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LSUHSC Emergency Medicine Residency Handbook 09-10 1

Revised February 10, 2009, M. Haydel, MD

LOUISIANA STATE UNIVERSITY HEALTH SCIENCE CENTER – NEW ORLEANS

EMERGENCY MEDICINE RESIDENCY PROGRAM

POLICIES TO SUPPLEMENT LSUHSC HOUSE OFFICER MANUAL & ROTATION GUIDE

“Prepared For the Worst ~ Providing the Best” LSUHSC Emergency Medicine Residency Handbook 09-10 2

TABLE OF CONTENTS LSU EM RESIDENCY MANUAL

INTRODUCTION...... 5 POLICIES – ACGME...... 6

ACGME CORE COMPETENCIES...... 6 Core Competencies Guidelines...... 6 CORE COMPETENCIES...... 6 Core Competencies & LSU EM...... 7 RESIDENT DUTY HOURS AND THE WORKING ENVIRONMENT...... 11 DUTY HOURS - EMERGENCY MEDICINE...... 13 POLICIES - LSUHSC...... 14

ETHICS CODE - LSUHSC EMERGENCY MEDICINE RESIDENCY...... 14 Code Of Professional Conduct...... 15 Honor Code...... 15 Grievance Policy - Academic...... 16 Ombudsman...... 20 MCLNO Quality of care statement...... 21 JOB DESCRIPTION - EM HOUSE OFFICER...... 22 House Officer I...... 22 House Officer II...... 22 House Officer III...... 23 House Officer IV...... 23 HOUSE OFFICER CONTRACT...... 24 COMPENSATION...... 25 INSURANCE...... 25 Health Plans...... 26 Disability Insurance...... 26 Medical Practice Liability Coverage...... 26 LEAVE:...... 26 Vacation Leave...... 26 Sick Leave...... 26 Maternity/Paternity Leave...... 26 Educational Leave...... 26 Military Leave...... 26 Leave of Absence...... 26 Family Leave...... 27 PAY SCALES - LSUHSC HOUSE OFFICER...... 31 EMERGENCY FUND FOR RESIDENTS...... 32 HOUSE OFFICER SELECTION AND ELIGIBILITY LSUHSC...... 33 CAMPUS ASSISTANCE PROGRAM...... 35 FITNESS FOR DUTY AND SUBSTANCE ABUSE POLICY...... 36 WORK RELATED INJURY/ILLNESS...... 38 DRESS CODE...... 39 LIBRARY - LSUHSC...... 48 WELLNESS CENTER...... 50 HOUSE STAFF CLEARANCE FORM...... 51 POLICIES – SECTION OF EM...... 53

MISSION STATEMENT...... 53 GOALS and OBJECTIVES...... 53 ROLE OF THE RESIDENCY IN THE EMERGENCY DEPARTMENT...... 54 EM RESIDENCY APPLICANTS...... 55 LSUHSC Emergency Medicine Residency Handbook 09-10 3

