Emergency Medicine

403.3 Emergency Medicine

Once scheduled, all requests for block changes or release from the Emergency Medicine elective must be received at least 30 days prior to the start of the elective.

Instructor: Annemieke Atema, M.D.

Location: Boston Medical Center, Dowling Building – 1st Floor, 9:00 a.m.
Emergency Dept. Conference Room

Telephone: 617 414-4805 email: Annemieke.Atema@bmc.org

Number of Students: 2
Period to be Offered: 4 weeks

Description of Elective:

Four weeks are spent working in the Boston Medical Center Emergency Department, a Level 1 trauma center. Students take an active role in the initial evaluation and treatment of patients, work alongside our senior residents, attendings, and nursing staff, and are exposed to wide variety of patients, illnesses, and procedures. For many patients, the ED is the first exposure that they have to the medical system and students will gain valuable experience as they are able to follow patients from presentation, through their workup, and onto their diagnosis and treatment. Field exposure to the pre-hospital care system is given with observation on a Boston EMS ambulance.

Students participate in daily teaching sessions, weekly departmental conferences, as well as a didactic lecture series designed specifically for them. The skills learned are as applicable to those going on to a career in EM, as to those entering other specialties.

BU students may sign up for the elective by completing an Add/Drop Form and bringing it to the office of Lisa Stapleton (Dowling 1 South, Rm 1324). Please also include your email address, phone number, and beeper number on the form so that we may send you confirmation and information regarding the rotation.

All BU students interested in Blocks 9-16 must speak with Dr. Atema prior to beginning the rotation.

Please note that students must be present for the orientation session on the first day of the rotation, as well as for an IBEX (computer tracking, order entry, documentation) training session on the first Tuesday of the rotation.

We look forward to meeting you.

403.33 Emergency Medicine Research

Instructor: James Feldman, M.D.

Contact: Patty Mitchell, RN, Assistant Research Director
Telephone: 414-4560

Location: Boston Medical Center, Dowling 1

Number of Students: One per month
Period to be Offered: One month

Description of Elective:

This four week elective is for the highly motivated student with an interest in Emergency Medicine. Students will arrange with the course director to assist investigators with various aspects of projects such as project design, data collection, statistical analysis. Students will work closely with the investigator though they may be given tasks to accomplish on their own.

This elective requires prior approval of the course director (Dr. Feldman) or a full time faculty member from the Department of Emergency Medicine who has agreed to serve as a research mentor. Students who are interested in conducting original research must meet with the course director at least 6 months prior to the planned elective. Availability dependent on ongoing research activities in the Department.

 

403.35 Emergency Ultrasound (EUS)

Instructors: Meera Muruganandan, M.D.
Location: Boston Medical Center, Dowling 1S, Ultrasound Office

Contact: Lisa Stapleton, Dowling 1 South, Room 1324
Telephone: 617 414-2801
Number of Students: 2 Fourth Year Medical Students
Period to be Offered: Four Weeks

Course Director: Meera Muruganandan, M.D.

SHORT SUMMARY OF ELECTIVE

SHORT SUMMARY OF ELECTIVE

 

This elective is a four-week elective designed to introduce 4th year medical students to the use of point-of-care (POC) ultrasound in the emergency department.  Students will receive hands-on training as well as a variety of didactics to learn the basics of emergency ultrasound.  Students will be given required readings and attend lectures to help develop background knowledge of each of the main areas of emergency ultrasound, which include: Physics/Instrumentation, Biliary, Renal, Aorta, EFAST (Extended Focused Assessment with Sonography for Trauma), Cardiac, Transabdominal Pelvic, Deep Venous Thrombosis, Skin/Soft Tissue/Musculoskeletal, Procedural.  Further, they will be given the opportunity to practice and develop their skills by scanning patients in the emergency department with the ultrasound faculty and independently on designated scanning shifts.  Images and videos will be saved electronically for review at the weekly image review sessions.

