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.
- What are the requirements I need to fulfill to complete this rotation?
- You need to complete 12 clinical shifts
- You need to log your patients seen in OASIS. You should try to log all patients you see, but you must log a minimum of one patient per shift. For visiting students at RUMC, you will complete a paper log and submit this to Karmen Howard.
- You need to write a note in the EMR for at least one patient per shift. (EPIC, CERNER or paper – whatever is done at your site).
- You need to complete a shift eval at 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.
- You’ll need to attend the didactic sessions. Attendance at clerkship didactics is mandatory.
- 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 form and submit this to the site 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
- These components go into calculating your grade (including professionalism)
- What is my role as a student during the shift?
- Is there a required textbook for this course?
- What happens if I’m going to be sick or late? And what about interviews?
- What’s the dress code?
- What is Rush’s policy on academic honesty?
- What can I do if I feel like I am being treated unfairly?
- What if I’m being evaluated by a doctor who once took care of me?
- What if I get stuck with a needle or something in my eye?
- How can I get safely to my car?
- Do you have any other helpful advice?
- Who are the course administrators?
- Other important phone numbers
Clinical Shifts
You’re expected to do twelve 8-hour shifts over the course of the four week rotation. Please note shifts at RUMC are designed to overlap with the oncoming team and are technically 9 hours, so expect for sign out to happen during the last hour of the shift, but you will usually be done around the 8.5 hour mark.
Of these:
- At least four evening shifts
- At least three night shifts
- At least two 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
- You may not work more than one shift on the same day.
The available shifts differ based on site.
| Rush | Rush Oak Park | County |
|---|---|---|
|
|
|
Attendance at all shifts is mandatory to pass the course. Clinical performance counts for 60% 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.
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.
- Abdominal pain
- Chest Pain
- Shortness of Breath
- Altered Mental Status / Intoxication / Psych
- Headache
Keep track of these patients your patients on a patient log.
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.
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. At Rush and Rush Oak Park, 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.
Mid-rotation Feedback
By the second Friday of the rotation, download and complete a mid-rotation feedback form. Discuss your progress and any issues you may have with your clerkship or site director. Meetings with the site director to discuss mid-rotation performance are encouraged, but not mandatory.
Didactic Attendance Policy
Attendance at all clerkship didactics is mandatory. If you miss one of the mandatory didactic sessions, the highest grade you can attain in the course is a High Pass. If you miss more than one mandatory didactic session the highest grade you can attain in the course is a Pass. Excused absences (discussed with clerkship or site director) will not affect your final grade. Interviews are not considered excused absences. The mandatory dates are provided far in advance to allow you to plan your interview and personal schedule. As these sessions are done primarily as hands-on simulation and requires resources such as the simulation lab and multiple faculty present to run effectively, no make-up options are available. Please note this policy applies at all sites.
Self-Directed Learning Project (EBM Project)
For students rotating at Rush or Rush Oak Park:
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. You’ll be required to submit a PICO question during the week of the rotation, and through email communications we’ll choose topics for the group to research. You’ll present your work on the 3rd Monday of the rotation.
Basically, you’ll
- 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?”
- 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?”
- 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.
- Appraise the evidence: how valid (close to the truth) is this answer and how applicable (useful in clinical practice)
- Apply the evidence: Tell me how you would manage the patient differently now that you know what you know.
For students rotating at Stroger:
You’ll do a portfolio project. More information is found here.
This counts for 5% of your final grade. More information is found here.
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, the SAEM exam. If you’ve taken a version of this exam previously, you must disclose this to the clerkship team and we will provide an alternate exam.
| 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.
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 complete an evaluation of your attending after each shift using the online shift card. Please also complete an evaluation through Oasis (Rush students). For visiting students at Rush, Karmen Howard will send you a rotation evaluation.
Grading
- 60% of your grade comes from your clinical evaluations.
- 25% of your grade comes from your final exam.
- 10% of your grade comes from your professionalism score (completing all requirements on time and professional conduct). 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).
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.
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.
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.
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 or trade shifts with one of your peers. While the medical school’s policy is “students may not take more than 3 days off during a 4-week elective for interview purposes,” please note that emergency medicine is a core clerkship and not an elective and days off for interviews are not guaranteed. We are happy to be flexible and work with you, however you will be required to complete all 12 of your clinical shifts and maintain attendance at required didactics. Interviews are not considered an excused absence.
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.
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 at a time arranged with the med student co-ordinator.
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.
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.
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.
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
- Wash injured area with soap and water. If eyes, nose, or mouth, use water only.
- Immediately report the incident to your preceptor, supervisor, and/or course instructor.
- 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.
- 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.
- Students will be counseled or treated as deemed appropriate by ES personnel.
- 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.
- 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.
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.
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.
Course Administration
At the Rush site:
- Clerkship Director: Thomas Alcorn, MD
- Associate Clerkship Director: Sophia Bodnar, DO
- Assistant Clerkship Director: Amy Marks, MD
- Clerkship Coordinator: Karmen Howard
At the Rush Oak Park Site:
- Site Director: Ray Hunsucker, DO
- Site Administrator: Marsha Hunter
At the County site:
- Site Director: Semhar Tesfai, MD
- Site Coordinator: Estella Bravo
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