RESIDENCY PROMOTIONS...... 56 EMERGENCY MEDICINE YEAR END COMPETENCIES...... 57 PGY1 YEAR...... 57 PGY2 YEAR...... 58 PGY3 YEAR...... 59 PGY4 YEAR...... 60 LIAISON & OVERSIGHT POLICY...... 61 DISMISSAL POLICY...... 62 SATISFACTORY ACADEMIC STANDING...... 67 EVALUATIONS...... 68 Monthly evaluation of Residents by Faculty...... 69 Annual evaluation of Faculty by Residents...... 71 Evaluation of Rotations by Residents...... 72 Evaluation of Program by Residents...... 73 6 month Evaluation of each Resident by Advisor...... 74 Yearly Eval and Final Exit Evaluation of Resident by Program Director...... 75 FACULTY ADVISORS...... 82 Evaluation of Resident Documents Policy...... 82 PROCEDURE AND PATIENT EXPERIENCE DOCUMENTATION...... 83 Procedures And Resuscitations...... 83 Ultrasound...... 84 Follow-Up Log...... 86 RESIDENCY PARTNER...... 87 EDUCATIONAL STIPEND...... 88 TRAVEL FORMS...... 89 MAILBOXES/ EMAIL...... 90 BEEPERS...... 91 VACATION...... 92 YEARLY SCHEDULE REQUESTS...... 92 ED SCHEDULES...... 93 DISASTER CALL...... 94 Disaster Call Scheduling...... 95 Disaster Call & Duty Hours...... 96 CODE GREY – HURRICANE GUIDELINES...... 97 ADVANCED LIFE SUPPORT PROGRAMS POLICY...... 100 MOONLIGHTING POLICY...... 102 CALL ROOM...... 103 SICK LEAVE...... 104 CONFERENCE ATTENDANCE POLICY...... 105 MONTHLY CORD EXAM...... 106 Journal Club Literature Critique Form...... 109 M & M PRESENTATIONS...... 110 MEDICAL RECORDS...... 112 Electronic Signature...... 112 LSU EM READING TOPICS 2008-09...... 113 RESEARCH REQUIREMENT...... 116 RESIDENT'S RESEARCH PROPOSAL AND PROGRESS FORM...... 117 CHIEF RESIDENT RESPONSIBILITIES...... 118 CHIEF RESIDENT QUESTIONNAIRE...... 118 RESIDENCY CURRICULUM...... 119 Model For Emergency Medicine...... 119 REFERENCE BOOK LOAN-OUT POLICY...... 120 MEDICAL LICENSE...... 121 State Licensure...... 122 DEA number...... 122 NPI number...... 122 LSUHSC Emergency Medicine Residency Handbook 09-10 4

Notary...... 122 GUIDELINES TO ROTATIONS/GOALS & OBJECTIVES...... 124 UH/ MCLANO Emergency Department...... 125 EMS Guidelines: NOHD...... 125 ANESTHESIA...... 132 CHABERT Medicine Wards...... 134 CHILDREN’S HOSPITAL...... 137 MICU...... 140 OBSTERICS...... 143 OCHSNER ED...... 149 SLIDELL ED...... 153 TOXICOLOGY...... 156 TRAUMA SURGERY...... 160 WEST JEFFERSON ED...... 163 ELECTIVE...... 167 LSUHSC Emergency Medicine Residency Handbook 09-10 5

INTRODUCTION

Welcome to the LSU Emergency Medicine Residency Program. This LSU EM Policies To Supplement LSUHSC House Officer Manual & Rotation Guide is meant to augment the LSUHSC School of Medicine, Office of Graduate Medical Education, House Officer Manual. The House Officer Manual is updated each year and is available on the LSUSHC website at: http://www.medschool.lsuhsc.edu/medical_education/graduate/HouseOfficerManual.asp

A hard copy of this manual is available in the emergency medicine offices and online at the LSU EM yahoo website. http://health.groups.yahoo.com/group/LSUEM/ LSUHSC Emergency Medicine Residency Handbook 09-10 6

POLICIES – ACGME

ACGME Core Competencies

Core Competencies Guidelines (ACGME 2007)

Core Competencies

The following are the 6 Core Competencies for ACGME accreditation purposes.

1. Patient Care 2. Medical Knowledge 3. Practice Based Learning 4. Interpersonal & Communication Skills 5. Professionalism 6. Systems Based Practice

Annual Competency Assessment – The programs must define competencies that are expected for each year of training taking into account the defined ACGME core competencies. Multiple tools may be used to evaluate these competencies. Competency evaluation of chief complaints, procedures, resuscitations and off-service rotations will be used as part of the annual competency evaluation.

Chief Complaint Competency - The RRC expects that programs will assess the competency of residents to handle key chief complaints in emergency medicine. At the time of program review, the program will demonstrate how it assesses resident competency for 3 chief complaints over the course of the training program. The program can use a variety of tools including direct observation, check-lists, simulations, etc.