 

DESCRIPTION OF ELECTIVE

 

This elective is designed to give students with an interest in emergency medicine the opportunity to develop their ultrasound skills prior to residency and gain additional exposure to patient care in the emergency department.  During this elective, students will be provided the time and mentorship to develop advanced skills in bedside emergency ultrasound.  All students will participate in designated 3 hour hands-on instructional sessions with an ultrasound faculty member.  They will also have assigned 4 hour scanning shifts where they will scan patients in the emergency department.  The student will be expected to complete a minimum of 100 scans during their rotation.  These will be kept in a log by the student, along with any confirmatory studies to correlate with their scans.

 

All scans will receive either realtime feedback during the instructional session or they will receive direct feedback on the ultrasound recordings, which are reviewed during the weekly quality assurance(QA) image review meetings.  During these image review meetings, all images recorded in the emergency department for that week are reviewed.  These meetings are run by the emergency ultrasound faculty and serve as both an educational tool for rotating residents and medical students and as the department of emergency medicine’s quality assurance program. This feedback is very important for helping the student to improve imaging technique and interpretation.  Students will also be expected to attend the weekly emergency medicine conference held on Tuesdays and every other Wednesday from 8a-12p.

 

Lastly, at the end of their rotation the student will be required to do a short, 15 minute, case-based presentation during the video review session on an interesting ultrasound case they acquired during their rotation.  Ultrasound textbooks and articles will also be provided for the student to review the basic skills of ultrasound and the different applications used within the scope of emergency medicine practice.  These will help in preparation for the final EUS presentation given by the student and in studying for the final exam.

 

The Emergency Ultrasound elective will be overseen by Dr. Meera Muruganandan .  Preference is given to students choosing a career in emergency medicine.  Each student must email Meera.Muruganandan@bmc.org to explain their specific interest in the emergency ultrasound elective for approval.  BU students may sign up for the elective by completing an Add/Drop Form and bringing it to the office of Lisa Stapleton (Dowling 1 South, Rm 1324). Any questions regarding block availability should be directed toward Lisa Stapleton.  Please also include your email address, phone number, and beeper number on the form so that we may send you confirmation and information regarding the rotation.  Sorry but faxed or emailed forms are not accepted.  For students from other medical schools to sign up for the elective, this must be done via VSAS.  There is no paperwork accepted directly to the department for students from outside schools.  Once your VSAS form is approved you may contact Lisa Stapleton for available dates to rotate Lisa.Stapleton@bmc.org.

 

Students will report to Dowling 1S ultrasound office on their first day of their rotation.  Please email  Dr. Meera Muruganandan at Meera.Muruganandan@bmc.org with questions and to arrange a meeting time.  The course will begin with an introductory lecture, an ultrasound pretest, and an introductory hands-on session with one of the emergency ultrasound faculty.  The student will set up ten 4 hour scanning shifts in which they will be in the emergency department performing bedside ultrasounds on patients, assisting with ultrasound-guided procedures performed by residents and faculty, and following up on cases from their prior scanning sessions.  The student is expected to perform educational ultrasounds in the emergency department Monday through Friday.  On days in which scan shifts are not assigned, the student should make time to scan on their own.

 

Grading will be based on the evaluations filled out by the ultrasound faculty (30%), pass/fail for the student’s final presentation (10%), a post-test assessment (20%), fufilling their scan requirements and handing in a completed log book (40%). In addition, the student must attend all lectures, scanning sessions, and weekly image review sessions.  Students evaluations are based on observed patient interactions and ultrasound skills focusing on the objectives, which includes a focus on medical knowledge, practice based learning and improvement, professionalism, and interpersonal and communication skills.

 

 

GOAL

The purpose of the emergency ultrasound elective is for the 4th year medical student to recognize the indications for using point-of-care emergency ultrasound in the practice of emergency medicine.  The student will also develop the skills to acquire and interpret point-of-care emergency ultrasounds in the main applications of: Biliary, Renal, Aorta, EFAST (Extended Focused Assessment with Sonography for Trauma), Cardiac, Transabdominal Pelvic, Deep Venous Thrombosis, Skin/Soft Tissue/Musculoskeletal, and procedural.

