Description: Anyone, anywhere, anytime can have an unforeseen emergency. All physicians will be called on to provide urgent decision-making and treatment in the office, hospital, and in your community. Using principles of advanced clinical reasoning, prioritizing information, identifying critical actions and self-correcting in real time will allow you to solve the case.
Goal & Objectives: 4th year medical students will integrate accumulated knowledge in order to:
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Identify an emergency (across different clinical settings) and learn a systematic approach to diagnosis, treatment, and disposition.
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Evaluate high-risk undifferentiated patients and generate a differential diagnosis using advanced clinical reasoning techniques.
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Perform patient management to include: rapid assessment of acuity, initial treatment, stabilization, and disposition. Procedural skills necessary to stabilize acutely unstable patients. Leadership, teamwork, and effective communications.
Secondary Objectives
- Understand necessity of a multidisciplinary team approach to promote quality and safety. Collaborate with colleagues in respiratory therapy, pharmacy colleagues, and case management.
- Understand and model best practices in professional behavior– empathy approach to patient/ family interactions, collegiality, conflict resolution skills, transitions of care, delivering bad news, and debriefing.
- Integrate of basic science material in didactics and simulation. Integration and review will occur during discussions of resuscitation, early goal directed therapy, and critical care therapeutics.
- Identification of systems issues in health care such as health care disparities, continuous quality improvement, and patient safety.
Scope of Content: A general approach to emergency and critical care
- Diagnosis and treatment in undifferentiated patients with high-risk chief complaints: chest pain, dyspnea, altered mental status, arrhythmia, abdominal pain, bleeding, shock, and arrest.
- Be able to develop accurate and complete chief complaint specific differentials using Worst-first, CARD, (Common, Atypical, Rare, Don’t miss) and VINDICATE formats.
- Gain proficiency in advanced clinical reasoning: understand the dual process approach, need for cognitive checks, and appropriate use of evidence based clinical decision rules. Example: Well’s Criteria and PERC rule.
- Approach to stabilizing the unstable/emergent patient: Airway (bag-valve mask, endo-tracheal intubation) Breathing ( BiPap, mechanical ventilation) Circulation (CPR, vascular access, vasopressors, anti-arrhythmics, cardioversion, and defibrillation)
- High acuity simulation scenarios will be used to integrate medical knowledge with skills by using scenarios to develop specific teamwork skills in the domains of leadership, situation monitoring, communications, and mutual support. Examples: closed loop communication and a standardized transition of care SBAR.
- Advanced presentation skills using SNAPP1 format (Summarize H&P, Narrow the possibilities, Analyze the differential, Probe the Preceptor, Select case related issue for self directed learning) and reverse presentation or ASOAP 2 format (Goal is commit to a specific Assessment (diagnosis) followed by Subjective /Objective data that supports this Assessment (conclusion) and finishing with treatment Plan.
- Wolpaw TM, Wolpaw DR and Papp KK. SNAPPS: A Learner-centered Model for Outpatient Education. Academic Medicine 2003;78(9):893-8.
- Becky Blankenburg and others, Revisiting How We Think, PAS Presentation, May 2011.
Education Methodologies
The course will be a combination of acute care clinical experiences (eight 8-hour emergency department shift), didactics, and simulation of clinical encounters and procedures. Students will be required to take leadership roles in case discussions and during simulation scenarios. Educational methods will include: case‐based learning, an asynchronous on-line curriculum, student presentations, high and low fidelity simulation with debriefing.
Formative Assessment:
- Preceptor and Clinical Site Director feedback (end-of-shift, direct observation, mid-rotation)
- Faculty and Peer to Peer feedback during simulation debriefing
- Small group participation
- Quizzes
Summative Assessment:
- Global summary clinical experience
- Participation during cumulative simulation scenarios final week
Course Schedule: The general structure of the course is on Mondays and Wednesdays, students will engage in all day didactic sessions and on Tuesdays students will participate in all day simulation activities which will take place in the interprofessional Center for Experiential Learning and Simulation (iCELS) on campus. Students work eight 8 hour clinical shifts Thursdays through Sundays during the rotation which will be scheduled by the coordinator at one of 9 clinical sites(all within a one hour radius to UMASS).
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