This chapter was reproduced from the Emergency Medicine Clerkship Primer, 2008, Chapter 4, with the permission of the Editor, for ease of viewing on mobile devices.
Regardless of your intended career path, the pathology and variety of illness encountered throughout your emergency medicine rotation will provide you with a great opportunity to learn. The importance of emergency medicine education at the undergraduate level is acknowledged by its inclusion in the LCME Educational Objectives (revised, June 2007), which state “educational opportunities must be available in multidisciplinary content areas such as emergency medicine.”
|The emergency department pro-vides health care for patients presenting at any time for any reason. . . . Our specialty truly provides a safety net to the mil-lions of under- or uninsured people in this country.|
Emergency medicine offers a truly unique educational experience for medical students for several reasons. First, there is an endless stream of patients. In recent years, more than 115 million visits were made annually to emergency departments across the country; half of these visits were categorized as urgent or emergent in acuity. These figures continue to rise, with annual emergency department visits increasing by 26% in the past decade (Institute of Medicine, 2006). Second, the emergency department provides health care for patients presenting at any time for any reason. Patient presentations range from the unexpected, life-threatening emergency to the more routine primary care problems encountered by patients with limited access to the health care system. Third, learners are exposed to patients with an undifferentiated complaint instead of a preliminary or confirmed diagnosis. More than 25% of all emergency department patient encounters present with seven common chief complaints (Nawar et al., 2007):
- Abdominal pain
- Chest pain
- Back pain
- Shortness of breath
Finally, because the doors of the emergency department never close, un-scheduled health care is provided to all regardless of age, ethnicity, economic status, or the ability to speak English. Our specialty truly provides a safety net to the millions of under- or uninsured people in this country.
Because of the unique population, pathology, and patient presentations, you are likely to encounter clinical scenarios with which you would otherwise have little or no direct contact with in other health care settings. You should view all of your patient encounters as educational opportunities. Where else could you encounter the acutely poisoned patient; interact with prehospital care providers; manage acute trauma; encounter environmental emergencies such as hypothermia, frostbite, or burns; treat an acute stroke or myocardial infarction; provide obstetrical care; all in the same shift? Your emergency medicine clerkship will help reinforce your medical interviewing and physical examination skills. Taken one step further, you will have an opportunity to focus and hone your ability to develop a case-specific differential diagnosis and implement patient management plans. Each of these and many other topics will be discussed in more detail in other sections of the Primer.
The emergency department can also provide you with procedural opportunities that are likely unparalleled in other clinical rotations. In a typical rotation, you may have an opportunity to perform phlebotomy, insert peripheral IV catheters or nasogastric tubes (NGTs), perform a lumbar puncture or arthrocentesis, and repair simple lacerations. From an educational standpoint, the ability to perform a particular procedure or exercise a clinical skill is but one facet of your development as a young physician. With repetition, proficiency in procedural skills often develops over time. However, it is often of equal if not greater importance, especially early in your training, to attain the understanding of why and when, not just how. This understanding should be a part of your emergency department clerkship.
Another key aspect of your education is to further enhance your ability to understand how certain diagnostic studies are used in the emergency department. By the completion of this rotation, you should have the opportunity to interpret dozens of radiographs [chest and abdominal plain films, computed tomography (CT) scans and ultrasounds], commonly ordered laboratory studies (basic metabolic profiles, complete blood counts, hepatic functions, ABGs, and cardiac enzymes), and 12-lead ECGs.
In addition, you will work with a number of medical professionals who can help you further develop certain intangible clinical skills, such as multitasking, time management, conflict resolution, and role modeling of professional behavior. These skills are best learned on the job by working with seasoned clinicians. This is also true for developing your case presentation skills and learning how to best interact with your consultants and other members of the health care team.
No matter how well your emergency medicine rotation is organized, much of what you get out of it is going to be based on what you put into it. Set individual goals based on your career interests. Supplement your clinical experience by reading about common chief complaints or certain illnesses that you encounter. Our goal is to help you along the path to becoming the best physician you are capable of being. The emergency department affords you with a wealth of clinical and educational opportunities.
- Institute of Medicine. The Future of Emergency Care: Key Findings and Recommendations from the Institute of Medicine. Washington, DC: National Academies; 2006. Available at: http://www.iom.edu/CMS/3809/16107/35007/ 35040.aspx. Accessed March 6, 2008.
- This fact sheet reports key findings and recommendations from the series of reports on the future of emergency care in the United States.
- Liaison Committee on Medical Education. Functions and Structure of a Medical School: Standards for Accreditation of Medical Education Pro-grams Leading to an MD Degree. Washington, DC: Association of American Medical Colleges; 2004 with updates as of February 2007. Available at: http://www.lcme.org/functions2007jun.pdf. Accessed April 9, 2008.
- This document outlines the accreditation standards for medical school training in the United States.
- Nawar EW, Niska RW, Xu J. National Hospital Ambulatory Medical Care Survey: 2005 emergency department summary. Advance Data From Vital Health and Statistics. 2007,386;1–32. Available at: http://www.cdc.gov/nchs/ data/ad/ad386.pdf. Accessed March 25, 2008.
- This article reviews nationally representative data on emergency department care in the United States. Data are from the 2005 National Hospital Ambulatory Medical Care Survey (NHAMCS).
- Russi CS, Hamilton GC. A case for emergency medicine in the undergraduate medical school curriculum. Acad Emerg Med. 2005;12:994– 998.
- This commentary reviews the benefit of undergraduate emergency medicine training, why emergency medicine is not fully integrated into the medical school curriculum, and how emergency medicine can best contribute to undergraduate medical education.