The University of Texas Medical School at Houston Department of Emergency Medicine
Department of Emergency Medicine
The Department of Emergency Medicine

Medical Student Education

Welcome to the Emergency Medicine student rotation at The University of Texas Medical School


This rotation is intended to give you an insight into the types of patients and problems that may be seen in a typical emergency department (ED). You will have the opportunity to be involved in all aspects of emergency care. We hope this rotation will be enjoyable and stimulating.

Course Goals

  • Develop skills to diagnose and manage life-threatening conditions
  • Improve ability to assess undifferentiated patients
  • Practice basic emergency medicine procedural skills

Course Objectives

  • Obtain problem-focused, accurate history and physical examination
  • Present history and physical examination in concise, orderly manner
  • Recognize immediate life-threatening conditions
  • Develop an appropriate differential diagnosis
  • Interpret results of common diagnostics and tests
  • Develop evaluation and management plan
  • Communicate effectively and professionally with patients and staff
  • Perform basic procedural skills
  • EMER 4001 Core Competency‐based Course Objectives [pdf]

The Facility

Memorial Hermann-Texas Medical Center (Memorial Hermann-TMC) is a level I trauma center and urban teaching hospital located in the Texas Medical Center. Memorial Hermann-Texas Medical Center has an annual ED census of approximately 60,000 patients and is a private, not-for-profit tertiary care center. The hospital is one of the primary teaching sites for UT-Houston.

The ED at Memorial Hermann-TMC has 37 beds and may expand as patient volume demands. It is separated into several different sections:

  • Trauma
  • Acute Care
  • Pediatrics

Shifts

You are expected to work 15 shifts during the month. Day shifts are from 7AM-3PM, evening shifts from 3PM-11PM, and night shifts from 11PM-7AM. The shifts are divided between the trauma, medicine, and pediatric parts of the ED. During orientation for the rotation, you will choose 1 track from the schedule grid. Sample shift grid

Patient Care

Before you go in to see a new patient, please let the attending or upper-level resident know. You should read the nurses' notes and make note of the vital signs before seeing the patient. If you enter a room and the patient appears ill, tell an upper-level resident or the attending immediately. Try to limit yourself to 10 minutes at the patient’s bedside performing your initial history and physical examination.

After your initial evaluation of the patient, you must discuss the history and physical examination findings with an upper-level resident or attending before performing any invasive procedures such as pelvic or rectal exams and before writing any orders. All orders must be co-signed by an upper-level resident or attending. Also you must talk to the attending before calling for any consults from other services. Finally, the attending must sign the chart before the patient is admitted or discharged.

The ED uses Poseidon template charts based on chief complaints (e.g., chest pain, respiratory distress). Because of billing issues, you should not be filling out the Poseidon charts. Instead there is a history and physical form specifically for you to fill out and turn in to the course director for evaluation. In an effort to allow more interaction between students and attendings, you should present at least 2 patients per shift to the attending and 2 to an upper-level resident.
H & P form, page 1 [pdf] H & P form, page 2 [pdf]

At the end of each shift, have the attending and the resident each fill out and sign a shift card and have him/her place it in the box in the residents' lounge in the ED. These shift cards are used to provide feedback about your clinical performance in the ED. Shift Card [pdf]

You are encouraged to get as much hands-on experience as possible in the ED. When performing a procedure, an upper-level resident or attending should supervise you. After the procedure is done, a procedure note needs to be included in the chart. You should perform at least 4 procedures per shift. Some of the more common procedures include Foley catheter placement, interpretation of cardiac monitor or EKG, NGT or OGT placement, peripheral IV access, splint application, wound closure, and venipuncture.

