Core EM Clerkship Topics

Core EM Clerkship Topics

In the last ten years, there are few published undergraduate emergency medicine curriculum recommendations (Hobgood et al., 2009; Manthey et al., 2010; Penciner et al., 2013; Santen et al., 2014).

Current undergraduate curriculum trends recommend longitudinal and horizontal integration, and the topic lists related to emergency medicine are extensive for medical students.

In this post, we provide International Federation for Emergency Medicine and Society for Academic Emergency Medicine’s recommendations (Manthey et al., 2010; Hobgood et al., 2009).

The chosen topics can ideally be re-discussed in the clerkship during the senior years of medical school.

  • Abdominal pain
  • Altered mental status
  • Cardiac arrest and arrhythmias
  • Chest pain
  • GI bleeding
  • Headache
  • Multiple trauma
  • Poisoning
  • Respiratory distress
  • Shock

Because the length of the rotations can vary between institutions, the topics list can be extended according to the length of the clerkship and local needs.

References and Further Reading

  • Hobgood, C., Anantharaman, V., Bandiera, G., Cameron, P., Halperin, P., Holliman, J., … & International Federation for Emergency Medicine. (2009). International Federation for Emergency Medicine model curriculum for medical student education in emergency medicine. Canadian Journal of Emergency Medicine, 11(4), 349-354.
  • Manthey, D. E., Ander, D. S., Gordon, D. C., Morrissey, T., Sherman, S. C., Smith, M. D., … & Clerkship Directors in Emergency Medicine (CDEM) Curriculum Revision Group. (2010). Emergency medicine clerkship curriculum: an update and revision. Academic Emergency Medicine, 17(6), 638-643.
  • Penciner, R. (2009). Emergency medicine preclerkship observerships: evaluation of a structured experience. Canadian Journal of Emergency Medicine, 11(3), 235-239.
  • Santen, S. A., Peterson, W. J., Khandelwal, S., House, J. B., Manthey, D. E., & Sozener, C. B. (2014). Medical student milestones in emergency medicine. Academic Emergency Medicine, 21(8), 905-911.

How to make the most of your EM Clerkship

How to make the most of your EM Clerkship

Emergency Medicine has something for everyone!

Starting the Emergency Medicine (EM) Clerkship is one of the most exciting times of any medical student’s life, regardless of whichever specialty they plan on specializing in because EM has something for everyone. It is like solving all those questions that begin with ‘A patient presents to the Emergency Department with…’ but in reality, at a faster pace and with more tricky situations. This can make students feel overwhelmed, as they find themselves juggling between books and resources as to which one to follow or which topics to learn, and I am here for just that! To share the approach that helps many students get the hang of EM and make the most of their time in one of the best learning environments of any hospital.

Prepare a list of common conditions

The basic approach would be first to jot down all the problems you can think of.

Here is a list to help you get started: Core EM Clerkship Topics

There are problems that you may be heard a lot such as Chest Pain, Heart Failure, Shock (and it’s types), Acute Coronary Syndrome, Sepsis, Pulmonary edema, Respiratory Failure, Coma, Stroke, Hypoglycemia, Subarachnoid Hemorrhage, Fractures, Head Trauma, Status Epilepticus, Diabetic Ketoacidosis, and Anaphylaxis.

As every doctor you meet will always say, common is common, so always focus on things that you have heard and seen most about, read about them, make notes on their clinical features, differentials, investigations and management. Most importantly, do not forget to read about the ABCDE approach in every critically ill and trauma patient.

Brush up on your history taking and examination skills

Know what to ask and when to ask. Patients in the ED are not in their most comfortable composure, so try to practice and frame questions that provide you with just enough information to make a diagnosis in the least possible time.
The same goes for examination, never forget the basics of examination and their importance. Practice examination as much as you can and you will automatically see it come to you naturally at a faster pace. Also, do not forget focused history and physical examination is a cornerstone of EM practice and saves a lot of time.
Where investigations can help you exclude a differential, 80% of your diagnosis will be built from what you ask, what you see and what you feel. Keep in mind that if you are not thinking or looking for something, you will not see and find it. So, be suspicious of life, organ and limb-threatening problems.

