West Jefferson ED

WEST JEFFERSON PEDIATRIC ED & FASTTRACK

You are scheduled for West Jefferson ED: Pediatrics for the month:

Orientation: Contact Jana Burst in their GME office [email protected] (504) 349 – 1897 two weeks prior to starting if this is your first rotation at West Jefferson Medical Center to be oriented to the electronic medical records system prior to starting.

Schedule: Two weeks prior to starting, contact the director of the rotation, Dr. Foster [[email protected]] for your schedule. You will do 10-hour shifts, 12pm-10pm: Monday, Tuesday, Thursday, Friday, Saturday

Responsibilities: You will be responsible for the care of patients in the Pediatric ED.

Conference: Residents must attend conference and Journal Club.

Extras: A patient list must be maintained each day. Procedures must be recorded in New Innovations.

Supervision: You will be supervised by board certified Emergency Medicine physicians.

Evaluations: Monthly evaluations on New Innovations.

Meals: provided in the West Jefferson cafeteria and doctor’s lounge.

GOALS and OBJECTIVES

What follows are the goals and objectives for the WJ Pediatric ED rotation, that will range from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take place at the West Jeff Hospital in the ED where you will see pediatric patients. The year of training will typically include PGY 1 residents only.

The educational objectives of the West Jefferson Pediatric ED rotation are to:

1) Gain expertise in the recognition and management of pediatric emergencies.

2) Gain expertise in pediatric resuscitation, including Pediatric Advanced Life Support, emergent intubation, fluid administration, and drug dosages.

3) Become familiar with the management of non-emergent pediatric conditions which commonly present to the Emergency Department.

4) Gain expertise in the performance of routine procedures such as venipuncture and arterial puncture.

5) Become familiar with pediatric medication dosages.

The clinical and didactic experiences used to meet those objectives included daily patient care in the Pediatric ED, along with bedside teaching. The rotating resident is encouraged to attend lectures available at West Jefferson pertaining to the care of the pediatric patient. This rotation experience is part of the greater pediatric emergency medicine curriculum, also including PALS provider and instructor certification and weekly didactics (part of the overall didactic curriculum).

The feedback mechanisms and methods used to evaluate the performance of the resident include an end of rotation global evaluation. Immediate feedback may also be given to the resident, and any significant problems will be discussed during the rotation with the LSU EM administration.

The resources and facilities in the institution that will be available to each resident include computer access to Up To Date and the LSU Library services, including current texts in pediatrics and emergency medicine. There is a rent free, secure apartment available during the rotation for resident use. The residents will have access to the resources of the hospital including medical texts, medical records and cafeteria.

The clinical experiences, duties and responsibilities the resident will have on the rotation: Residents will act as a part of the Emergency Medicine team in a community pediatric hospital under the supervision of a staff physician. The residents will participate in the initial management of emergency department patients, to include pediatric trauma and general medical patients.

The relationship that will exist between emergency medicine residents and faculty on the service: The overall goals of resident education and patient care will govern the relationship between faculty and residents. Residents will receive 24 hour supervision while on the rotation. All patient care and medical charts will be reviewed and signed by the ED faculty prior to patient discharge.

Duty hours for this rotation will not exceed an average of 60hrs/week, and will include 1 in 7 days off.

This rotation summary has been reviewed and agreed to by the service director and LSU Program Director.

Community ED: Specific Competency-based Goals & Objectives, based on Level of Training: West Jefferson Medical Center Pediatrics ED

1. While in the community ED, the resident will demonstrate skill in “Data Gathering” that includes but not limited to: a. PGY1: Perform an appropriate focused history and physical exam (* PC, MK, ICS, PR) b. PGY2: Appropriate ordering and interpretation of ancillary tests (* PC, MK, SBP) c. PGY3: Gather essential and accurate information from all available sources (* PC, SBP) d. PGY4 Challenges assumptions. Able to establish rapport in order to obtain historical date in difficult situations. (* PC, IPC & PR)

2. While in the community ED, the resident will demonstrate skill in “Problem Solving” that includes but not limited to: a. PGY1: Generate an appropriate and complete differential diagnosis for an undifferentiated patient (* PC, MK) b. PGY2: Appropriate organization of data collection in relation to patient management decisions (* PC, MK, PBL) c. PGY3: Generate an expanded differential diagnosis including possible atypical presentations (* PC, MK, PBL) d. PGY4: Able to supervise and teach problem-solving skills to lower level residents. (* PC, MK, PBL)

