COMPETENCY-BASED TEACHING OBJECTIVES

This course is an introduction to the specialty, its role in the continuum of care, and
its unique clinical approach. At the completion of this program, medical students
will be expected to demonstrate competence in the following areas:
 

Medical Knowledge

Interpersonal and Communication Skills

Professionalism, Moral Reasoning and Ethical Judgment

Clinical Skills and Patient Care

Lifelong Learning, Problem Solving and Personal Growth

Social and Community Context of Healthcare

                                                          MEDICAL KNOWLEDGE

 

Rationale. Students should develop a differential diagnosis that is prioritized on

potential life-threatening conditions and likelihood of disease. Students should

demonstrate knowledge (or understanding) of basic diagnostic modalities and

interpretation of results. Most importantly, students should cultivate an

appreciation of risk stratification and pretest probabilities for selected conditions.

Students will be able to:

1.         1.   Relate the basic science (anatomy, physiology, biochemistry, etc.) to patients encountered

                  in the Emergency Department.

2.   Identify the relevant catastrophic ("think of the worst first") potential diagnoses.

3.   OB Emergencies

       a. Review the common causes of abdominal pain and vaginal bleeding in early pregnancy

           (ex:  ectopic)
       b. Describe strategies for diagnosis and management of abdominal pain and vaginal

           bleeding in early pregnancy
       c. Examine the role of bedside ultrasound in pregnancy

4.   Pulmonary Emergencies
        a. Discuss the role and most appropriate indications for diagnostic testing in the evaluation

            of pulmonary embolism
        b. Describe the critical decisions and interventions in a patient with pneumonia
             i. Review appropriate resuscitation
             ii. Outline diagnostic testing
             iii. Discuss appropriate antibiotic selection and timely administration
             iv. Differentiate appropriate patient disposition
        c. Define emergent assessment and management of acute asthma exacerbation
        d. Describe the treatment of COPD exacerbation
5.  Orthopedic Emergencies
        a. Review general principles (ex: assess ligament and tendon integrity, assess distal 

            neurovascular compromise) in the assessment of a patient with a potential fracture
        b. List risk factors that increase the chance of a septic joint
        c. Describe the proper method of diagnosis and treatment of a septic joint
        d. Review the assessment and management of a potential scaphoid fracture
        e. Employ evidence based medicine using NEXUS criteria to identify which patients require

            cervical spine imaging in the setting of blunt trauma
         f. Employ evidence based medicine using Ottawa ankle and knee rules to distinguish which

            patients require ankle and knee xrays in the setting of blunt trauma
         g. Recognize the signs and symptoms of compartment syndrome
         h. Describe the indication for thumb spica, sugar tong, posterior mold (elbow) and

             posterior mold (foot/ankle) plus demonstrate the application of these splints
         i. Review the indications for xrays in the setting of low back pain
6.   Neurologic Emergencies
         a. Review the differential diagnosis of altered mental status
         b. Discuss the diagnosis and management of acute stroke
         c. Describe the patient presentation, diagnostic testing, and medical management of

             meningitis
         d. Identify the patient presentation, role of diagnostic testing, and management of

             subarachnoid hemorrhage
7.   Care accelerated
         a. Review the principle of rapid evaluation and management of critical patients in the ED
8.   Toxicology
         a. Outline general assessment and management of the poisoned/potentially poisoned

             patient
         b. Discuss basic toxidrome recognition and management
             i. Sympathomimetic
             ii. Sedative Hypnotic
             iii. Opiate
             iv. Anticholinergic
             v. Cholinergic
         c. Explain assessment and management of patients with acetaminophen toxicity
         d. Define emergency preparedness and describe guiding principles in the initial

             management of patients with chemical agent exposures

         e. Review  

              animal bites at high risk for rabies.
9.   Wilderness Medicine
         a. Define wilderness medicine as a subspecialty, the role of emergency medicine within

             the field of wilderness medicine, define the unique aspects of patient assessment in

