Observation Medicine Acting Internship
Title of Elective: Observation Medicine
Elective type: Acting Internship
Department: Emergency Medicine
Clerkship Site: St. Vincent Mercy Medical Center
Course Number: ERMD 714
Blocks Available: start and end dates flexible
Number of Students: 1 student max per block
Faculty: David Ledrick, MD
Length of Elective: 4 weeks
Description:
Observation medicine is an extension of emergency medicine and is increasingly playing a role in the delivery of acute healthcare. Over half of all observation units (OUs) in the nation are led by emergency medicine. Learners should be exposed to observation medicine to begin acquiring the necessary skills to manage patients dispositioned to an observation unit successfully; this is best done by the Department of Emergency Medicine as most observation units are administered by the hospital’s emergency department. Additionally, this rotation will offer an opportunity for each trainee to gain a robust understanding of the interface between inpatient and outpatient care, and how to arrive at the most appropriate disposition for ED patients.
- This curriculum is based on an observation medicine curriculum developed and implemented at the Ronald O. Perelman Department of Emergency Medicine at NYU Langone Health (New York City, New York).
- An Observation Medicine Curriculum for Emergency Medicine Education. JETem 2021. 6(2):C1-72. https://doi.org/10.21980/J87P92 4
Requirements:
Shifts are from 7a to 5p. Eighteen shifts will be assigned during a 4-week rotation. During morning rounds, the learner will formulate a management plan that simultaneously addresses diagnostics and therapeutic strategies, coordinates care with consultants and allied health professionals, evaluates clinical progression, and develops an effective sign out at shift change. Learners will interface with nursing, social work, pharmacy, and case management and will participate in team-based rounds to comprehensively address the needs of their assigned patients. Each learner will develop an understanding of the social determinants of health and how they impact disposition planning and outpatient care. Learners will use the electronic medical record (EMR) to document and place orders via order sets specific to observation care consistent with evidence-based clinical protocols.
Pathology encountered may include:
- Acute kidney injury, Abdominal pain, Alcohol withdrawal, Allergic reaction, Asthma, Atrial Arrhythmia, Back Pain, Cellulitis, Chest pain, Coronary catheterization, Coronary CT angiography, Colitis, Dehydration, Delirium, Deep vein thrombosis, Gastrointestinal disorders, Geriatric care, Headache, Head injury, Hyper-hypoglycemia, Kidney stone, Metabolic derangement, Pancreatitis, Peripheral vertigo, Pneumonia, Seizure, Sickle cell pain, Syncope, Transfusion, Transient Ischemic Attack, Trauma, Urinary tract infection
Educational Course Objectives and Links to EPOs:
- Formulate management plans and coordinate care with consults and allied health professionals for commonly encountered conditions in the observational unit (EPOs: PC-4, PC-6, PC-7)
- Perform basic EKG interpretation, including commonly encountered abnormal tracings in the emergency department and observation unit (EPO: MK-4)
- Demonstrate essential skills for patient management in the observation unit, including central line placement, lumbar puncture, intubation, cardiac pacing (EPO: PC-8)
- Discuss procedures commonly encountered in the observation unit setting (EPO: PC-6)
- Demonstrate accountability, teamwork, kindness, empathy, resilience and grit (EPOs: PB-1, PB-2, PB-3)
- Discuss the unique challenges and differences of observation medicine relevant to emergency medicine (EPOs: SBP-1, SBP-4)
- Conduct independent study and read relevant literature based on conditions seen and feedback received during shifts (EPOs: PBL-1, PBL-2, PBL-3)
- Complete the required documentation for observation care such as the initial observation history and physical (H&P) with attention to OU anticipated care, the history of present illness (HPI), the complete past medical, surgical, social and family histories, a 10-point review of systems, code status documentation, medication reconciliation, and goals of care (EPO: PC-1)
- Demonstrate the ability to communicate with patients, nursing, colleagues, and ancillary personnel at all times in a situationally appropriate manner (EPOs: IPC-1, IPC-2, IPC-3)
Professionalism:
UTCOMLS students will meet or exceed the institutional standards for professionalism as stated in the current Educational Program Objectives and the current Educational Course Objectives for the Sponsoring Department
Educational Methods: The strategies used include:
- Clinical experience: experiential learning through supervised direct patient care
- Independent learning based on prescribed literature
- Didactic teaching
Evaluation Methods:
- Acting Internship assessment by faculty
- Completion of simulation activities
- Logging of experiences and clinical hours in RocketMed
Prerequisites: Successful completion of all third-year required clerkships
Clerkship Director: Dr. Allen Williams
Clerkship Coordinator: Amy Blevins
Phone Number: 419-383-6318
Email: Amy.Blevins@utoledo.edu
ECC Approved
August 2024