“You are not here to treat patients; you are here to LEARN how to treat patients.”

The role of the medical student in the emergency room is to see and experience the presentation of acute medical conditions and to participate in the care and treatment of these patients. It is not the role of the medical student to “keep the patients moving.” Managing the acute evaluation of several patients simultaneously is a difficult skill to acquire and master. Students should “look in” on many more cases than they are directly involved in. For example, take the opportunity to examine a multiple trauma patient even though you will not be managing them primarily.

The medical student should take several cases each day from presentation to disposition. The exact number depends upon the type of cases being seen and the department volume.  In general, it is preferable for a student to have fewer, thorough evaluations than many superficial ones.  While the house officers will take the cases in the order they are placed in the rack, students are allowed to sift through the charts and find an interesting/appropriate case. You MUST ASK the attending physician or resident if you can see that patient and review the information on the nurse’s triage assessment prior to interviewing the patients. After obtaining the history and examining the patient, present the patient to the resident/attending, along with your initial assessment and your plan for the initial evaluation of the patient. Don’t be surprised if you are questioned about your assessment and plan; we want to know your reasoning for ordering tests & x-rays.  You should follow your patient through entire ED course and check on their progress/status repeatedly during their ED stay.   Emergency Medicine relies heavily on people functioning as a team, so it is essential that you communicate clearly and often with your supervising physician regarding their expectations of you and your clinical findings on a patient.

It is permitted for students to write orders in the UMHS ED; however, all orders must be countersigned by a physician before a nurse or tech may act upon them.  SJMH uses a computerized entry system that is only available to residents and attendings.  It is extremely helpful if the student does take notes as to their findings on the H&P and other studies.  This assists the resident / attending in creating the formal documentation of the patient’s care.  Students are not required to document during their EM rotation; however, assistance with collecting data is considered a part of your responsibilities.

Aftercare instructions are a vital part of EM. Appropriate follow up is crucial. You should print all your discharge instructions in easily understood language and determine that the patient can read and understand them. Make certain, if you are making a follow-up clinical appointment, they understand what it is for. Also, determine if they have a personal physician. They may need to be followed by him/her. If the patient needs to be seen within a week or two, you must get approval from one of the service’s physicians (i.e. neurology consultant for an urgent neurology clinic visit to have the patient scheduled as an add-on. You should provide the approving physician’s name to our scheduling clerks and the patient so they can obtain the urgent appointment. Always ask the patient to call back to the ED if they have problems obtaining the appointment within the time frame you think they need to be seen.

It is appropriate for a student to participate in admitting a patient or obtaining a consult agreed upon with your supervising physician.  When you are going to admit a patient to a medical service, the patient is not admitted until the senior resident on the service on call or the fellow, in the case of the ICU services, is notified.

The patients appropriate for evaluation by the medical student are sometimes difficult to define. Clearly inappropriate patients for a student to see independently include multiple trauma, cardiac arrest, acute MI’s, and other conditions that require emergent intervention. However, you can and should participate in the resuscitation of these patients as a part of the medical team.

WHEN IN DOUBT, CONTACT THE ATTENDING PHYSICIAN

One of the hazards of the Emergency Department is that patients do not typically present clearly labeled as to their illness.  It is not uncommon to have a patient’s condition rapidly change.  If you are concerned about a patient, it is a mark of good clinical judgment to get rapid assistance from an experienced physician.

NURSE-TECH SHIFT

All students will complete a minimum of 1 nurse-tech shift during their EM rotation.  During this shift, the student will be matched with a team of ED nurses and techs.  The primary purpose of this shift is to gain procedural experience.  Common procedures during these shifts are

• IV starts
• Phlebotomy
• Splint application
• EKG tracings
• Foley catheter insertion
• Nasogastric tube insertion
• Arterial blood gases

Students may participate in any procedures performed by a nurse or tech; however, they may not administer medications.  As with most experiences, students who are enthusiastic and proactive about their education, obtain more experiences.

At the start of an assigned nurse-tech shift, the student will report to the ED charge nurse at the main desk for assignment to a team.  Students must complete the ED procedures lab which is held on the first Monday of the rotation prior to completing this shift. If all requested procedures are completed, the student may leave the shift early.