Didactics

Didactics during the rotation include: teaching sessions specifically for medical students, weekly resident conferences, and self-directed reading. Through this combination of modalities, you will learn about the core educational topics in emergency medicine. Core Educational Topics & Corresponding Chapters in An Introduction to Clinical Emergency Medicine [pdf]

  • Medical Student Teaching Sessions
    The medical student teaching sessions consist of lectures and procedure labs that are presented by faculty and residents. Procedure labs provide you with the opportunity for hands-on practice of skills including suturing, spliting, FAST ultrasound, and airway management/intubation.
  • Weekly Resident Conferences
    The Department of Emergency Medicine holds weekly teaching conferences on Wednesdays from 7:30AM-12:00PM. These lectures are given by emergency medicine faculty and residents as well as guest lecturers and cover a variety of topics. You are required to attend these lectures (except for the Chairman's Hour). If you are working a Wednesday day shift, you are excused from the beginning of your shift for conference. If you are between night shifts, you are excused from conference.
  • Self-Directed Reading
    The recommended text for the rotation is Introduction to Clinical Emergency Medicine by SV Mahadevan and GM Garmel (2005). A copy will be provided to you for the duration of the rotation. Reading complements your clinical experiences and the other formal didactics of the rotation.

Grading

Final evaluations are based on your clinical performance in the E.D., written history and physical exams, and performance on an end-of-rotation quiz.

In order to be considered for an honors grade, you must give a 15 minute case presentation using Powerpoint (or an equivalent slide format) to the course director. You should present an interesting case in which you were involved in the ED during the course of your rotation. Your presentation should include the patient’s presentation (pertinent historical and examination findings), your differential diagnosis, work-up, and treatment/final disposition. Finally you should devote at least 5 minutes to discussing key teaching points (e.g., the approach to a patient with a similar chief complaint or information about the final diagnosis such as its workup and/or treatment).

By the end of the rotation, you should turn in to Jennifer or Dr. Van Meter your written history and physical exams (minimum of 10), shift cards (minimum of 15) textbook, and evaluation of the rotation. If you do not return your textbook, Jennifer will not release your grade.
Shift Card [pdf]

Important Forms for Rotation

  • Case presentation evaluation form [pdf]
    Used by faculty to evaluate oral case presentation.
  • Core competency-based course objectives [pdf]
    Based on objectives described in Report of the Task Force on National Fourth Year Medical Student Emergency Medicine Curriculum Guide. Ann Emerg Med. 2006: 47; E1-E7.
  • Core educational topics [pdf]
    Listed with corresponding chapters in An Introduction to Clinical Emergency Medicine. Based on core educational topics described in Report of the Task Force on National Fourth Year Medical Student Emergency Medicine Curriculum Guide. Ann Emerg Med. 2006: 47; E1-E7.
  • Course evaluation [pdf]
    Turned in at the end of the rotation to provide feedback about the rotation.
  • History and physical exam form page 1 [pdf] , page 2 [pdf]
    Used to document history and physical examinations.
    • Patient log [pdf]
    To track the types of patients that you see during the rotation. You should use this log to record all of your patient interactions and procedures for the month. Turned in at the end of the rotation.
  • Shift card [pdf]
    To be filled out by supervising resident and/or faculty member. Turned in each shift.
  • Sample shift grid template [pdf]
    During orientation to the rotation, choose 1 tract (e.g., A, B, etc.) from these options.
  • Written history and physical exam rubric [pdf]
    Used by faculty to evaluate written history and physical examinations.

Contact Information

Course Director (EMER 4001: Memorial Hermann Hospital)
Michael Van Meter, MD, MPH
Michael.W.VanMeter@uth.tmc.edu

Course Director (EMER 4004: Lyndon Baines Johnson Hospital)
Michael Van Meter, MD, MPH
Michael.W.VanMeter@uth.tmc.edu

Course Coordinator
Jennifer Chavez
Office Telephone: 713-500-6561
Fax:713-500-0758
Jennifer.Chavez@uth.tmc.edu

For visiting students who are interested in an away rotation at UT-Houston, please contact Ms. Chavez for further information.