Procedural Competency – The primary responsibility for the determination of procedural competency rests with the program director and the faculty. The RRC accredits programs, and does not certify or credential individuals.

The RRC expects programs to assess the competency of residents to perform key index procedures. At the time of program review, the program will need to demonstrate how it assesses competency of residents for 3 procedures.

Selected index procedures should consequentially impact patient care, and ideally facilitate competency assessment initiatives across disciplines.

One of the selected procedures must be ED bedside ultrasound (PR V.B.2.b; appendix 1)

Resuscitation Competency – The RRC expects programs to assess resident competency in the LSUHSC Emergency Medicine Residency Handbook 09-10 7

resuscitation of critical patients. These include adult and pediatric medical and trauma resuscitations. At the time of program review, the program will demonstrate how it assesses competency in one type of resuscitation. The program may use a variety of techniques including simulations and direct observations.

Off-Service Rotations – The program should define measurable competency objectives for off- service rotations, how the objectives are assessed and remediated when necessary. At the time of program review, it is expected that measurable objectives and the tools used for evaluation will be available for half of the off-service rotations.

Core Competencies & LSU EM The residency program must require that its residents obtain competence in the six areas listed below to the level expected of a new practitioner. Programs must cite examples how these competencies are taught and evaluated within the training program.

1. Patient Care: Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health.

Among other things, residents are expected to:

a. Gather accurate, essential information in a timely manner. b. Generate an appropriate differential diagnosis. c. Implement an effective patient management plan. d. Competently perform the diagnostic and therapeutic procedures and emergency stabilization. e. Prioritize and stabilize multiple patients and perform other responsibilities simultaneously. f. Provide health care services aimed at preventing health problems or maintaining health. g. Work with health care professionals to provide patient-focused care.

Residency Experience: each clinical rotation and every off site ED rotation, didactic/lecture sessions, skill labs, simulation labs, US, Tox, all orientations, teaching ACLS/PALS/ATLS and freshman anatomy labs.

Residency Assessments: Direct observation and documentation of Daily, Monthly and Yearly evaluations, simulation cases, oral board cases, Morbidity and Mortality cases 360 evaluations.

2. Medical Knowledge: Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care.

Among other things, residents are expected to: LSUHSC Emergency Medicine Residency Handbook 09-10 8

a. Identify life threatening conditions, the most likely diagnosis, synthesize acquired patient data, and identify how and when to access current medical information. b. Properly sequence critical actions for patient care and generate a differential diagnosis for an undifferentiated patient. c. Complete disposition of patients using available resources. Residency Experience: each clinical rotation, every off site ED rotation, didactic/lecture sessions, skill labs, simulation labs, US, Tox, all orientations, teaching ACLS/PALS/ATLS and freshman anatomy labs. Residency Assessments: National In-service Exam, Quarterly local in-service exams, Quarterly question sets, Daily, Monthly and Yearly evaluations, 360 evaluations, oral board cases, simulation cases and journal club.

3. Practice-Based Learning: Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence and improve their patient care practices.

Among other things, residents are expected to:

a. Analyze and assess their practice experience and perform practice-based improvement. b. Locate, appraise and utilize scientific evidence related to their patient’s health problems. c. Apply knowledge of study design and statistical methods to critically appraise the medical literature. d. Utilize information technology to enhance their education and improve patient care. e. Facilitate the learning of students and other health care professionals.

Residency Experience: each clinical rotation, every off site ED rotation, didactic/lecture sessions, skill labs, simulation labs, US, Tox, all orientations, journal club, teaching ACLS/PALS/ATLS and freshman anatomy labs.

Residency Assessments: Daily, Monthly and Yearly evaluation, 360 evaluations, oral board cases, simulation cases, journal club, Trauma Conference, Toxicology rotation, RSI forms, End of Year evaluations and Ultrasound QA.

4. Interpersonal and Communication Skills: Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their families and professional associates.

