (Day)
  • 7 am to 3 pm Pod B (Day)
  • 2 pm to 10 pm Pod B (Evening)
  • 3 pm to 11 pm Pod B (Evening)
  • 10 pm to 6 am Pod B (Night)
  • 11 pm to 7 am Pod B (Night)

  • 8 am to 4 pm Pod C (Day, M-F only)
  • 9am to 5 pm Pod C (Day, Weekends only)
  • 10am to 6 pm Pod C (Day, M-F only)
  • 4 pm to 1 am Pod C (Evening, M-F only)
  • 6 pm to 3 am Pod C (Evening, M-F only)
  • 5 pm to 2 am Pod C (Evening, Weekends only)
  • 7 am to 3 pm Green Team (Day)
  • 3 pm to 11 pm Green Team (Evening)
  • 11 pm to 7 am Green Team (Night)

  • 7 am to 3 pm Red Team (Day)
  • 3 pm to 11 pm Red Team (Evening)
  • 11 pm to 7 am Red Team (Night)

  • 7 am to 3 pm Blue Team (Day)
  • 3 pm to 11 pm Blue Team (Evening)
  • 11 pm to 7 am Blue Team (Night)

Attendance at all shifts is mandatory to pass the course. Clinical performance counts for 50% of your grade. Not showing up for a scheduled shift is unprofessional behavior. If you cannot make a shift, you may switch shifts with your classmates, or talk to the clerkship coordinator to arrange alternative arrangements. Please see the individual site orientation page for how schedules are made

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Patient Types

You also need to see one of each of these chief complaints during your rotation. If you feel like you are unable to do this, let your site director know as soon as possible so we can make appropriate arrangements.

  1. Abdominal pain
  2. Chest Pain
  3. Shortness of Breath
  4. Altered Mental Status / Intoxication / Psych
  5. Headache

Keep track of these patients your patients on a patient log.

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Shift Evaluations

Additionally you’ll need to a shift evaluation for each shift from the faculty with whom you worked. This is done via an online form that can be found under shift evaluation on the main menu. Please have your attending complete an evaluation at the end of every shift.

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Faculty Observed History and Physical

At approximately the 2nd or 3rd week of the rotation, you’ll need to have a faculty-witnessed history and physical. Faculty at RMC include both attending and housestaff physicians. Housestaff physicians are comprised of interns, residents and fellows. On this rotation, you will be primarily working with and evaluated by attending and resident faculty. You can only be evaluated by senior emergency medicine residents and attendings. So at Rush, only attendings can fill out the evaluation. At Stroger, senior EM residents and attendings can complete it.

We will be focusing on taking a differential-diagnosis focused history and physical. The components you will be responsible for include:

  • Using the patient’s chief complaint, form a differential diagnosis which includes 3 to 5 life threatening, must-not-miss diagnoses.
  • Characterize the complaint with the standard descriptors: character, onset, location, duration, radiation, exacerbators, allieviators, etc
  • In your history, ask questions specific to your differential diagnosis. For example, if you are assessing an acute coronary syndrome for chest pain, ask about exertional symptoms or family history.
  • On your physical exam, look for findings specific to your differential diagnosis. For example, if you are assessing for appendicitis, check the right lower quadrant and assess for peritoneal signs.

At the Rush site, the best way to do this may be to go see the patient and then fill out the Observed History and Physical Evaluation Form. Then you can present the patient and do the physical in the patient room with the faculty member. They can check off the form, offer you feedback and then return it to you. This form needs to be turned in to the course coordinator by the end of the rotation.

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Midrotation Feedback

By the second Friday of the rotation, download and complete a midrotation feedback form.  Discuss your progress and any issues you may have with your clerkship director.

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Self-Directed Learning Project (EBM Project)

This is a clinically-focused, self-directed learning exercise in which you first develop your own learning objective, then acquire evidence to answer your question, and finally present it to the class. We’ll decide on topics during the first week of the rotation, and you’ll present your work on the 3rd Friday of the rotation.

Basically, you’ll

  1. Start with a patient with whom you had a question, perhaps “Could I have used the d-dimer in ruling out PE on my patient?”
  2. Then formulate a question: try to use the PICO format, “In young males with low probability Wells Scores, how good is the d-dimer in ruling out PE?”
  3. Acquire the evidence: use appropriate resources to search for an answer. You may find an article, the Cochrane Database. Avoid Up-To-Date or Wikipedia.
  4. Appraise the evidence: how valid (close to the truth) is this answer and how applicable (useful in clinical practice)
  5. Apply the evidence: Tell me how you would manage the patient differently now that you know what you know.

This counts for 5% of your final grade. More information is found here.