3. While in the community ED, the resident will demonstrate skill in “Patient Management” that includes but not limited to: a. PGY1: Development of a basic treatment plan (* PC, MK, SBP) b. PGY2: Prompt recognition and appropriate emergency stabilization of the unstable patient (*PC, MK, SBP) c. PGY3: Institutes appropriate advanced treatment plans autonomously (* PC, MK, ICS, PR, SBP) d. PGY4 Multitasks, appropriately utilizes resources, facilitates patient flow. (* PC, MK, ICS, SBP)

4. While in the community ED, the resident will demonstrate skill in “Medical Knowledge” appropriate for level of training that includes but not limited to: a. PGY1: Demonstrates a basic fund of medical knowledge (*MK) b. PGY2: Understands the scientific basis for their decisions (*MK, PBL) c. PGY3: Demonstrates an advanced fund of medical knowledge (*MK) d. PGY4: Demonstrates an advanced fund of knowledge and challenges assumptions using problem-based learning techniques. (*MK, PBL)

5. While in the community ED, the resident will demonstrate technical proficiency in “Procedural Skills” consistent with level of training that includes but not limited to: a. PGY1: Suturing, lumbar puncture, splinting, I/D abscess (*PC) b. PGY2: Endotracheal intubation, central venous access, direction of medical and trauma resuscitation (*PC) c. PGY3: Conscious sedation, ultrasound, and direction of medical and trauma resuscitation (*PC) d. PGY4: As above, but also skilled in teaching procedures to lower level residents.

6. While in the community ED, the resident will demonstrate skill in “Efficiency” of care that includes but not limited to: a. PGY1: Effectively manages 1 patients per hour (*PC, MK, SBP) b. PGY2: Effectively manages 1.5 patients per hour (*PC, MK, SBP) c. PGY3: Effectively multi-tasks and adjusts to increased patient care demands as needed, with a goal of 2 patients per hour (*PC, MK, SBP) d. PGY4 Effectively multi-tasks and adjusts to increased patient care demands as needed, with a goal of >2 patients per hour (*PC, MK, SBP

7. While in the community ED, the resident will demonstrate appropriate “Interpersonal and Communication Skills” that includes but not limited to: a. PGY1: Demonstrates effective information exchange with patients, their families, and professional associates (*ICS, PR) b. PGY2: Demonstrates appropriate conflict resolution skills (*ICS, PR) c. PGY3: Works effectively with others as a leader (*ICS, PR) d. PGY4: Models and teaches leadership skills to lower level residents. (*ICS, PR) 8. While in the community ED, the resident will demonstrate appropriate “Professionalism” that includes but not limited to: a. PGY1: Introduces self to patient and/or family (*PR) b. PGY2: Respectful of patient’s privacy and confidentiality (*PR) c. PGY3: Demonstrates respect, compassion, and integrity, even under stressful situations (*PR) d. PGY4: Models and teaches professionalism skills to lower level residents. (*PR)

9. While in the community ED, the resident will demonstrates skills in proper “Documentation” that includes but not limited to: a. PGY1: Medical record is accurate, complete, timely, and appropriate (*PC, ICS) b. PGY2: Appropriately documents medical decision making (*PC, ICS) c. PGY3: Documents ED course including re-evaluation of patient if applicable (*PC, ICS) d. PGY4: Models and teaches verbal and written documentation skills to lower level residents. (*PC, ICS)

10. While in the community ED, the resident will demonstrates an understanding of a “Systems-Based Practice” that includes but not limited to: a. PGY1: Understands basic resources available for care of the emergency department patient in the community setting. (*SBP) b. PGY2: Utilizes the consultation process appropriately (*SBP, PC) c. PGY3: Provides appropriate medical command to pre-hospital providers (*SBP, PC) d. PGY4 Models and teaches system-based practice skills to lower level residents. (*SBP)

11. While in the community ED, the resident will demonstrate skills in “Practice Based Learning and Improvement” that includes but not limited to: a. PGY1: Uses appropriate information resources (ie, texts, online web sites, etc.) for care of patient (* PBL, PC) b. PGY2: Applies knowledge of scientific studies to patient care decisions (* PBL, PC) c. PGY3: Facilitates the learning of professional associates (* PBL, MK) d. PGY4: Models and teaches practice based learning and self-improvement skills to lower level residents. (*PBL) Director of the ED: Dr. Chugden ([email protected])