Among other things, residents are expected to:

a. Develop an effective therapeutic relationship with patients and their families, with respect for diversity and cultural, ethnic, spiritual. Emotional and age-specific differences. b. Demonstrate effective participation in and leadership of the health care team. c. Develop effective written communication skills. d. Demonstrate the ability to handle situations unique to the practice of emergency medicine. LSUHSC Emergency Medicine Residency Handbook 09-10 9

e. Effectively communicate with out-of-hospital personnel as well as non-medical personnel.

Residency Experience: each clinical rotation, every off site ED rotation, didactic/lecture sessions, skill labs, simulation labs, US, Tox, all orientations, bedside teaching, teaching ACLS/PALS/ATLS and teaching freshman anatomy labs.

Residency Assessments: Daily, Monthly, Yearly evaluation, 360 evaluations, oral board cases and simulation cases.

5. Professionalism: Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population.

Residents are expected to demonstrate a set of model behaviors that include but are not limited to:

a. Treats patients/family/staff/paraprofessional personnel with respect. b. Protects staff/family/patient’s interests/confidentiality. c. Demonstrates sensitivity to patient’s pain, emotional state and gender/ethnicity issues. d. Able to discuss death honestly, sensitivity, patiently and compassionately. e. Unconditional positive regard for the patient, family, staff and consultants. f. Accepts responsibility/accountability. g. Openness and responsiveness to the comments of other team members, patients, families and peers.

Residency Experience: each clinical rotation, every off site ED rotation, didactic/lecture sessions, skill labs, simulation labs, US, Tox, all orientations, death notification, cultural competency, pain management, conflict resolution, AMA, teaching ACLS, PALS and ATLS.

Residency Assessments: Daily, Monthly, yearly evaluations, 360 evaluations, oral board cases and simulation cases.

6. Systems-Based Practice: Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

Among other things, residents are expected to:

a. Understand access, appropriately utilize and evaluate the effectiveness of the resources, providers and systems necessary to provide optimal emergency care. b. Understand different medical practice models and delivery systems and how to best utilize them to care of the individual patient. c. Practice cost-effective health care and resource allocation that does not compromise quality of care. d. Advocate for facilitates patients’ advancement through the health care system. LSUHSC Emergency Medicine Residency Handbook 09-10 10

Residency Experience: each clinical rotation, every off site ED rotation, didactic/lecture sessions, skill labs, simulation labs, US, Tox, all orientations, Disaster Drills, Hazmat, EMS, chart/EMS run report reviews, patient follow ups and CQI project (RSI sheets, radiology call backs and M & M)

Residency Assessments: Daily, Monthly, Yearly evaluations, 360 evaluations, oral board cases, simulation cases, Toxicology rotation, M & M and interesting case conference LSUHSC Emergency Medicine Residency Handbook 09-10 11

Resident Duty Hours and the Working Environment (update ACGME 2003)

Providing residents with a sound academic and clinical education must be carefully planned and balanced with concerns for patient safety and resident well-being. Each program must ensure that the learning objectives of the program are not compromised by excessive reliance on residents to fulfill service obligations. Didactic and clinical education must have priority in the allotment of residents’ time and energies. Duty hour assignments must recognize that faculty and residents collectively have responsibility for the safety and welfare of patients. 1. Supervision of Residents a. All patient care must be supervised by qualified faculty. The program director must ensure, direct, and document adequate supervision of residents at all times. Residents must be provided with rapid, reliable systems for communicating with supervising faculty b. Faculty schedules must be structured to provide residents with continuous supervision and consultation. c. Faculty and residents must be educated to recognize the signs of fatigue and adopt and apply policies to prevent and counteract the potential negative effects. 2. Duty Hours a. Duty hours are defined as all clinical and academic activities related to the residency program, ie, patient care (both inpatient and outpatient), administrative duties related to patient care, the provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences. Duty hours do not include reading and preparation time spent away from the duty site. b. Duty hours must be limited to 80 hours per week, averaged over a four-week period, inclusive of all in-house call activities. c. Residents must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call. One day is defined as one continuous 24-hour period free from all clinical, educational, and administrative activities. d. Adequate time for rest and personal activities must be provided. This should consist of a 10 hour time period provided between all daily duty periods and after in-house call. 3. On-Call Activities The objective of on-call activities is to provide residents with continuity of patient care experiences throughout a 24-hour period. In-house call is defined as those duty hours beyond the normal work day when residents are required to be immediately available in the assigned institution. a. In-house call must occur no more frequently than every third night, averaged over a four-week period. b. Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to six additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care as defined in Specialty and Subspecialty Program Requirements. LSUHSC Emergency Medicine Residency Handbook 09-10 12