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Final Exam

The final exam counts for 25% of your grade. This is the National Board of Medical Examiners (NBME) exam in Emergency Medicine. I haven’t seen the exam and so can’t tell you what’s on it. I do know it is based on the material on the CDEM website, so know that stuff. For visiting students, you will not take the NBME exam, but rather an equivalent exam written by the course directors.

General Principles including ethics and patient safety 1%–5%
Organ Systems *
95%–99%
Immunologic Disorders
Diseases of the Blood
5%–10%
Mental Disorders
Diseases of the Nervous System
10%–15%
Cardiovascular Disorders 15%–20%
Diseases of the Respiratory System 10%–15%
Nutritional and Digestive Disorders 10%–15%
Gynecologic Disorders 1%–5%
Renal, Urinary, Male Reproductive Systems 5%–10%
Obstetric Disorders 1%–5%
Disorders of the Skin 1%–5%
Disorders of the Musculoskeletal System and Connective Tissue 5%–10%
Endocrine and Metabolic Disorders 5%–10%
* A subset of items across the organ system section includes content that focuses on resuscitation/trauma (~15%) and environmental/toxicologic disorders (~15%)
Physician Tasks
Promoting Health and Health Maintenance 1%–5%
Understanding Mechanisms of Disease 5%–10%
Establishing a Diagnosis 25%–35%
Applying Principles of Management 45%–55%

In order to help prepare for the exam, we highly recommend you take the SAEM practice tests that are also available. Don’t want till the last week. There are two exams listed as “National EM M4 exam” and “National EM M4 exam (Version 2).” These are not practice tests and are not available for our use.

The times for the final exam will vary due to the computer lab availability. Your clerkship coordinator will let you know when the exam is.

In order to pass the course, you have to exceed the minimum pass level (MPL) which is set two standard deviations below the national mean for the exam.  The MPL is adjusted annually. A score that is not above the MPL leads to failure of the course, a period of required remedial study, and a re-take of the exam.

In order to be eligible for Honors and High Pass grades on the rotation, you will need to obtain a minimum threshold for final exam scores. The minimum score required to obtain an Honors is 74, and the minimum score required to obtain high pass is 66.

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Rotation Evaluation

Completion of evaluations is an important responsibility as it provides important feedback about what is working and what needs to be changed both in courses and faculty performance. Professional behavior includes the timely completion of evaluations.

It also helps us create a better experience for future students. Please take the time to finish this evaluation of us.

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Grading

  • 50% of your grade comes from your clinical evaluations.
  • 25% comes from your final exam.
  • 20% of your grade comes from your professionalism score (completing all requirements on time). You must have a passing grade on professionalism to pass the rotation.
  • 5% of your grade comes from your self-directed learning project (EBM project).

Professionalism is made up of two components during the rotation:

  • Professional behavior while working clinically (showing up on time, properly dressed, appropriate behavior), and
  • Professional behavior as a student (completing requirements on time, showing up to required activities).

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Student Role

On this rotation, you function like a sub-intern. In this role you’ll need to be sure to call all necessary consultants, speak with family and call report to admitting teams on any patients you have stay in the hospital.

You may see some critical patients. This is part of your training and an excellent opportunity. If you ever see a patient who has become unstable or has the potential to do so, please inform the attending immediately. You will continue to cover the patient, but with the appropriate back up. Remember, patient care and safety is always our priority.

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Required text

There is no required text book for this course, instead we will be using a website created by Clerkship Directors in Emergency Medicine from around the country. These reading modules are targeted at all medical students, not just those going into emergency medicine. This can be found at CDEMCurriculum.com.

The material there is broken down into two sections. The first section offers students an “approach to” a specific chief complaint. Each one gives you an idea of not only what critical diagnoses to consider, but also what initial actions must be taken even before arriving at a definitive diagnosis.

The second section is disease specific. These modules describe the classic presentation of disease processes (though rarely will something present classically), explanations of diagnostic tests, hints on how to make the diagnosis, treatment options and pitfalls to avoid.

Supplemental material may be provided by your site director. Check the site’s didactic page on this site for more information. A recommended text book for the rotation is “Clinical Emergency Medicine” by Sherman, Weber, Schindlbeck and Patwari. Drs. Sherman, Weber and Schindlbeck are EM physicians at Cook County Hospital. Dr. Patwari is an EM physician at Rush. You can borrow copies of these books during your rotation from the clerkship coordinator. Be sure to return them at the end.

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If you’re going to be sick or late

While tardiness effects everyone adversely, we know that sometimes things come up that are hard to control. Should you be late for your shift, please call ahead and let us know. Call the main ER number and let the faculty know.

Should you need to be absent from a shift, let your site coordinator know and we’ll work on rescheduling it.

Per the medical school’s illness policy, any more than 2 days absent need to be reported to the Office of Medical School Programs. Just not showing up to shifts is unprofessional behavior.