Read about common ED procedures

ABG, Intubation, Central Lines, FAST Scan, Suturing, Catheter and Cannula placement are some of them. As a medical student, you will probably not be required to perform any, but it is good to have an idea about the procedures when you see them. If you can practice, then that is even better, ask a resident or intern to show you how and you can have a go yourself under their supervision! Remember, “see one, do one, teach one.”

Watch videos on examination, interpreting X-rays, & procedural skills

Youtube is an asset when it comes to medical education, make good use of it. There are also plenty of videos on the iEM website that you can watch and learn from.

Interpretation of ECG & X-rays

Google is your best friend for this! You have the list of common conditions, all you need to do is a google search on the most common ECG findings and x-rays in medical emergencies and you will be good to go. You can also always learn these from the doctors around you in the ED, as the more you see and try to interpret, the better you get at differentiating the normal from abnormal.

Books

Before the rotation

Before the rotation, read a review book, recall your basic knowledge from internal medicine/family medicine and surgery because EM almost covers all of the acute problems of those fields. Moreover, do not forget, EM is an independent specialty and has its’ own textbooks.

iEM Clerkship book is a very good source to get started with! Download Now! – iEM Book (iBook and pdf)

If you are the kind, who likes solving questions, the Pretest Emergency Medicine is a great source.

During the rotation

During the rotation – Learning what you see is the best way to keep things in your long term memory. After your shift ends, and you go home, get some rest, recall the cases of the day and read about them on Up to Date/ Medscape or any resource that you prefer, this will help you relate what you saw with what you are reading and will help you recall it better later on.

These are just a few tips to help in making the most of your EM rotation. Remember to study hard, but also practice, brush up on your communication skills, talk to patients, be there for them. The EM Clerkship prepares you for life as a doctor, as you practice every aspect of medicine during this time and learn to answer questions about acute medical problems and their severity when asked by those around you.

Cite this article as: Sumaiya Hafiz, "How to make the most of your EM Clerkship," in International Emergency Medicine Education Project, October 4, 2019, https://iem-student.org/2019/10/04/how-to-make-the-most-of-your-em-clerkship/, date accessed: October 16, 2019

Mnemonic for Right Lower Quadrant Pain

From Experts To Our Students! – GIB

A 69-year-old male with altered mental status

In case you didn’t encounter an elderly with altered mental status today!

631.1 - subdural

A 69-year-old male was brought to the ED by EMS because of altered mental status described by relatives. He hardly communicates and is not oriented. He has a motor weakness on the left upper and lower extremities 2 and 3 out of 5, respectively. BP: 183/88 mmHg. Other vitals are in normal range. CT scan image is given. What is next?

iEM Education Project Team uploads many clinical picture and videos to the Flickr and YouTube. These images are free to use in education. You can also support this global EM education initiative by providing your resources. Sharing is caring!

Sudden Severe Headache

665-  SAH

In case you didn’t encounter a sudden severe headache today!

A 46-year-old female patient presented with severe headache. BP: 178/88 mmHg, HR: 103 bpm, RR: 22/min, T: 37, SpO2: 98% in room air. She has no history of disease. She is unconscious (GCS E1, V3, M4). No obvious lateralized motor deficit. Bedside gluco-check is normal. You intubated her to secure airway and send her to the CT (above image). What is your next action?

iEM Education Project Team uploads many clinical picture and videos to the Flickr and YouTube. These images are free to use in education. You can also support this global EM education initiative by providing your resources. Sharing is caring!

Happy educational week!

You can listen all EM clerkship core topics.

Do you need clinical images/videos?