c. No new patients, as defined in Specialty and Subspecialty Program Requirements, may be accepted after 24 hours of continuous duty. d. At-home call (pager call) is defined as call taken from outside the assigned institution. 1. The frequency of at-home call is not subject to the every third night limitation. However, at-home call must not be so frequent as to preclude rest and reasonable personal time for each resident. Residents taking at-home call must be provided with 1 day in 7 completely free from all educational and clinical responsibilities, averaged over a 4-week period. 2. When residents are called into the hospital from home, the hours residents spend in-house are counted toward the 80-hour limit. 3. The program director and the faculty must monitor the demands of at-home call in their programs and make scheduling adjustments as necessary to mitigate excessive service demands and/or fatigue. 4. Moonlighting a. Because residency education is a full-time endeavor, the program director must ensure that moonlighting does not interfere with the ability of the resident to achieve the goals and objectives of the educational program. b. The program director must comply with the sponsoring institution’s written policies and procedures regarding moonlighting, in compliance with the Institutional Requirements III. D.1.k. c. Moonlighting that occurs within the residency program and/or the sponsoring institution or the non-hospital sponsor’s primary clinical site(s), ie, internal moonlighting, must be counted toward the 80-hour weekly limit on duty hours. 5. Oversight a. Each program must have written policies and procedures consistent with the Institutional and Program Requirements for resident duty hours and the working environment. These policies must be distributed to the residents and the faculty. Monitoring of duty hours is required with frequency sufficient to ensure an appropriate balance between education and service. b. Back-up support systems must be provided when patient care responsibilities are unusually difficult or prolonged, or if unexpected circumstances create resident fatigue sufficient to jeopardize patient care. 6. Duty Hours Exception An RRC may grant exceptions for up to 10 % of the 80-hour limit, to individual programs based on a sound educational rationale. However, prior permission of the institution’s GMEC is required. h:teamstoll\acgme\dutyhourslanguage.wpd February 24, 2003 LSUHSC Emergency Medicine Residency Handbook 09-10 13

Duty Hours - Emergency Medicine Update April, 2004 ACGME

The common duty hour standards include these provisions: • An 80-hour weekly limit, averaged over four weeks. • An adequate rest period, which should consist of 10 hours of rest between duty periods. • A 24-hour limit on continuous duty, with up to six added hours for continuity of care and education. • One day in seven free from patient care and educational obligations, averaged over four weeks. • In-house call no more than once every three nights, averaged over four weeks. • Programs can request an increase of up to 8 hours in the weekly hours, if this benefits resident education and is approved by the sponsoring institution and the ACGME residency review committee for the particular specialty.

Duty Hours on Emergency Medicine Rotations

“There must at least an equivalent period of continuous time off between scheduled work periods. Residents may attend educational activities between work periods, but at some point in the 24 hour period must have an equivalent period of continuous time off between the end of one activity (work or educational) and the start of another activity (work or educational).” ACGME 2007

As a minimum, residents shall be allowed 1 full day in 7 days away from the institution and free of any clinical or academic responsibilities. While on duty in the emergency department, residents may not work longer than 12 continuous hours providing direct patient care. There must be at least 10 hours off between scheduled work periods. The residents should not work more than 60 scheduled hours per week seeing patients in the emergency department and no more than 72 duty hours per week including residency related activities. LSUHSC Emergency Medicine Residency Handbook 09-10 14

POLICIES - LSUHSC

Ethics Code - LSUHSC Emergency Medicine Residency

I agree to abide by the moral standards and ethical behavior deemed suitable for a training physician in emergency medicine. I will not copy or relay exam materials for other's benefit. I will present all patient cases and patient exams in a truthful manner, to the best of my knowledge and capabilities. I will not condone patient, student, or House Officer abuse or degradation.