Here is the Rush Medical College attendance policy:

Group interactions enhance the educational process and establishing habits of punctuality and attendance are essential features of professionalism. Rush Medical College students are encouraged to attend all educational activities and to actively participate in those activities. Medical students, as adult learners. may elect not to attend some activities for which attendance is not required. M1 and M2 educational program leaders will mark some sessions on the time table as those for which attendance is required. For all small group learning sessions in the Physicianship Program and all clinical programs (SCE, others clinical activities in M1 and M2 years, and all M3 and M4 activities), attendance is required. A single unexcused absence may lead to failure of a block, course or program. Acceptable absences are those that are legitimate, excused absences approved in advance by the course director or absences that are the result of an emergency situation.

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Interviews

We don’t give you specific time off for you to go on interviews. Your schedule in the ER is fairly flexible, so if you have a few interviews, you should be able to arrange your schedule to accommodate them. The medical school’s policy is that “students may not take more than 2 days off during a 4-week elective for interview purposes.”

If you have a large number of interviews, it might be best for you to take a month off to concentrate on those.

Your didactics are mandatory, so please remember that when scheduling your interviews. You cannot pass the course if you miss these.

Many students have asked for special exceptions due to the number of interviews they had scheduled. While there is a lot of flexibility in the course schedule for you to take a few interviews, it is difficult to accommodate all the student’s needs and still have an effective rotation experience. If you cannot fulfill the requirements of the course, we encourage you to take it at another time. Instead focus on your interviews. Those are very important, give them the attention they need. We welcome you to take our rotation at a later date.

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Dress code

While on duty, all students are required to be clean, well groomed and wear a Rush photo identification above the waist with their picture clearly visible.

Rush student lab coats are required with dress attire. No denim jeans, tee shirts, or open toed sandals are to be worn. Blue or green non-logo scrubs can be worn. Cut off shirts that display a bare midriff section, short skirts that display the upper thighs, or low cut shirts that display a low neckline are not allowed. Dark glasses are only permitted with documentation of a medical necessity. Undergarments should not be visible. Imprinted promotional logo shirts/slacks are not to be visible. Hoisery/socks are to be worn. Tattoos are to be covered. Acrylic or false finger nails are not allowed. Nails are to be a length of no longer than 1/4 inch.

Closed toed, non-slip shoes are to be worn in the clinical area. Slacks should be ankle length or longer. Dresses or skirts should be knee length or longer. Noticeably scented personal products are not allowed in the clinical area. All clothing must be cleaned, pressed, coordinated and fitted properly and appropriate for work. Hair must be clean and appropriately restrined. Facial hair must be well trimmed and maintained. No visible body piercing may be worn with the exception of earrings. Visible jewelry related to an established religious tradition may be worn.

Should you be found to be wearing inappropriate clothing you will be asked to change. Should this require you to go offsite, you will be required to make up that shift plus another (for a total of two shifts) at a time arranged with the med student co-ordinator.

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What is Rush’s policy on academic honesty?

Rush University students and faculty belong to an academic community with high scholarly standards. As essential as academic honesty is to the relationship of trust fundamental to the educational process, academic dishonesty violates one of the most basic ethical principles of an academic community, and will result in sanctions imposed under the University’s disciplinary system. A partial list of academically dishonest behaviors that would subject a student to disciplinary action includes:

  • Cheating: Using unauthorized material or unauthorized help from another person in any work submitted for academic credit
  • Fabrication: Inventing information or citations in an academic or clinical exercise
  • Facilitating Academic Dishonesty: Providing unauthorized material or information to another person
  • Plagiarism: Submitting the work of another person or persons, as one’s own without acknowledging the correct source
  • Unauthorized Examination Behavior: Conversing with another person, passing or receiving material to/from another person or temporarily leaving an examination site to visit an unauthorized site

I copied this information from the Rush webpage on academic honesty.

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What can I do if I feel like I am being treated unfairly?

Rush has a zero-tolerance policy on mistreatment. Zero! If you feel that you are being mistreated, please bring that to the attention of the clerkship director. There will be no repercussions on you or your grade or your evaluations. We want this to be a safe and secure place for you to learn.

If you feel uncomfortable coming to the clerkship director, you have other resources. You can go speak with Dr. Boyd in the Office of Medical Student Programs or go to the Special Committee on the RMC Environment (SCORE). Dr. David Ansel serves as the ombudsman for SCORE. You can click here for an online reporting form for SCORE.

Here is the information shared with our faculty.

For more information, you can view SCORE’s information PDF.

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What if I’m being evaluated by a physician who once took medical care of me?

In order to avoid any conflict of interest, health professionals who have provided psychiatric/psychological counseling or other health services to a medical student must have no involvement in the academic assessment or promotion of the medical student receiving those services. Therefore, students should not be assigned to work with faculty (attending or residents) who may have provided these health services. With awareness of this policy, students must proactively bring any identified conflicts of this nature to the attention of the course director as soon as possible so that alternative assignments may be made.