Visit our Flickr channel

Visit our YouTube channel

SAEM/CDEM EM Clerkship Core Topics

Abdominal Pain

by Shaza Karrar Case Presentation A 39-year-old female presented to the emergency department (ED) complaining of right-lower-quadrant (RLQ) pain; pain duration was for 1-day, associated

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Altered Mental Status

by Murat Cetin, Begum Oktem, Mustafa Emin Canakci  Case Presentation An 80-year-old female presents to the emergency department with a tendency to sleep (altered mental

Read More »

Cardiac Arrest

by Abdel Noureldin and Falak Sayed Quick link to Spanish Version Introduction A 23-year-old female was brought into the emergency department. Her frantic family members

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Poisonings

by Harajeshwar Kohli and Ziad Kazzi Case An 18-year-old, previously healthy female, presents to the Emergency Department with nausea, vomiting, and tremors. She states 45

Read More »

Multiple Trauma

by Pia Jerot and Gregor Prosen Case Presentation A 28-year old male was a restrained driver in a head-on motor vehicle collision. He was entrapped and

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Respiratory Distress

by Ebru Unal Akoglu Case Presentation A 40-year-old female with a history of diabetes mellitus presents with a complaint of 6 days cough and muscle

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Headache

by Matevz Privsek and Gregor Prosen Introduction Headache is a subjective feeling of pain, crushing, squeezing or stabbing anywhere in the head. They are typically

Read More »

Gastrointestinal Bleeding

by Moira Carrol, Gurpreet Mudan, and Suzanne Bentley Case Presentation A 61-year-old man with a history of liver cirrhosis secondary to chronic EtOH abuse presents to

Read More »

Chest Pain

by Asaad S Shujaa Introduction Chest pain is one of the most common symptoms presented in the emergency department (ED), and it is worrisome because

Read More »

Shock

by Maryam AlBadwawi Introduction Shock, in simple terms, is a reduced circulatory blood flow state within the body. The inadequate circulation deprives the tissues of its

Read More »

Today’s Headache

In case you didn’t encounter headache today!

450 - subacute-chronic subdural haematoma

iEM Education Project Team uploads many clinical picture and videos to the Flickr and YouTube. These images are free to use in education. You can also support this global EM education initiative by providing your resources. Sharing is caring!

Elbow Pain

In case you didn’t encounter a child with elbow pain today!

iEM Education Project Team uploads many clinical picture and videos to the Flickr and YouTube. These images are free to use in education. You can also support this global EM education initiative by providing your resources. Sharing is caring!

A 22-year-old male

Appendicitis

Acute Appendicitis

by Ozlem Dikme, Turkey

A previously healthy 22-year-old male was brought to the emergency department (ED) with recently-started abdominal pain. He had not eaten anything since that morning due to loss of appetite. He was nauseated and vomited three times. His abdominal pain started around the umbilicus and epigastric area. His pain increased as it moved towards his right lower quadrant (RLQ). The maximum pain was felt on the right iliac fossa. He had not taken any medication. His social history revealed that he was non-drinker, non-smoker and did not use any illicit drugs. His diet mostly consisted of carbohydrates. The past and family histories were unremarkable. His blood pressure was 120/70 mmHg, pulse rate was 100/min, the temperature was 37.8°C (100°F), and respiration rate was 22/min. 

What is the cut-off number in Alvarado score to suspect appendicitis?

Touch Me

Alvarado Score

1-4 appendicitis unlikely, 5-6 appendicitis possible, 7-8 appendicitis probable, 9-10 appendicitis very probable
Answer
51.1 - abdominal - pain - appendicitis ultrasound

Physical examination showed normal bowel sounds, tenderness and voluntary guarding, particularly over the right iliac fossa. The costa-vertebral angles were not tender. Oral intake was stopped, intravenous (IV) catheter was inserted, blood and urine tests were planned, and fluid therapy was started. The urinalysis was normal. White blood cell (WBC) count was 14,500 with 89% polymorphous and 11% lymphocytes. The ultrasonography (USG) showed a non-compressible tubular structure of 9 mm in diameter at RLQ. He admitted to the surgical ward with the diagnosis of acute appendicitis.

Core EM Clerkship Topics

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