ER

• R-1 Rotation

• R-2 Rotation

• R-3 Rotation

• Reading List

Faculty: Michael Tuggy, MD

Emergency Department Rotations for R-1s (back to top)

Time Commitments

2. The first day of the rotation the resident is expected to present a schedule of obligation for the month. Any other special request must be accompanied by a letter of approval from Dr. Tuggy. Permission for such special request will still be given at the discretion of the Emergency Attending.

3. Prior to beginning the rotation, an orientation to the department will be given by the Department Manager, Julie Campbell, RN. This orientation should be scheduled in advance with Julie (386-2592).

4. The R-1 will be released at the discretion of the Emergency Attending Physician two to three times a week at 7:30 A.M. to go to South Surgery to practice intubations. Residents should go to the anesthesia workroom in main surgery on those mornings for assignments.

5. Two mornings every week R-1's will be excused for clinics in the FPC.

6. Residents will be excused from at 12:15 on Tuesday for afternoon conferences.

7. Residents are otherwise expected to be in the ER from 7:00 a.m. to 6:00 p.m.

Dress Code

2. Male residents will be expected to wear a tie.

3. Residents will be expected to wear stockings or socks; bare feet and thong sandals are not acceptable.

Didactic Experiences

2. It is impossible to teach anyone the full scope of the pathology that presents in the Emergency Department. What we hope to do primarily is to develop judgment and to teach an approach to the emergent problems you will face in primary care.

3. The R-1s will be expected to learn to recognize, treat and appropriately handle disposition of acute problems such as MI, pulmonary edema, bronchospasm and traumatic injuries.

4. Techniques such as suturing, splinting, intravenous line placement and ABG collection will also be emphasized.

5. In addition to the above, R-1s will be required to show a proficiency in basic CPR and familiarize themselves with emergency equipment. Julie Campbell, RN, Department Manager, will be responsible for working with the resident on these skills. Prescribing of appropriate medications will be emphasized during the R-1 rotation. The attending physicians will help with this instruction. Chart completion should also be learned at the R-1 level.

6. Residents should present a list of any specific areas of interest the first day of the rotation. The Emergency Attendings will make every effort to work with the residents in reviewing such interests.

7. Dr. Dobson has developed a reading file for all residents in the ED. Residents should familiarize themselves with the contents and use this for reading material during slow time in the ED.

8. Evaluation of the R-1's performance during the rotation will be made by all the attendings. The review will then be given to Dr. Tuggy for inclusion in the resident's file.

Relationship with the Emergency Department Attending

2. The R-1, therefore, should present every case to the Emergency Attending prior to ordering any labs or contacting any other attending. The Emergency Physician and the resident will decide on an appropriate course of diagnosis and treatment together. Family Medicine patients must also be reviewed by the Emergency Attending as they are technically E.D. patients while in the E.D., although FPC residents will be responsible for evaluation and treatment of all FPC patients. The latitude to relax these guidelines will be at the discretion of the attending, not the resident.

3. Before a resident can admit a clinic patient, the ED physician must first discuss the case with the FP attending physician, who will then determine whether to admit the patient; then the on-call resident is to be contacted by the FP attending physician. This policy also includes No-Doc admissions; our FP faculty has to OK any No-Doc admits before a resident physician can evaluate the patient in the ED.

Emergency Department Rotations for R-2's (back to top)

Emergency Department experience for R-2's is provided at the Mary Bridge Children's Hospital. See Pediatrics section.

Emergency Department Rotations For R-3's (back to top)

Time Commitments

The resident will be expected to report to the Emergency Department at 6:00 P.M. on weekdays (usuallly a Monday, Wednesday or Friday). The resident may leave the E.R. at 10:00 pm after checking with ED staff to be sure that no Family Medicine patients are present or en route. S/he remains responsible for any Family Medicine patients that need to be seen emergently until 12 midnight. The resident sees all Family Medicine patients and is supervised by the ED attending physician, and the Family Medicine faculty on call is the ultimate backup. When patients are admitted through the ED on these days, the resident on call for the FP Service is expected to be available to see and admit the patient. R-3's will be assigned a total of 28 shifts in the ED during the third year.

In House Emergencies

(See "Duties of Back-Up Resident.")

Dress Code

(Remains the same as for R-1's.)

Experience

R-3's are expected to build on their experience gained as an R-1 in the ED as well as their hospital rotations. R-3's learn the systematic approach to patients seen in the ED setting, and treat the spectrum of problems ranging from simple surgical problems to managing the critically ill. The residents work closely with the ED attendings to outline diagnostic, therapeutic and disposition planning. Every patient is presented to the ED attending physician before the patient leaves the department. The resident should contact the patient's private physician for any admission, questions about disposition and most problems that will require follow-up.

Evaluations

Each resident's performance is evaluated periodically by the ED staff, and results are presented both in writing and directly to each resident. Early on, this gives feedback so adjustments can be made and progress assessed.

Emergency Department Coverage When a Resident is Not on Duty in ED

It is the expectation that all FPC patients presenting to the ED will be seen by a resident when a resident is assigned to duty in the ED. On other shifts, the senior resident on the Family Medicine service, who is also on-call for the clinic population, will see FPC patients instructed by him/her to come to the ED for evaluation except after midnight. In these instances, the resident will call the ED and notify the staff that a FPC patient will be arriving. Upon arrival of the patient, the FP resident will be notified by the ED staff and will see the patient in the ED. FPC patients who arrive unannounced to the ED without prior telephone triage by the FP resident on call for the clinic will be treated like all other ED visitors and may be seen by the ED staff without contacting the FP resident on call.