Please don’t be offended, but most of us will not remember treating you as an M1, so we will unlikely know to excuse ourselves from grading you. Please bring this to our attention ahead of time so we can avoid these situations.

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What if I get stuck with a needle or something splashes into my eye?

If you are exposed to a hazardous or potentially infectious substance, please follow the Rush protocol below, for on campus and off campus occurrences. This information is also included in the Core Common Syllabus Appendix D, and on the laminated card behind your ID badge.

Exposure Incident Definition: Eye, mouth, mucous membrane, non-intact skin contact, or parenteral exposure to blood or potentially infectious or hazardous materials

Procedure at Rush University Medical Center

  1. Wash injured area with soap and water. If eyes, nose, or mouth, use water only.
  2. Immediately report the incident to your preceptor, supervisor, and/or course instructor.
  3. Immediately report to Emergency Services (ES), Room 1203, 1st Floor Tower, 1620 W. Harrison St., 312-947-1000. Please bring your student ID or indicate you are a student and not an employee.
  4. Supply ES nurse/physician with the following information on the source: (a) name, (b) date of birth, (c) medical record number, (d) known medical diseases (Hepatitis B, HIV), an (e) patient room number. All information is recorded confidentially in the Blood/Body Fluid Exposure Record.
  5. Students will be counseled or treated as deemed appropriate by ES personnel.
  6. E-mail RU.Report_Exposures@rush.edu regarding exposure with exposed student’s name, college, course, date, time, and details of exposure for follow-up, and ensure proper billing of the services received.
  7. Follow up with consultants as directed for lab work and treatment as indicated. Medical students will follow up with Lifetime Medical Associates (LMA).

Procedure if off Campus

Follow the protocol at your facility. If directed to Rush ES facility, bring source patient information (#4 above) and source blood in one lavender top and one marble top tube labeled “source patient.” Email RU.Report_Exposures@rush.edu with exposed student’s name, college, course, date, time, and details of exposure for follow-up and billing. Follow-up care should be received at ES or at consultants as directed by ES.

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How can I get safely to my car?

You will be working some late night shifts when you’ll either be coming to or leaving from the hospital at night time. Please be safe and contact security for a safe way to your car or home.

Rush University Medical Center provides free shuttle service between medical center buildings at designated times during the day and evening. The green and white shuttle van is available to transport students from the Stroger Hospital location to the parking garage at Rush, and other nearby locations. Please use good judgment in walking around the medical center after dark, consult posted shuttle schedules, and take advantage of this service.

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More helpful advice

Be proactive! One great trick is at the beginning of each shift pick one thing you want to work on during that shift. This could be “reading EKG’s” or “having more focused patient presentations.” Then let your attending know at the beginning of the shift, “Dr. Davis, on this shift I’d like to work on my presentations so I’d appreciate any feedback during this shift.” This will also make it easier for us to give you concrete feedback.

Flex your clinical decision making muscles. This is one of your final opportunities to be wrong while someone is backing you up. Consider placing the orders required for your patients care for your attending to co-sign. Discuss this with your attending at the beginning of the shift, as many will have different preferences. Next year, your decisions and orders have consequences. Use this opportunity to make decisions. It is better to make a commitment (“I’d like to discharge this patient”) and be wrong (“Sorry, this patient needs to be stay.”) than to make no decision at all. Our mistakes are often our best teachers.

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Course Administration

At the Rush site:

  • Clerkship Director: Carolyn Clayton, MD
  • Associate Clerkship Director: Thomas Alcorn, MD
  • Assistant Clerkship Director: Urvi Patel, DO
  • Clerkship Coordinator: Karmen Howard

At the County site:

  • Site Director: Sean Dyer, MD
  • Site Coordinator: Estella Bravo

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Are there any other numbers I should know?

Of course, and here they are…

  • Office of Associate Provost Student Affairs — 312/942-2819
  • Rush University Counseling Center — 312/942-3687
  • RUMC Campus Security — 312/942-5678
  • RUMC Emergency Room — 312/947-0100
  • RUMC Employee & Corporate Health Services — 312/947-0699
  • Lifetime Medical Associates — 312/942-8000

Crisis Lines

  • Chicago Police Department — 911
  • Illinois Poison Control Center — 800/222-1222
  • National Suicide Hotline — 800/273-8255
  • YWCA Rape Crisis Hotline — 888/293-2080
  • Alcoholics Anonymous 24-hr. Hotline — 312/346-1475
  • Narcotics Anonymous 24-hr. Hotline — 708/848-4884
  • Northwestern Memorial Hosp 24-hr. Hotline — 312/926-8100
  • Domestic Violence Help Line (City of Chicago) — 877/863-6338
  • Sarah’s Inn Hotline (domestic violence) — 708/386-4225

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