Undergraduate Emergency Medicine Clerkship

Emergency Medicine is a specialty with the responsibility for the early, rapid management of a variety of acutely and critically ill or injured patients.  It differs from other specialties in scope, breadth, volume, variety, organisation and complexity.

 

Emergency Medicine is defined by the International Federation for Emergency Medicine (IFEM) as

“A field of practice based on the knowledge and skills required for the prevention, diagnosis and management of acute and urgent aspects of illness and injury affecting patients of all age groups with a full spectrum of undifferentiated physical and behavioural disorders. It further encompasses an understanding of the development of pre-hospital and in-hospital emergency medical systems and the skills necessary for this development.”

 

Opportunities and Objectives

During your attachment we offer you an opportunity to:

  1. Experience and receive instruction on a broad variety of acutely ill and injured patients
  1. Learn how to ask relevant questions in a brief period of time in the emergency department
  1. Learn how to a perform a brief, focused, and clinically relevant examination
  1. Discover how to discriminate life threatening from non-life threatening problems
  1. Learn what pitfalls to avoid in the emergency department
  1. Become more proficient in a variety of important practical procedures
  1. Learn how to communicate with patients, relatives and colleagues.

 

Specifically, the student should be able to:

  1. Describe the correct sequence of priorities for assessing patients.
  1. List the diagnostic possibilities and complications arising from common presenting symptoms and signs.
  1. Explain the initial steps for managing patients with these symptoms.
  1. State the most appropriate investigations and identify common abnormalities.
  1. Perform basic suturing.

 

Priorities

In nearly every avenue of life, people have to set priorities, and nowhere is this more clearly tested than in the emergency medicine environment.

There are two possible ways of approaching problems and establishing diagnoses in the emergency department:

  1. To focus on common conditions
  2. To focus on serious conditions

 

Common Conditions

The general guideline that ‘common things are common’ applies as much to emergency medicine as any other specialty.  It is more likely that a patient will present with an unusual form of a common disorder than with a rare disorder.  Having a list of common disorders in relation to various symptoms, signs and systems and will help you to make a reasonable diagnosis in the majority of cases.

However, because of limitations in resources and time, it is unreasonable to expect emergency physicians to make a completely accurate diagnosis in many cases.  Best guess attempts are reasonable for the majority of cases but involve an element of risk.  In more serious cases we wish to reduce the risk of misdiagnosis to a minimum.  In order to do this we need to alter our focus from thinking of common conditions to thinking of serious ones.

 

Serious Conditions

It is safer if emergency physicians are orientated towards detecting those cases that are potentially life-threatening or seriously disabling.

Therefore emergency physicians need to have two questions in mind when they see each individual case.

  1. What is the most likely diagnosis or possible diagnoses in this patient?
  2. Are there any life-threatening or life-disabling possibilities that I need to detect or exclude?

 

Emergency Department Areas

Important – Students are expected to take the initiative and ask both doctors and nurses for permission to observe and do the above practical procedures.  Don’t be frustrated if not all your requests are accepted.  Keep on asking and you may have a chance next time.

  1. Triage area
  2. Resuscitation room
  3. Trolley area
  4. General (‘Walk-in’) area
  5. Plaster room
  6. Emergency Medicine Ward (ward rounds with Specialist)
  7. ED X-ray and CT rooms
  8. Ambulance

Important – Please try and limit the number of students with each doctor and/or patient to a maximum of three during a consultation. This also applies in the Trauma and Resuscitation Rooms.

 

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