I have reviewed with the Residency Director, the LSU Emergency Medicine Residency Program Policy Manual and I understand its contents.

______NAME (Print clearly)

______DATE

______Signature LSUHSC Emergency Medicine Residency Handbook 09-10 15

Code Of Professional Conduct

The residents and faculty of the section of emergency medicine are expected to maintain the level of professionalism dictated by the School of Medicine's Code of Professional Conduct.

PREAMBLE

The academic community of the School of Medicine is committed to maintaining an environment of open and honest intellectual inquiry. Faculty, residents, and students have the right to enjoy an educational environment characterized by the highest standards of ethical professional conduct. The individuals who comprise the LSUMC campus come from many different cultural backgrounds. Discriminatory comments or actions relative to gender, sexual orientation, racial origin, creed, age, physical or mental status can interfere with an individual's performance and create an intimidating, hostile, and offensive educational and work environment. Individuals who manifest such unprofessional behavior in any of these areas are disruptive and in violation of the School of Medicine's Code of Professional Conduct and of LSU Medical Center Policy. Report of such conduct will be reviewed by the Council on Professional Conduct according to the "Rules of Procedure" set forth in the Code.

The students, residents, and faculty share the responsibility, to themselves and to their colleagues, to protect their individual rights and those of the academic community as a whole. To this end, and to ensure the rights of due process to members of the academic community, the students, residents, and faculty of the School of Medicine have adopted this Code of Professional Conduct. This Code governs questions of professional conduct, including but not limited to, dishonest, disruptive, discriminatory, and illegal activities. Penalty for such misconduct could lead to dismissal from the LSU School of Medicine.

Honor Code

On my honor, I will uphold the ideals of the medical profession and protect the name of the LSU School of Medicine for the duration of my career. Continuing its tradition of excellence, I vow to leave the school better than it was left to me and expect others to do the same.

Mission Statement Through an Honor Code, the students of the LSU School of Medicine affirm their adherence to several basic principles. As students at an institution of professional education and members of the medical community, we seek to promote a mutual trust and honor between faculty, students, and staff. As future physicians, we must maintain our educational pursuit at a level consistent with the integrity of our chosen profession. We believe that ethics, social responsibility, and academic integrity are an essential part of our experience as medical students in a diverse community that encompasses a wealth of people and their experiences. Violation of these basic principles will be considered an Honor Offense. An Honor Offense is not limited to, but includes:

1. Dishonesty on an examination or assignment through the use of outside materials; receiving or giving unauthorized aid on an examination or assignment 2. Plagiarism 3. Theft of property, either intellectual or physical LSUHSC Emergency Medicine Residency Handbook 09-10 16

4. Conduct deliberately hindering the education of other students 5. Illegal, unprofessional, or inappropriate behavior when representing the LSU School of Medicine at outlying facilities or on the campus of LSUHSC

Any offense of the Honor Code can be reported to the Committee on Professional Conduct by faculty, students, or staff. The Committee on Professional Conduct is composed of students and faculty members of the School of Medicine. Failure to report a potential offense, while in itself not an Honor Offense, violates the spirit of the system. Report of such offenses will be reviewed by the Council on Professional Conduct according to the "Rules on Procedure" set forth in the Code of Professional Conduct. Recommendations made by the Committee on Professional Conduct range from a formal apology to dismissal from the School of Medicine. Each student will be required to read and sign a copy of the Honor Code at the beginning of the academic year prior to the completion of registration.

The Pledge

The pledge, to be signed by students on all examinations and assignments, is as follows:

I pledge, on my honor, as a member of the medical community, to uphold the Honor Code of the LSU School of Medicine.

