In order to successfully complete the rotation, you MUST complete all of the following:


A. Clinical shifts (15) with satisfactory clinical performance
B. Lectures and clinical labs unless excused absence by course director.
C. Computer modules
D. Submission of patient log
E. Demonstrate professional behavior
F. Written exam
G. Standardized Patient Interaction: Informed Consent  
F. 2011-2012 EM Black Out Dates

A. Clinical Shifts/Performance

Schedule Requirements

• Students will complete 15 8-hour shifts, distributed throughout the times the ED is in operation which includes days, evening, nights, and weekends.  These shifts will include the following distribution:
  • 2 (minimum) Pediatric Emergency Medicine shifts (6 shifts maximum)
  • 1 Nurse/tech shift (2 shifts maximum) or equivalent procedural experience
  • 6 Adult Emergency Medicine shifts
• For patient safety and to preserve the integrity of the learning experience, shift scheduling will adhere to the following guidelines which respect the ACGME duty hours:
• Shifts will not be scheduled “back-to-back” and there will be a minimum of 10 hours off between shifts.
• Students will average 1 day off per week over the four-week rotation.
• Students will not average more than a 50 hour work week over the course of the four-week clerkship.
• Exceptions to these guidelines must be approved in writing by the clerkship director and site director and will only be granted in exceptional circumstances.

Shift Changes

• All shift changes must be approved by course coordinator or director. Changes made without their approval are cause for discipline and possible failure of the rotation.
• Requests should be made in writing (e.g. e-mail)
• A requested schedule change is not considered final, until it is approved, the master schedule updated, and written (e-mail) confirmation provided
• Students may initiate a shift switch with a classmate; however, the switch must be submitted in writing (e-mail) for approval and may be denied.  The scheduling requirements listed above must still be met. 

Schedule Requests

• Students must submit schedule requests for their rotation no later than 2 weeks prior to the start of the rotation.
• A maximum of 3 schedule requests will be considered from each student.  Please note that one request is one day.  For example, requesting off Friday through Sunday would count as 3 requests.  Exceptions to this must be approved by the clerkship director in advance of the request deadline.
• The rotation schedule will be released approximately 1 week prior to the start of the rotation.  Once released, the schedule will be considered final barring exceptional circumstances.
• In accordance with University of Michigan Medical School policies, time off will not routinely be   allowed during this rotation for residency interviews or to take USMLE Step II.
  http://www.med.umich.edu/medstudents/
  http://www.med.umich.edu/em/education/rotation.htm

  Illness / Personal Emergency

  • In the event that illness or a personal emergency prevents a student from completing a scheduled shift, that shift will be made up with a similar shift type.
  • Once a student is aware that they cannot attend a scheduled shift, the clerkship office must be notified as soon as possible.  Failure to provide appropriate notification will be considered a significant lapse of professional standards.
  • E-mail or voice mail to the clerkship office is acceptable after hours.  Phone contact during working hours is preferred.
  • For extreme situations or when special assistance is needed, the clerkship director should be contacted via pager.
  • Outside of working hours, the student should also contact the ED and notify the resident / Attending of their absence.
    

  Shift Expectations

  While working in the ED, students will be matched with a senior EM resident usually an EM3 or 4 (occasionally EM2) or attending physician.  Students will obtain a focused history at physical examination on designated patients.  They are also expected to generate a differential diagnosis and propose an initial management plan.  Students will present patients to their assigned attending or senior resident. The student will then follow each patient evaluated throughout the ED course and participate in all aspects of their care.  Additional information on the student’s role in the ED is contained on the EM student website.
  
  

  http://www.med.umich.edu/em/education/msrole.htm

  Due to the nature of Emergency Medicine, it will be typical for a student to work with multiple residents and faculty over the course of the month.  Therefore, it is crucial that you establish expectations for your role at the beginning of each shift.   You are also strongly encouraged to ask for performance feedback from your supervising physician at the conclusion of each shift.

  Evaluations

   Since your supervising physician will change daily, a clinical evaluation will be performed for each shift.  At the end of each clinical shift, you should distribute a clinical evaluation notecard to the resident and/or attending physician.  These online forms are completed by the faculty and residents and returned to the EM Student Coordinator to compile your grade and provide you with feedback. Please also update the match-up sheet with the names of your Attending and Resident for each shift, so that we can track your evaluations.  A copy of this log should be submitted at Monday 3 lectures and final exam.  The evaluation form utilized for this rotation is available for your review and additional copies can be obtained from the office or downloaded from the student EM website located at:

  http://www.med.umich.edu/em/education/medicalstudents.htm

  During office hours, you may review your completed evaluations in order to receive feedback on your clinical performance. Individual evaluations are blinded as to the evaluator in order to obtain timely and unbiased feedback.  If a significant concern is identified on an evaluation, the course director will contact you to discuss it further. 