             the field and the difference to that of EM
         b. Define heat related injuries including hyperthermia, heat stroke, heat exhaustion, heat

             cramps, and heat syncope. Describe presentation and pathophysiology of heat illness

             and aspects of assessment and management in the field vs the ED
         c. Define cold related injuries including hypothermia, frostbite, frostnip, and chilblains and 

             cold water immersion. Describe presentation and pathophysiology of cold injuries and

             aspects of assessment and management in the field vs the ED
         d. Define high altitude injuries including acute mountain sickness, high altitude cerebral

             edema, and high altitude pulmonary edema. Describe the presentation and

             pathophysiology of high altitude illnesses and aspects of assessment and management

             in the field vs the ED
        e. Discuss basic principles of bite and sting assessment and management from spiders,

            snakes, ticks and hymenoptera
10.  Cardiovascular Emergencies
         a. Acute coronary syndrome (ACS)
             i. Define the spectrum of ACS
             ii. Outline the value and limitations of chest pain history in the evaluation of patients

                 with suspected ACS
             iii. Report risk stratification of patients with suspected ACS based on TIMI risk score
             iv. Review atypical presentations of ACS, both the patient populations and chief

                  complaints
             v. Describe the initial approach to management of patients with ACS
             vi. Recognize the role of various medications (oxygen, aspirin, betablockers, Heparin,

                  Lovenox, Plavix, GP IIb/IIIa inhibitors, thrombolytics) in the setting of ACS
             vii. Outline the utility of cardiac enzymes in the setting of chest pain
         b. Discuss the pathogenesis and management of patients with chest pain associated with
             cocaine use
         c. Recall risk factors and identify common patient presentations with aortic dissection
         d. Review the utility of various diagnostic studies in the evaluation of aortic dissection
         e. Cite the initial management of a patient with aortic dissection
         f. Identify the effects of cardiogenic shock on cardiac output and systemic vascular

            resistance and be able to compare these findings to those of anaphylactic shock and

            septic shock
11.  EKG
         a. Review the systematic approach to EKG interpretation
         b. Correlate the EKG findings with infarcted region of myocardium
         c. Identify special case EKG interpretation in the context of Wellens syndrome and Brugada 

             syndrome
12.  BLS
         a. Review initial approach to a patient in suspected cardiopulmonary arrest
         b. Recall appropriate compression to ventilation ratios
         c. Identify the correct ventilation rate in a patient with ongoing CPR who has an advanced

             airway in place
13.  ACLS/PALS
         a. Identify which rhythms require defibrillation
         b. List the differential diagnosis considerations for pulseless electrical activity and 

             management related to those causes (ex: hypoglycemia, hyperkalemia, tension

             pneumothorax)
         c. Identify management of a pediatric patient with symptomatic bradycardia
         d. Explain management of supraventricular and ventricular tachycardia
         e. Recognize options for medication delivery when peripheral IV access canít be easily

             obtained

         f. Identify routinely used medications in pediatric and adult cardiac arrest 
14.  ATLS
         a. Describe the components and means of assessment of a primary survey
         b. Discuss appropriate time to transfer a trauma patient to a trauma center
15.  Airway
         a. Describe the method to open an airway with and without a potential cervical spine injury
         b. Demonstrate appropriate bag-valve-mask use
         c. Recall the means to confirm proper endotracheal tube placement
         d. List potential advanced airway techniques in the setting of a failed intubation
16.  Dermatology in the ED
         a. Recall basic methods to describe rashes
         b. Recognize life threatening rashes from necrotizing fasciitis, toxic epidermal necrolysis,

             staphylococcal scalded skin syndrome, disseminated intravascular coagulation, and

             meningococcemia
         c. Define anaphylaxis and recall emergent medical treatment methods
17.  GYN in the ED
         a. Recognize the various forms of vaginitis and distinguish which causes are sexually

             transmitted
         b. Review the diagnosis and management of PID
         c. Identify the common patient presentation with ovarian torsion and explain the evaluation