Confidentiality

Every effort will be made to maintain the confidentiality of all parties involved in an investigation and/or trial of an Honor Code offense. Anyone found to be in violation of confidentiality shall themselves be brought before the Committee and tried accordingly.

Amendments This document can be amended by a two-thirds vote of the Student Government Association and a majority vote of the Student body.

Grievance Policy - Academic

Questions of academic grievances are addressed through procedures established specifically for that purpose.

Resolving allegations of unethical professional conduct: rules of procedure

1. Composition of the Council on Professional Conduct.

Initial review of an allegation of unethical professional conduct is the responsibility of the Council on Professional Conduct This Council consists of twenty-seven active Representatives. The Student Body is represented by twelve Council Representatives; each class elects three Representatives from its general membership. The Faculty is represented by five Representatives from the Basic Science Departments and five Representatives from the Clinical Science Departments, elected by the Faculty Assembly from the general full-time faculty, Resident representatives are recommended by the Chairman of each of the Departments of Medicine, OB-GYN, Psychiatry, Pediatrics and Surgery and appointed by the Dean of the School of Medicine. Chairmanship of the Council is shared by one student and one faculty Representative, elected by the twenty seven Council Representatives from their own members. In the event that a Co-Chairman is unable to serve, the vacancy shall be filled by an individual selected from the pool LSUHSC Emergency Medicine Residency Handbook 09-10 17

of remaining Committee Representatives by majority vote. The Council maintains its right to nominate additional members to the Council if the need arises.

Student Representatives are elected during regular class elections in October of their freshman year with expectation that their tenure is for duration of their enrollment in LSUMC's School of Medicine.

Resident Representatives are appointed for the duration of their residency.

Faculty Representatives are elected for an indeterminate number of years.

2 Filing a Complaint: a. Initiation of Complaint.

A student (with or without the input of the Student Advocacy Group), resident, or faculty member may initiate a complaint of unethical professional conduct against a student or resident by submitting an allegation in writing to any member of the Council on Professional Conduct, including a Co-Chairman. The written statement must include a description of the circumstances that gave rise to the charges and must be signed by the author(s).

If the written allegation is submitted to a Council member who is not a CoChairman, the Council member shall deliver the allegation to a Co-Chairman of the Council, who in turn shall arrange for investigation of the facts and circumstances of the cases. b. Deadline for Filing a Complaint

A complaint by a student (with or without the input of the Student Advocacy Group), resident, or faculty member alleging-unethical professional conduct by a student or resident must be submitted in writing to a Council member, including a Co-Chairman, within fifteen working days of the alleged unethical professional conduct. c. Confidentiality of Person Initiating Complaint

Because of the gravity of any allegation of unethical professional conduct, the identity of the author of a complaint shall be held in confidence throughout the investigation; however, a witness's identity may become known during a final hearing. d. Interim grade

If a complaint of cheating is filed against a student or resident, that student or resident shall be assigned a grade of "incomplete" for the work in question during the investigation of the complaint. A student or resident subsequently found innocent of the complaint will be evaluated for a final grade on the basis of his/her performance.

3. Investigation of Complaint and Determination of Sufficient Cause:

A written allegation of unethical professional conduct is submitted to a Council member, or to one of the Co- Chairmen. The Co-Chairman shall arrange for a preliminary investigation. One faculty Representative to the Council is selected by the Co-Chairmen of the Council to assist in the preliminary investigation. In the case of an allegation against a student, the President of the Student Body will act as primary Fact Finder. In the case of an allegation against a resident, a Fact Finder will be appointed from among the LSU residents at large.

Investigation of an allegation of unethical professional conduct is conducted in confidence. The purpose of the investigation is to determine all possible evidence, both tangible and testimonial, that bears on the allegation of unethical professional conduct. Inquiries by the Student Body President or Resident Representative (i.e. the Fact Finder) and the faculty Representative are strictly confidential, as is the information amassed during the course of the investigation, and the identity of the person who submits the complaint. LSUHSC Emergency Medicine Residency Handbook 09-10 18

The period of investigation is limited to five working days. During the period allotted for the investigation, the Co- Chairmen of the Council select three members of the Council to serve as an ad hoc panel for determination of sufficient cause for convening a formal hearing of the Council. The members of the ad hoc panel are excluded from further deliberations on that particular case.

