Emergency Medicine

Clinical Goals & Objectives

During your rotation in Emergency Medicine, you will be expected to assess undifferentiated emergency department patients, perform a focused history and physical examination, formulate a preliminary differential diagnosis and investigation and management plan, and then present these cases to your preceptor. If you do see any acutely ill patients, notify your attending staff immediately.

You are expected to see at least 50 patients during your rotation. Of these 50 patients you are expected to see at least two each of the following presentations as well as log the cases into MedSIS:

  • Chest pain (two different causes)
  • Abdominal pain (two different causes)
  • Infectious Disease
  • Trauma
  • Headache
  • Weakness/Dizziness
  • Allergic/Anaphylactic reaction
  • Behavioral/Psychiatric problem
  • Toxicologic problem
  • Altered level of consciousness

General Goals

  • A. Patient Assessment Skills

    - Performing an initial evaluation of patients with a wide variety of undifferentiated medical, surgical, psychological and social problems. In an Emergency Department setting, this requires an appropriately focused history and physical examination based on a patient's presentation.

    - Formulating a working differential diagnosis and an efficient investigation plan, with appropriate, cost-effective use of laboratory and radiological studies.

  • B. Patient Management Skills

    - Understanding the concept of triage and prioritization of care when simultaneously managing multiple patients.

    - Appreciating the importance of organizational skills and efficiency in maintaining patient flow.

    - Performing procedural skills pertaining to Emergency Medicine (see below).

  • C. Recognition and Management of Emergencies

    - Rapidly recognizing acute life- or limb-threatening illnesses or injuries.

    - Demonstrating a systematic, prioritized approach to resuscitation and stabilization of medical, surgical, and traumatic emergencies.

  • D. Understanding of Emergency Medicine

    - Understanding the role of the Emergency Department in the health care system and how it relates to other hospital and community health services.

    - Understanding the role of Emergency Physicians in Pre-hospital Care.

  • E. Professional Behaviors

    - Effectively communicating with patients, colleagues and other health care professionals.

    - Establishing and maintaining effective working relationships with colleagues and other health care professionals.

    - Recognizing and managing the psychosocial and ethical issues that commonly arise in the Emergency Department.

    - Acquiring good documentation habits, with concise recording of pertinent positive and negative findings.

    - Acting in a professional ethical manner including being punctual, dressing appropriately and attending mandatory teaching sessions.


Course Objectives

  • A. Medical Expert

    - Discuss the role of the Emergency Department in the health care system.

    - Demonstrate an understanding of the concept of triage.

    - Distinguish seriously ill or injured patients from those with minor conditions.

    - Demonstrate a 'focused' history and physical examination.

    - Outline the first-line priorities of assessment and treatment of any critically ill or 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 who presents in shock.

    - Outline the features and treatment of a patient with anaphylaxis.

    - Demonstrate the principles of initial evaluation, stabilization, and management of patients with the following presenting symptoms:

    a) Abdominal pain

    b) Abnormal behaviour and coma

    c) Allergic reaction

    d) Chest pain

    e) Headache

    f) Infectious disease

    g) Syncope

    h) Weakness and dizziness

    i) Trauma

    - Demonstrate the principles of initial evaluation, stabilization, and management of patients with the following clinical problems commonly encountered in the Emergency Department:

    a) Respiratory (acute asthma and COPD, pulmonary embolism, pneumonia)

    b) Cardiovascular (unstable angina and acute myocardial infarction, acute congestive heart failure, cardiac dysrhythmias including EKG interpretation)

    c) Neurological (status epilepticus, meningitis, acute cerebrovascular accident)

    d) Ophthalmological (the approach to the red eye, use of the slit lamp and tonometry)

    e) Trauma (outline the management priorities in a trauma patient with multiple injuries, outline the principles of assessment and management of patients with head injury, discuss the general approach to the assessment and management of common fractures/dislocations/soft tissue injuries, discuss the principles of tetanus prophylaxis)

    f) Toxicology (outline the initial assessment and resuscitation of the poisoned patient, discuss the use of activated charcoal as a decontaminant, discuss the role of gastric-emptying procedures, describe the following 'toxidromes': anticholinergic, cholinergic, sympathetic, narcotic, sedative-hypnotic, outline the general management of patients with substance abuse including both intoxication and withdrawal states)

    - Perform, observe or discuss the following skills: suturing of minor wounds, application of splints and casts, intravenous lines, arterial puncture, urinary catheter insertion, CPR, procedural sedation, reduction of fractures/dislocations, lumbar puncture, and endotracheal intubation.

    - Perform, observe or discuss the following skills: arterial blood gases, electrocardiograms, radiographs (5 different types). 

  • B. Communicator

    - Demonstrate effective, empathetic communication with patients and their families.

    - Have an approach to managing 'difficult' patients (e.g., violent patients, drug seekers, alcoholics).

    - Recognize that Emergency Department care is episodic and therefore clear follow-up instructions are important.

    - Charts clearly, including positive and negative findings, investigations, reassessments and discharge instructions.

    - Present a clear verbal case report to attending staff.

  • C. Collaborator

    - 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 good documentation habits, with concise recording of pertinent positive and negative findings.

    - Discuss the roles of various providers of pre-hospital care.

  • D. Leader

    - Demonstrate an awareness of the role of the ED in the health care system.

    - Understand the principles of ED triage.

    - Identify patients who need hospital admission, in-ED consultation, or out-patient follow-up.

  • E. Health Advocate

    - Demonstrate an awareness of the underlying psycho-social and socio-economic problems that may precipitate an Emergency Department visit.

    - Be an effective patient advocate.

    - Understand and respect wishes for resuscitation and life support.

  • F. Scholar

    - Read through mandatory resources on UGME EM website, be prepare for seminars.

    - Attend and participate in weekly seminars and simulation day during the rotation.

    - If able, attend the Emergency Medicine Grand Rounds and Journal Club (dates and locations on website).

    - Identify at least one learning objective per shift.

    - Read around cases, using appropriate resources.

    - Be able to perform a literature search while working a clinical shift and be familiar with commonly used search engines and databases.

  • G. Professional

    - Is on time for shifts and seminars.

    - Exhibit honesty, integrity, commitment altruism, and respect for the practice of medicine.

    - Recognize his or her limitations and know when to ask for help.

    - Appreciate the significance of ethical decisions made in the ED (e.g., 'DNR' considerations), and the impact of these decisions on the patient, their family, and the health care workers involved.

    - Ability to act in a professional ethical manner including being punctual, dressing appropriately, and attending mandatory teaching sessions.