             of this condition
         d. For patients with endometriosis, recognize their increased risks for certain conditions
18.  Hypertension in the ED
         a. Distinguish the various categories of hypertensive crisis in the ED and be able to

             categorize a hypertensive patient based on their presentation
         b. Identify the appropriate level of assessment and treatment of hypertension in the ED
         c. Review cerebral autoregulation and the characteristics of hypertensive encephalopathy
19.  Abdominal pain
         a. Recognize key points in assessment, management, and treatment of abdominal pain from

             cholecystitis, pancreatitis, appendicitis, AAA dissection, mesenteric ischemia, ectopic

             pregnancy, and PID
20.  Sepsis
         a. List the components of SIRS criteria
         b. Identify appropriate workup for a patient with suspected sepsis
         c. Describe management of septic shock based on the LUMC sepsis guidelines
21.  Psychiatric Emergencies
         a. Identify the emergent assessment and management methods of psychiatric patients

             in the ED
         b. Define "medical clearance" of psychiatric patients from the ED
         c. Review medical illnesses that present as psychiatric disorders and be able to recall patient

             presentation and initial management of several of these conditions including hepatic

             encephalopathy, UTI, hypoglycemia, DKA, thyroid storm, and normal pressure

             hydrocephalus
         d. Cite psychotropic medications (and their potential clinically significant side effects) 

             used in the ED for acute management of agitated but not psychotic patients, psychotic

             patients, patients with medical etiology for their psychosis, and patients with substance

             withdrawal
         e. Identify the regulations and risks behind physical restrains
         d. Recognize patients at high risk for suicide
22.  Hematology
         a. Identify the initial evaluation and management of patients with suspected sickle cell crisis
         b. Identify mechanism of action of Warfarin and how this translates into management of an

             overdose
         c. Review the risks associated with blood transfusion and the options for pretreatment

             prior to transfusion
23.  Ophthalmology
         a. Review the systematic approach to an patient with a ophthalmologic complaint in the ED
         b. Recall causes of visual loss and basic management principles
         c. Recognize the presentation of herpes zoster involving the face and the associated risks
         d. Describe management principles for traumatic hyphema
         e. Identify management principles for chemical exposure to the eye
24.  ENT
         a. Develop an appropriate differential diagnosis for common ENT complaints of otalgia and

             odynophagia
         b. Review most common causative agent and management principles of various ENT

             conditions seen in the ED (otitis media, otitis externa, mastoiditis, peritonsillar abscess,

             retropharyngeal abscess, epiglottitis, dental infections, Ludwigs angina)
         c. Recognize common presentation of streptococcal pharyngitis
         d. Recall methods of epistaxis management
         e. List common causes of dentalgia and associated treatment
25.  Pediatric Emergencies
         a. See above objectives that have a unique correlation with common pediatric illnesses

             under BLS, PALS, Airway, and ENT
         b. Apply pediatric rapid cardiopulmonary assessment principles to assess ill pediatric

             patients
         c. In the setting of a pediatric patient with a fever, recognize the diagnostic test variation

            based on the patients age
         d. Describe the management of pediatric patients with hypoglycemia
26.  Death disclosure
         a. Recognize the importance of expressing empathy, sitting down when delivering bad

             news, using the term "died" or "dead", encouraging family viewing of the body, and

             being available for questions
27.  Legal
         a. Recognize the requirements for a lawsuit and determination of the standard of care in a

             lawsuit
         b. Recognize importance of good documentation
         c. Recognize high liability conditions seen in the ED
         d. Identify EMTALA requirements for permitting patient transfer
28.  Wound care
         a. Recognize the role of irrigation in wound care
         b. Match laceration location with suture choice and duration until suture removal
         c. Recognize the need to assess for foreign body in a wound
         d. Define the role of wound closure and antibiotics in cat, dog and human bites
         e. Recognize the indications for tetanus immunization in the setting of a laceration
         f. Demonstrate appropriate simple interrupted suturing technique
29.  Bedside point of care ultrasound in the ED
         a. Explain the basic physics of ultrasound imaging
         b. Utilize ultrasound terminology to describe echogenicity and image orientation
         c. Cite the indications for the various ultrasound transducers and scanning modes
         d. Recognize the various applications, indications and limitations of bedside 