Schedule: If this is your first rotation at West Jefferson, report to the GME office (347- 5511) in the week prior to starting rotation to obtain ID, parking info and electronic medical record access and orientation. Contact the director of the rotation, Dr. Mayer [[email protected]] 2-3 weeks prior to your rotation to submit a schedule. All shifts must be covered, unless a resident is scheduled to be on Vacation that month. Each resident will be assigned 15-16 shifts a month; 12noon to 12midnight. No more than one resident per shift. Send a copy of your schedule to Kathy Whittington.

Responsibilities: You will be responsible for the care of individual patients in the ED.

Conference: You must attend conference and journal club.

Extras: A patient list must be maintained each day. Procedures must be recorded in New Innovations.

Supervision: You will be supervised by board certified Emergency Medicine physicians.

Evaluations: Monthly evaluations via New Innovations.

Meals: provided in the West Jefferson cafeteria and doctor’s lounge.

West Jefferson Medical Center Emergency Department Rotation

GOALS and OBJECTIVES

The following are the goals and objectives for the West Jefferson ED rotation, that will range from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take place at the West Jefferson ED. The year of training may include PGY 1-5.

The educational goals and objectives for the West Jefferson ED rotation are to provide residents with an opportunity to experience and learn about the initial evaluation and management of emergency patients in the community setting as well as the following:

1. Prehospital emergency medical services

2. Multicasualty incidents and disasters

3. Legal aspects of emergency care 4. Emergency procedures

5. Emergency department consultation

6. Billing

The clinical and didactic experiences used to meet those objectives included daily patient care in the West Jefferson ED, along with bedside teaching. This rotation experience is part of the greater emergency medicine curriculum, also including PALS/ACLS/ATLS provider and instructor certification and weekly didactics (part of the overall didactic curriculum).

The feedback mechanisms and methods used to evaluate the performance of the resident include an end of rotation global evaluation. Immediate feedback may also be given to the resident, and any significant problems will be discussed during the rotation with the LSU EM administration.

The resources and facilities in the institution that will be available to each resident include computer access to Up To Date and the LSU Library services, including current texts in emergency medicine. The residents will have access to the resources of the hospital including medical texts, medical records, doctor’s lounge and cafeteria.

The clinical experiences, duties and responsibilities the resident will have on the rotation: Residents will act as a part of the Emergency Medicine team in a community hospital under the supervision of a staff physician. The residents will participate in the initial management of emergency department patients, to include trauma, psychiatric, obgyn, pediatric and general medical patients.

The relationship that will exist between emergency medicine residents and faculty on the service: The overall goals of resident education and patient care will govern the relationship between faculty and residents. Residents will receive 24 hour supervision while on the rotation. All patient care and medical charts will be reviewed and signed by the ED faculty prior to patient discharge.

Duty hours for this rotation will not exceed an average of 60hrs/week, and will include 1 in 7 days off.

This rotation summary has been reviewed and agreed to by the service director and LSU Program Director.

Community ED: Specific Competency-based Goals & Objectives, based on Level of Training: PGY1-4 1. While in the community ED, the resident will demonstrate skill in “Data Gathering” that includes but not limited to: a. PGY1: Perform an appropriate focused history and physical exam (* PC, MK, ICS, PR) b. PGY2: Appropriate ordering and interpretation of ancillary tests (* PC, MK, SBP) c. PGY3: Gather essential and accurate information from all available sources (* PC, SBP) d. PGY4 Challenges assumptions. Able to establish rapport in order to obtain historical date in difficult situations. (* PC, IPC & PR)

2. While in the community ED, the resident will demonstrate skill in “Problem Solving” that includes but not limited to: a. PGY1: Generate an appropriate and complete differential diagnosis for an undifferentiated patient (* PC, MK) b. PGY2: Appropriate organization of data collection in relation to patient management decisions (* PC, MK, PBL) c. PGY3: Generate an expanded differential diagnosis including possible atypical presentations (* PC, MK, PBL) d. PGY4: Able to supervise and teach problem-solving skills to lower level residents. (* PC, MK, PBL)

