Case Western Reserve First Year Elective in Emergency Medicine

Name of Institution: Case Western Reserve University School of Medicine

Contact Person: Lynn Dezelon, MD, Director, EM Education

Phone: 216-778-5088

Title: Introduction to Emergency Medicine, Critical Care and Trauma

Target audience: First Year (MS1) Elective

Description of Experience:
This elective was the first EM elective at CWRU School of Medicine to be designed and implemented. It was first offered in April, 1988. The content is simple : after an orientation [conducted in a medical school classroom], the students observe in the Emergency Department, with Cleveland EMS, in an intensive care unit, with Metro Life Flight, and in a community Emergency Department. Since 1993, rounds with the Director of Trauma have been included. A wrap - up session concludes the elective. Total time commitment ranges from 20 to 36 hours, depending on student initiative. Since all observer areas operate 24 hours/day, the students self - schedule their time around their other educational needs. This allows flexibility and increases their opportunity to learn.

The orientation session is designed to describe the educational philosophy of the elective and the EM curriculum. Individual components of the course are discussed. There is a lengthy handout describing the course. Safety briefings [for EMS and Life Flight] occur and the students self - schedule. I allow only one student per component per day so that each student gets the complete attention of the faculty. I also use the orientation to promote other EM educational offerings that may be of interest.

Observation in the ED is the biggest educational component. The student is given the run of the ED and encouraged to help with splinting, suturing and other minor procedures. They also observe all resuscitations, some even get to practice their basic life support skill. Students are also encouraged to see patients with pathology that is being concurrently covered in the core curriculum [e.g. an asthmatic patient who is wheezing when the core curriculum is covering pulmonary diseases]. The clinical correlation improves learning and satisfaction with the elective.

Observation with Cleveland EMS serves a different purpose. First, the student learns the basics of out - of - hospital care. Second, they have a chance to learn about the environment from where patients come. Finally, they get to see the advantages and limitations of field care.

The same is true of Life Flight, with the addition of flight physiology considerations as well as issues involving scene runs and interhospital transfers. This portion of the elective is very popular and great care is taken to point out the risks, need for safety and the medical mission of helicopter use.

Trauma and ICU rounds offer a chance to see very sick patients, frequently patients that were observed in the ED or with EMS or Life Flight. Basic physiology is reviewed and correlations with basic science are emphasized. Discussion of the patient care continuum from onset of symptoms or injury through return to function is emphasized.

The wrap up session is to debrief the students about the elective. Questions about specific patients or care systems are answered. I also ask for suggestions to improve the elective [the most common are "make this required" and " can I do this again?"] and promote other EM courses.

This elective was intentionally designed to be fun for the students and to teach information not covered elsewhere. It is an interesting alternative to the MS1 core curriculum (anatomy, biochemistry, physiology) and most students vividly remember information from this course years after they graduate. Over the years, changes suggested by student feedback have been incorporated into the elective. Student feedback has been uniformly positive.

Implementation:
We started with six students per class, 5 six-week classes per year [the maximum number of classes permitted] in 1988. We have increased this to 10 students per class, five classes per year in 1998, so that now approximately 40% of the students in each graduating class take this elective. Calculated another way, more than 400 students total have taken this class.