  In addition, you will receive written mid-rotation feedback on the third Monday of each rotation, indicating whether you are performing satisfactorily and containing any major suggestions for improvement.   Your CLTP patient and procedures log will be reviewed at that time as well. 

  Dress Code

  An ID badge from your assigned hospital must be prominently worn at all time along with your white coat.  Shirt and tie or equivalent professional attire for women is expected during all clinical activities. Clean scrubs worn under short white coat are also appropriate for the adult ED.  However, scrubs may not be worn in the UMHS Pediatrics Emergency Department except on overnight shifts.  Blue jeans and shorts are not acceptable for patient care activities but are reasonable for lectures/labs.  Comfortable closed toe shoes should be worn in the ED.

  return to top

  B. DIDACTIC CURRICULUM

  The didactic curriculum will occur on the first two days of each period, and the third Monday with a final exam on the morning of the final Friday of the four-week rotation. Occasionally, a different date (usually Monday 2) will need to be utilized due to scheduling conflicts. The didactic curriculum will be attended by all rotators, regardless of what site they are assigned. Shift assignments will allow students appropriate release time to fully participate.

  The course will use Mahadevan and Garmel’s An Introduction to Clinical Emergency Medicine as the textbook. This text will be loaned to you during the rotation and must be returned in good condition at the final exam in order to receive credit for this course. If the textbook is returned with any marks or highlights, you will be charged $75.00 and we will withhold your grade until the fee is paid. Corresponding reading assignments to topics are as listed below.  

  Trott’s Wounds and Lacerations is available to be checked out by interested students during the rotation. It must be returned in good condition by the final exam or a $72 charge will be incurred.

  Correlative Reading  

  Monday 1
  8a-10a	ED procedures lab	Appendix A
  10-11a	Course introduction	Chapter 1
  11-12:30	Shock & basic resuscitation	Chapter 5
  12:30	Lunch break
  1-3p	Wound Care and suture lab	Appendix B, C
  3-4:30p	Intro to Trauma & C-Spine lab	Chapter 6
  4:30p	UMHS ED Orientation

    ***Student rotating at other sites will arrange Site orientation with the site director

  Tuesday 1
  8a	Fractures & Splinting lecture & lab    ***Wear clothes that you are willing to get plaster on	Chapter 20
  10-12:30	Airway management	Chapters 2, 33, 34
  12:30	Lunch break
  1-2p	Toxicology	Chapter 36
  2-4:30p	Intro to ACLS & w/ simulated codes	Chapter 3

  Monday 3:
  8a-12p	BBN SPI / Simulation Cases	LRC / CSC
  12-1p	Lunch break
  1-2p	Environmental Emergencies	Chapter 42
  2-2:30p	Managing the Violent Patient	Article
  2:30-3:30p	Lumbar Punctures
  Friday 4
  10a-1p	Final written exam

  **One additional time for the entire class for exam administration may be arranged with the course coordinator, dependent on proctor and room availability (typically Tuesday 4).

  Goals and objectives for each didactics session are available on the EM student website at: http://www.med.umich.edu/em/education/medicalstudents.htm

  return to top

  C.  COMPUTER MODULES

  These modules allow you to work through the diagnostics and evaluation of common ED complaints. These cases utilize the Professional Skill Builder Program located at:  https://www.umms.med.umich.edu/psb/.

  You will need your unique name and Kerberos password for access. These programs work optimally with a broadband connection on a PC (not Mac). You will also need to disable your pop-up blocker.  You will be responsible for this information on the final exam.

  Topics include:  
  
  
  • Febrile child
  • Breaking bad news (must be completed prior to the SPI on Monday 3)
  • return to top

    D. PATIENT & PROCEDURE LOG

    In order to provide structure to the clinical portion of the rotation, students must complete a chief complaint and procedure log. Students are responsible for entering ALL patient encounters and procedures into CLTP online system(https://www.umms.med.umich.edu/cltp/addpatencounter.htm)by Friday 4 @ 3pm following the EM final exam. Use the following as a guide.

    Patient Complaints	Procedures
    Chest pain (2)	Wound care (3)
    Dyspnea (2)	Initiation of IV access (6)
    Abdominal pain (2)	C-spine clearance (2)
    Traumatic injury (3)	Airway procedures (3)
    Altered mental status (2)	Application of extremity splint (1)
    Intoxication / overdose (2)	Arterial blood gas draw (1)
    	Placement of NG tube (2)
    	Placement of Foley catheter (2)
    	Participation in a lumbar puncture (1)

     Should you be unable to encounter all the required patient complaints, on-line cases are available for review at www.cdemcurriculum.org.  An additional nurse-tech procedures shift may also be scheduled by speaking with the rotation coordinator.
                                                  

                          return to top

    E. PROFESSIONAL BEHAVIOR

    It is expected that all students will demonstrate high levels of professional behavior during this rotation. The Emergency Department is the ultimate fishbowl with patients and families able to easily observe the activities of medical personnel.  This mandates that everyone working in the ED display exemplary behavior at all times.  Failure to do so will require a meeting with the course/site director and/or additional measures. Examples of unprofessional behavior would include:

    • Disrespect toward patients/staff
    • Unexcused absence from orientation, lecture or shift (including partial)
    • Failure to submit paperwork
    • Excessive schedule requests
    • Identifying yourself as a resident or attending

    return to top

    F.  WRITTEN EXAMINATION

    A written examination is given at the end of the rotation. This is based on the objectives for each of the chapters and modules assigned, as well as the lectures and labs. The objectives are available on the website http://www.med.umich.edu/em/education/rotation.htm

    It takes on average about 1.5-2 hours. A passing grade for the exam is 70% or higher. You must pass the exam in order to pass the rotation.

    .

    return to top

    G.  STANDARDIZED PATIENT INTERACTION
         
    Beginning with the 2009-2010 academic year, the Medical School has initiated an SPI on Breaking Bad News. This activity will be scheduled the morning of the 3rd Monday of the rotation after didactics. Occasionally, a different date will need to be utilized due to scheduling conflicts. You will be assigned a time for this activity. This cannot be changed without course director approval. Background materials are housed on the PSB in the BBN module. You will also need to complete the pretest, which is linked to the PSB module. This interaction must be successfully completed and passed in order for your EM grade to be finalized and released.

    F. Emergency Medicine Black Out Dates for 2011-2012

    Period	Dates	Monday  1 Orientation 8a-5	Tuesday  1 Didactics 8a-4:30p	Monday  3 SPI/Didactics 8a-3:30p	Friday  4 Exam 10a-1p
    1	5/9/11 – 6/5/11	5/09/11	5/10/11	5/16/11*	6/03/11
    2	6/6/11 – 7/3/11	6/06/11	6/07/11	6/13/11*	7/01/11
    3	7/4/11 – 7/31/11	7/05/11	7/06/11	7/18/11	7/29/11
    4	8/1/11 – 8/28/11	8/01/11	8/02/11	8/15/11	8/26/11
    5	8/29/11 – 9/25/11	8/29/11	8/30/11	9/12/11	9/23/11
    6	9/26/11 – 10/23/11	9/26/11	9/27/11	10/10/11	10/21/11
    7	10/24/11 – 11/20/11	10/24/11	10/25/11	11/07/11	11/18/11
    8	11/21/11 – 12/18/11	11/21/11	11/22/11	12/05/11	12/16/11
    9	1/9/12 – 2/5/12	1/09/12	1/10/12	1/30/12*	2/03/12
    10	2/6/12 – 3/4/12	2/06/12	2/07/12	2/20/12	3/02/12
    11	3/5/12 – 4/1/12	3/05/12	3/06/12	3/19/12	3/30/12
    12	4/2/12 – 4/29/12	4/02/12	4/03/12	4/16/12	4/27/12

    *For Periods 1 & 2 only, Monday 3 didactics will be held on Monday 2 due to circumstances beyond our control.
    *For Period 9 only, Monday 3 didactics will be held on Monday 4 due to circumstances beyond our control.

    Attention: Attendance on EM black out dates is required. 

    The above black out dates apply to the following Emergency Medicine rotations:

    	Course ID	Catalog Nbr.
    UM Adult Emergency Medicine	031115	000MEDO.U
    UM Pediatric Emergency Medicine (UM PEM)	038860	2MEDO.U
    St. Joseph Mercy Hospital Emergency Medicine (SJMH)	032727	2MEDO.S
    Hurley Medical Center Emergency Medicine (HMC)	041141	1MEDO.F

    For EM rotations at William Beaumont Hospital (WBH - 032724) or Henry Ford Hospital (HFH - 032726), black out dates include Day 1 and Monday 3 AM SPI only (For Periods 1 & 2 only, SPI will occur Monday 2 AM). Check with site director/coordinator for black out dates specific to that site.

    For Away EM rotations at sites other than listed above, check with site director/coordinator for black out dates specific to that site. In addition in order for Dr. Hopson to approve an Away EM rotation, you must commit in advance to an SPI date.  

    NOTE: EM rotation and SPI Breaking Bad News must be completed for grade to be released.

    UMMS Policy Reminders

    • M4 Interviewing – Time off to interview during clerkships will not be granted.
    • Step 2
    • Clinical Knowledge (CK) – Students are permitted 1 day to take the Step 2 CK but it cannot conflict with the required EM Clerkship blackout days.
    • Clinical Skills (CS) – Students will be permitted 3 days for this exam during an elective clerkship or interview month. Students are NOT allowed days off for Step 2 CS during the required EM clerkship.
    • Requesting more than 3 consecutive days off requires prior approval from course director, Laura Hopson (lhopson@umich.edu )

    If additional information is needed, please contact the EM clerkship coordinator, Heather Wourman (cerovski@umich.edu ).

    .

    return to top

    .