3. While in the community ED, the resident will demonstrate skill in “Patient Management” that includes but not limited to: a. PGY1: Development of a basic treatment plan (* PC, MK, SBP) b. PGY2: Prompt recognition and appropriate emergency stabilization of the unstable patient (*PC, MK, SBP) c. PGY3: Institutes appropriate advanced treatment plans autonomously (* PC, MK, ICS, PR, SBP) d. PGY4 Multitasks, appropriately utilizes resources, facilitates patient flow. (* PC, MK, ICS, SBP)

4. While in the community ED, the resident will demonstrate skill in “Medical Knowledge” appropriate for level of training that includes but not limited to: a. PGY1: Demonstrates a basic fund of medical knowledge (*MK) b. PGY2: Understands the scientific basis for their decisions (*MK, PBL) c. PGY3: Demonstrates an advanced fund of medical knowledge (*MK) d. PGY4: Demonstrates an advanced fund of knowledge and challenges assumptions using problem-based learning techniques. (*MK, PBL)

5. While in the community ED, the resident will demonstrate technical proficiency in “Procedural Skills” consistent with level of training that includes but not limited to: a. PGY1: Suturing, lumbar puncture, splinting, I/D abscess (*PC) b. PGY2: Endotracheal intubation, central venous access, direction of medical and trauma resuscitation (*PC) c. PGY3: Conscious sedation, ultrasound, and direction of medical and trauma resuscitation (*PC) d. PGY4: As above, but also skilled in teaching procedures to lower level residents.

6. While in the community ED, the resident will demonstrate skill in “Efficiency” of care that includes but not limited to: a. PGY1: Effectively manages 1 patients per hour (*PC, MK, SBP) b. PGY2: Effectively manages 1.5 patients per hour (*PC, MK, SBP) c. PGY3: Effectively multi-tasks and adjusts to increased patient care demands as needed, with a goal of 2 patients per hour (*PC, MK, SBP) d. PGY4 Effectively multi-tasks and adjusts to increased patient care demands as needed, with a goal of >2 patients per hour (*PC, MK, SBP

7. While in the community ED, the resident will demonstrate appropriate “Interpersonal and Communication Skills” that includes but not limited to: a. PGY1: Demonstrates effective information exchange with patients, their families, and professional associates (*ICS, PR) b. PGY2: Demonstrates appropriate conflict resolution skills (*ICS, PR) c. PGY3: Works effectively with others as a leader (*ICS, PR) d. PGY4: Models and teaches leadership skills to lower level residents. (*ICS, PR)

8. While in the community ED, the resident will demonstrate appropriate “Professionalism” that includes but not limited to: a. PGY1: Introduces self to patient and/or family (*PR) b. PGY2: Respectful of patient’s privacy and confidentiality (*PR) c. PGY3: Demonstrates respect, compassion, and integrity, even under stressful situations (*PR) d. PGY4: Models and teaches professionalism skills to lower level residents. (*PR)

9. While in the community ED, the resident will demonstrates skills in proper “Documentation” that includes but not limited to: a. PGY1: Medical record is accurate, complete, timely, and appropriate (*PC, ICS) b. PGY2: Appropriately documents medical decision making (*PC, ICS) c. PGY3: Documents ED course including re-evaluation of patient if applicable (*PC, ICS) d. PGY4: Models and teaches verbal and written documentation skills to lower level residents. (*PC, ICS) 10. While in the community ED, the resident will demonstrates an understanding of a “Systems-Based Practice” that includes but not limited to: a. PGY1: Understands basic resources available for care of the emergency department patient in the community setting. (*SBP) b. PGY2: Utilizes the consultation process appropriately (*SBP, PC) c. PGY3: Provides appropriate medical command to pre-hospital providers (*SBP, PC) d. PGY4 Models and teaches system-based practice skills to lower level residents. (*SBP)

11. While in the community ED, the resident will demonstrate skills in “Practice Based Learning and Improvement” that includes but not limited to: a. PGY1: Uses appropriate information resources (ie, texts, online web sites, etc.) for care of patient (* PBL, PC) b. PGY2: Applies knowledge of scientific studies to patient care decisions (* PBL, PC) c. PGY3: Facilitates the learning of professional associates (* PBL, MK) d. PGY4: Models and teaches practice based learning and self-improvement skills to lower level residents. (*PBL)