             ultrasound in the ED
         e. Identify the 5 windows needed for an EFAST scan and the related key anatomical

             structures
         f. Successfully utilize a bedside ultrasound device to complete an EFAST scan
         g. Diagnose free fluid using static ultrasound images of an EFAST scan and formulate a 

             management plan based on it

         h. Clarify the indications and limitations of various diagnostic modalities in the setting of a

              hypotensive trauma patient

30. Violent patient/person management

Lecture Objectives:
At the end of this presentation, students will be able to:
a. List medical causes which may potentially lead a patient or visitor to develop violent

    behavior.
b. Recognize characteristics that suggest a person may become violent
c. Recite the on-campus number for Loyola Security and identify appropriate times to call.
d. Identify the common denominator of violence.
e. Define weapons of opportunity and understand their use in assaults in the healthcare

     setting.
f. Employ verbal and non-verbal de-escalation strategies while waiting for security to

     respond to 

      a potentially violent or violent person situation.
g. Properly document threatened or actual acts of violence by patients or visitors and

     understand the importance of doing so.
 

31. Inter-professional practice objectives:

a. Identify similarities & differences in roles and perspectives of other professionals.

b. Recognize informational conflict and apply Team Stepps techniques in interprofessional

              communication to assure patient safety.

c. Demonstrate understanding of the key principles of Team Stepps (leadership, situation

              monitoring, mutual support, communication).

 

 

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                                      INTERPERSONAL AND COMMUNICATION SKILLS

 

Rationale. Students are an important element of the health care team, and effective
communication with patients and other health care providers is essential for patient
care. Students must demonstrate interpersonal and communication skills that
result in effective information exchange and interaction with patients, family
members, and health care providers.

Students will be able to:
1.  Present cases in a complete, concise, and organized fashion
2.  Include information in their case presentation that reflects their differential and  

     thought process and justifies their diagnostic and management plan
3.  Effectively communicate with consultants and admitting services
         a. Present a coherent, brief, focused history and physical exam, ED workup, and

             rationale for consultation or admission
4.  Effectively communicate with patients and families including death disclosure in

     the Emergency Department
          a. Describe and demonstrate appropriate death disclosure technique based on

              Education in Palliative and End-of-life Care for Emergency Medicine (EPEC-EM) method
          b. Employ supportive verbal and nonverbal behavior
5.  Openly communicate with other members of the health care team in order to insure a       

     coordinated multi-disciplinary approach to patient care
6.  Demonstrate verbal and nonverbal compassion and take a nonjudgmental and culturally  

     sensitive approach to patients
7.  Document in an accurate, organized, and legally prudent manner

 

Violent patient/person management

Lecture Objectives:
At the end of this presentation, students will be able to:
1.   List medical causes which may potentially lead a patient or visitor to develop violent behavior.
2.   Recognize characteristics that suggest a person may become violent
3.   Recite the on-campus number for Loyola Security and identify appropriate times to call.
4.   Identify the common denominator of violence.
5.   Define weapons of opportunity and understand their use in assaults in the healthcare setting.
6.   Employ verbal and non-verbal de-escalation strategies while waiting for security to respond to 

      a potentially violent or violent person situation.
7.   Properly document threatened or actual acts of violence by patients or visitors and understand 

      the importance of doing so.
 

Inter-professional practice objectives:

1.    Identify similarities & differences in roles and perspectives of other professionals.

2.    Recognize informational conflict and apply Team Stepps techniques in interprofessional

       communication to assure patient safety.

