Clinical Goals & Objectives

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:
  • Abdominal pain
  • Abnormal behaviour and coma
  • Allergic reaction
  • Chest pain
  • Headache
  • Infectious Disease
  • Syncope
  • Weakness and dizziness
  • Trauma
• Demonstrate the principles of initial evaluation, stabilization, and management of patients with the following clinical problems commonly encountered in the Emergency Department: 
  • Respiratory (acute asthma and COPD, pulmonary embolism, pneumonia)
  • Cardiovascular (unstable angina and acute myocardial infarction, acute congestive heart failure, cardiac dysrhythmias including EKG interpretation)
  • Neurological (status epilepticus, meningitis, acute cerebrovascular accident)
  • Ophthalmological (the approach to the red-eye, use of the slit lamp and tonometry)
  • Trauma (outline the management priorities in a trauma patient with multiple injuries, outline the principles of assessment and management of patients with a head injury, discuss the general approach to the assessment and management of common fractures/dislocations/soft tissue injuries, discuss the principles of tetanus prophylaxis)
  • 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 type

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 a 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 the UGME EM website, be prepare for seminars.
• Attend and participate in weekly seminars, high yield, and simulation days during the rotation.
• If able, attend the Emergency Medicine Grand Rounds and Journal Club (dates and locations on the 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.

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 Behaviours

• 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 a concise recording of pertinent positive and negative findings.
• Acting in a professional ethical manner including being punctual, dressing appropriately and attending mandatory teaching sessions.