Emergency Medicine

Medical Student Advanced Elective/Sub-Internship in Emergency Medicine

Welcome to the Kaiser Permanente Emergency Department in Modesto and Manteca! Thank you so much for your interest in our program. We look forward to having you rotate with us. We are confident that you will have a fantastic educational experience in our department and that you will gain a true appreciation for emergency medicine.

Our Emergency Medicine clinical clerkship is offered as a four-week elective rotation or sub-internship. During the rotation, students caring for our patients will be exposed to diverse clinical encounters with a breadth of pathology and a wide variety of diagnoses. They will have the chance to work closely with our fantastic Emergency Medicine residents and faculty. In addition to clinical exposure, our rotating students will participate in weekly student didactics, our emergency medicine residency conference, journal club, grand rounds lectures, simulation sessions and procedure labs.

Our mission is to support and educate our future physicians, helping to develop basic skills with regards to the diagnosis and treatment of common emergency department complaints with specific attention to conditions requiring immediate, life-saving interventions. We will help to expose students to the workflows, interprofessional teamwork, transitions of care, patient safety systems, and the pace of the emergency department setting.

Visiting student may start applying to our EM clerkship rotation via VSAS/VSLO and our department will start accepting rolling admissions until all of our spots have been filled. We recommend those who are interested in our sub-internship to apply as early as possible.

Goals and Objectives

Patient Care: Provide patient-centered care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health
Medical Knowledge: Demonstrate knowledge of established and emerging principles of clinical sciences, as well as the application of this knowledge to patient care, diagnostic and therapeutic decision making, clinical problem solving, and other aspects of evidence-based care.
Practice Based Learning and Improvement: Demonstrate the ability to investigate and evaluate their care of patients, to appraise and assimilate scientific evidence, and to continuously improve patient care based on constant self-evaluation and lifelong learning
Interpersonal and Communication Skills: Demonstrate interpersonal and communication skills that result in the effective exchange of information and collaboration with patients, their families, and health professionals
Professionalism: Demonstrate a commitment to carrying out professional responsibilities and an adherence to ethical principles
Systems Based Practice: Demonstrate an awareness of and responsiveness to the larger context and system of health care, as well as the ability to call effectively on other resources in the system to provide optimal health care
Interprofessional Collaboration: Demonstrate the ability to engage in an interprofessional team in a manner that optimizes safe, effective patient- and population-centered care
Personal and Professional Development: Demonstrate the qualities required to sustain lifelong personal and professional growth including self-awareness, healthy coping mechanisms, conflict management, flexibility and maturity, trustworthiness and leadership skills.

Information for Current Rotators

Expectations

Shifts

14 8-hour shifts during the month including overnights in both Modesto and Manteca
If you have procedures/logs you need signed off on shift, please let your preceptors know at the beginning of shift so we can help you accomplish them
Be a part of the team!
Take ownership of your patients
- follow up on labs, look at EKG’s, call or follow up on consults, make final dispositions

Professionalism

Please wear scrubs and comfortable close toed shoes (white coats are optional but not required)
Please wear your hospital ID badge at all times
Be on time, set up and ready at the beginning of shift.
Attitude counts (both good and bad)
Be part of the care team but remember to own your patients. These are YOUR patients too.
Treat all your patients and colleagues with respect
If you ever feel uncomfortable in a situation please speak up and let your attending know
If there are any issues please let us know immediately
If you are going to be late please let us know. We may ask you to call the Modesto/Manteca ED and inform your preceptor for the day.
If you are sick, please call Dr. Branham or Dr. Ju AND Sherry Sandoval

Patient Care

Chief complaint-driven history
thorough physical examination
10-15 minutes max, ideally
please do not perform sensitive exams (GU/rectal/breast) exams without the knowledge or presence of your attending and make sure to have a chaperone in the room
generation of a broad differential diagnosis
present patients to attending
focused, succinct, but thorough presentation
2-3 minute presentation with chief complaint, pertinent HPI, PMH, meds, allergies, pertinent SH/FH
present the physical exam starting with the vital signs and a general description of the patient, discuss pertinent findings
develop a broad differential focusing on the most deadly first (it’s a good idea to know the differentials for common ED chief complaints for example chest pain, abdominal pain, dyspnea)
one to two sentence summary
have a well thought out plan to rule in/out each item on your differential diagnosis
resuscitation and stabilization
if initially seeing a patient and you think they are sick- notify the attending
treatment plan and intervention
procedures
if comfortable, volunteer to do any/all procedures
peripheral IV insertion, US guided IV’s
nasogastric tube placement
phlebotomy
laceration repairs and suturing
orthopedic reductions and splinting
arterial blood gas draws
intubations
lumbar punctures
central venous access

Charting

plan on max 1-2 charts per shift but ask your attending their preference. Your clinical experience, exposure and learning is more important than writing notes but there is a utility in practicing and getting accustomed to writing notes
close/sign all charts by the end of the shift

Didactics

Student orientation
Student SIM
Student lecture series
EM residency conference is every Thursday typically from 8-12 in the 5th floor conference room
EM residency SIM usually once a month typically starting at 8:30 in the SIM lab and conference/residency rooms
You may have other obligations to your schools as well. Please keep us informed and let us know ahead of time

Grading and Evaluation Requirements

Sub-Internship/Auditioning MS4

End of Shift Evaluation (75%)

Every shift signed by an attending physician
Proof you have completed required number of shifts
Your job to get it to them and their job to fill it out
You may ask and should be getting informal feedback
It is not necessary for you to see the completed evaluation

End of Clerkship Exam (25%)

Given at the end of your rotation
You will receive an email with the SAEM/CDEM login information
There are many practice tests available to take that are not required but recommended

MS3/MS4 Elective

End of Shift Evaluations (100%)

EM Match Advice

Considering a future in Emergency Medicine? Not sure if this specialty is the one for you? Want to apply but not sure where to start? Please feel free to reach out to Dr. Branham and Dr. Ju for any mentorship needs with any questions or concerns about emergency medicine, rotations, applications, match. Our faculty and residents would be more than happy to provide advice and guidance.

Also, check out these resources:
https://www.aliem.com/em-match-advice-series/
https://www.emra.org/books/msadvisingguide/msag/
https://www.cordem.org/globalassets/files/committees/student-advising/2018-applying-guide-cord-cdem-emra-rsa.docx.pdf

EM Journals and Organizations

Annals of Emergency Medicine
Academic Emergency Medicine
Western Journal of Emergency Medicine (West JEM)
Journal of Emergency Medicine (JEM)

American College of Emergency Physicians (ACEP)
Emergency Medicine Residents’ Association (EMRA)
American College of Osteopathic Emergency Physicians (ACOEP)
Society for Academic Emergency Medicine (SAEM)
American Academy of Emergency Medicine (AAEM)
Council of Emergency Medicine Residency Directors (CORD)