3.    Demonstrate understanding of the key principles of Team Stepps (leadership, situation

       monitoring, mutual support, communication).

 

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                      PROFESSIONALISM, MORAL REASONING AND ETHICAL JUDGMENT

 

Rationale. Professionalism should be viewed as an academic virtue, not just an
expected set of behaviors. Students should learn to reflect on their professionalism
during clinical rotations and learn from faculty role models.

Students will be able to:
1.   Be conscientious, on time, accountable, and responsible
2.   Maintain patient confidentiality
3.   Maintain a professional appearance
4.   Work in a collegial manner with others
5.   Work diligently and systematically complete tasks
6.   Be sensitive to cultural issues
7.   Introspectively examine experiences in the ED

 

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                                               CLINICAL SKILLS AND PATIENT CARE

 

Rationale. Under direct faculty supervision, students will be given primary
responsibility for patient care (of noncritical patients) and begin to act independently.

Primary responsibility for patient care will help foster the students' ability to think

critically, assess their knowledge and skills, and allow them to make clinical decisions

affecting patient care.

Students will be able to:
1.   Quickly obtain an accurate problem-focused history and physical exam
      without taking notes
2.   Obtain information that reflects the differential diagnosis and justifies. The

      management plan, with special attention to low probability but catastrophic conditions
3.   Integrate information obtained at the bedside and immediately synthesize diagnostic

      and management plans
4.   Develop assessments using schematic-inductive reasoning rather than pattern

      recognition
5.   Recognize immediate life-threatening conditions
6.   Make prompt and accurate assessments regarding patients' general condition and

      likelihood of admission
7.   Develop disposition and follow-up plans
8.   Promote health and safety through discussions and discharge planning related

      to the patient's chief complaint
9.   Multi-task by not only effectively performing simultaneous duties but also by

      prioritizing these tasks and addressing the most time sensitive responsibilities first
10. Improve their speed and efficiency in caring for patients
11. Interpret labs, EKGs, X-rays, and Ultrasound

 

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                LIFELONG LEARNING, PROBLEM SOLVING, AND PERSONAL GROWTH

 

Rationale. Practice-based learning can be demonstrated through systematically
evaluating patient care and population features; teaching other students and health
care professionals; and applying knowledge gained from a systematic evaluation of
the medical literature, including study design, and statistical methodology.

Students will be able to:
1.  Effectively and quickly use available information technology, including medical

     record retrieval systems and other educational resources, to optimize patient care

     and improve their knowledge base
2.  Access -information resources regarding cases that are concurrently being managed

     in the ED ("Read on the run")

 

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                                  SOCIAL AND COMMUNITY CONTEXT OF HEALTHCARE

 

Rationale. Systems-based practice extends beyond the individual patient's bedside
to include an understanding of how EM relates to other practitioners, patients, and
society at large, while considering the cost of health care and the allocation of health
care resources. Understanding the "system" involves learning ways to advocate for
patient care and assist patients in dealing with system complexities (such as
assuring appropriate follow-up) and how to partner with health care providers to
assess, coordinate, and improve patient care.

Students will be able to:
1.  Recognize when patients should be referred to the ED
2.  Recognize the importance of follow-up plans for patients being discharged from the ED
3.  Recognize why patients present to the ED and how they are processed
4.  Appraise the reasons for ED overcrowding and its influence on access and quality

     of the health care system in general
5.  Recognize some of the reimbursement, regulatory, and social issues that are unique

     to emergency medicine
6.  Describe the "Prudent Lay Person" definition of an emergency
7.  Recognize the role of pre-hospital health care and the ED in the continuum of healthcare
8.  Recognize the role of the Poison Center in the medical and lay communities
9.  Recognize the indications, cost, risks, and evidence behind commonly performed

     ED diagnostic tests
 

 

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 © 2001 Loyola University Chicago Stritch School of Medicine. All rights reserved.
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Please send questions or comments to: Renata Barylowicz
Updated: 05/18/2011... Created: 05/16/2011