 

OBJECTIVES

 

By the end of the Emergency Ultrasound elective, the BUSM student will be able to:

 

  1. Describe the indications for Point-of-Care (POC) ultrasound in the emergency department and the basic physics and instrumentation involved in acquiring adequate images for the diagnosis of patient pathology. (U)
  2. Formulate a differential diagnosis for the identified pathology during scanning sessions and describe a plan for applying Emergency Ultrasound (EUS) to these clinically complex problems in order to improve patient care in the emergency department. (U, S)
  3. Perform the standard views or “windows” for each application of emergency ultrasound: Biliary, Renal, Aorta, EFAST, Cardiac, Transabdominal Pelvic, Deep Venous Thrombosis, Skin/Soft Tissue/Musculoskeletal, and Procedural. (U, E)
  4. Demonstrate the ability to accurately interpret their POC ultrasounds during the weekly image review sessions with the clerkship director and to participate in the review of departmental scans during this session. (U, E, C)
  5. Document a minimum of 100 recorded ultrasound studies during their four week rotation and produce a completed logbook at the end of the rotation. (U, E)
  6. Research one ultrasound case seen during their rotation and develop a case-based presentation to share with the clerkship director and rotating trainees during one of the weekly image review sessions. (R, U, E)
  7. Communicate effectively with the EUS faculty and members of the medical team to contribute to the care of the emergency department patient. (U, C, E)
  8. Demonstrates professionalism by participating in and attending all required sessions and lectures. (B, A)
  9. Demonstrates good beside manner when performing a bedside ultrasound on a patient within the emergency department, always respecting privacy and explaining the purpose of educational ultrasounds. (B, C, A)

 

 

CURRICULUM

The curriculum includes

-          Orientation session and pretest

-          Individual 3 hour hands-on scanning sessions with the ultrasound faculty

-          Ten 4 hour scheduled scanning shifts

-          Attendance at the weekly emergency medicine conferences on Tuesday 8a-12p and every other Wednesday 8a-11a

-          Completion of reading material and computer-based ultrasound tutorials

-          Participation in weekly image review sessions of departmental EUS scans.

-          Review their minimum of 100 documented ultrasound scans for the rotation with ultrasound faculty and respond to feedback

-          Final case-based EUS presentation to be given at the final weekly image review session of the student’s rotation

-          Post-rotation ultrasound review test

 

Resources:

  1. O. John Ma, James Mateer, Michael Blaivas.  Emergency Ultrasound, ed 2. The McGraw-Hill Companies, Inc, 2008.
  2. Vicki E. Noble, Bret Nelson, A. Nicholas Sutingco. Manual of Emergency and Critical Care Ultrasound. Cambridge University Press, New York, NY. 2007.
  3. Beatrice Hoffmann. Ultrasound Guide for Emergency Physicians: An Introduction.  ACEP 2008. http://www.sonoguide.com.
  4. Megan Leo. BMC Emergency Ultrasound Handbook. 2011.

 

EVALUATION

- Students are evaluated  based on observed patient interactions and ultrasound skills focusing on medical knowledge, practice based learning and improvement, professionalism, and interpersonal and communication skills. Grading will be based on the evaluations filled out by the ultrasound faculty (30%), pass/fail for the student’s final presentation (10%), a post-test assessment (20%), fufilling their scan requirements and handing in a completed log book (40%). In addition, the student must attend all lectures, scanning sessions, and weekly image review sessions.

 

- Grades are Fail, Pass, High Pass and Honors.

- Honors is achieved by approximately 50% of the students who rotate through the department.  In order to achieve this, it is necessary for the student to record and document their minimum number of scans, attend all their assigned shifts, conferences, and image review sessions. In addition, the student must present an ultrasound case at the end of the rotation that they participated in during the month. The student must uniformly get honors-level feedback forms from the ultrasound faculty in order to achieve an honors grade in this rotation.

- The final summative evaluation will be a composite evaluation written by the clerkship director