The Fact Finder presents the results of the investigation to the ad hoc panel. If the panel determines that there is sufficient cause for convening the Council, a formal hearing of the Council is scheduled. If the panel determines that there is insufficient cause for convening the Council, all charges are dismissed and all proceedings cease immediately. Although the circumstances constituting sufficient cause necessarily will vary from case to case, the statement of one person, with no other corroborating witness or corroborating tangible evidence, shall not be considered sufficient cause.

If the ad hoc panel makes a preliminary determination of sufficient cause, the panel shall formulate the formal charges against the accused in writing, and shall set forth the witnesses to be called and the tangible evidence to be presented against or for the accused. The identity of any person filing an allegation shall remain confidential, although such person shall be listed as a witness.

The Fact Finder shall present the case to the Council. Presentation of the case includes introducing tangible evidence and calling witnesses against or for the accused.

4 Formal Hearing: Council on Professional Conduct a. Notification to Council and Parties.

The Co-Chairmen of the Council shall give written notification to the Council members, the accused, and the Fact Finder: 1) the determination of a possible breach of ethical professional conduct, and 2) the designated time and place for the formal hearing of the case. This notification, together with the formal charge and a list of the witnesses and evidence in support of the charge, must be distributed to' the above-named persons within two days of the determination of sufficient cause. The Fact Finder shall notify the named witnesses of the designated time and place for the formal hearing. b. Hearing Procedure.

The hearing by the Council shall be conducted within five working days after the accused receives written notice of the formal charge against him/her. An extension of up to five working days may be requested by the accused under special circumstances; granting this request is within the discretion of the Co-Chairmen of the Council. In any event, the hearing must be convened within ten working days of written notification to the accused. Persons who must be Present for the formal Council hearing include: eight participating members of the Council (four faculty members and four additional Council members chosen from students and/or residents, reflecting those involved in the case), the designated witnesses against the accused, and the Fact Finder. The accused may present additional witnesses or other evidence in his or her behalf. The accused has the option of being accompanied during the hearing by any one member of the Medical Center community. This person accompanying the accused may be present as an advisor but may not address the Council. Each witness will be present only during the time devoted to his or her own testimony. The evidence and personal testimony supporting the allegations are presented to the Council by or at the request and direction of the Fact Finder. Thereafter, the accused presents his or her own defense and offers testimony of persons who support his or her defense. During the presentation of evidence and personal testimony, members of the Council may ask questions at any time. Following the presentation of evidence and personal testimony, the Fact Finder followed by the accused may summarize their positions orally; these final presentations are not interrupted by questioning.

The Co-Chairmen shall control the proceedings and are charged with conducting a hearing that is both thorough and fair for all parties. The Co-Chairmen may limit duplicative testimony. The hearing is intended to allow informal but complete presentation of all relevant information. LSUHSC Emergency Medicine Residency Handbook 09-10 19

The proceedings of the Council are confidential. An appointed secretary shall take and transcribe written notes of the proceedings, which are maintained in confidence by the Co-Chairmen. No tape recorders are permitted at any hearing of the Council. c.Recommendation of the Council.

Following the presentation of all evidence and testimony, the Council shall deliberate privately and determine, within two working days, the recommendation to be submitted to the Dean of the School of Medicine. The Co- Chairmen of the Council shall submit the written recommendation of the Council, the basis for its recommendation, and a transcript of the notes of the proceedings, to the Dean and the accused within two working days of the Council's decision as to a recommendation.

Any member of the Council who dissents from the recommendation of the Council may submit the reasons for his or her dissent in writing at the time that the recommendation of the Council is submitted to the Dean and the accused.

5.Initial decision: Dean. School of Medicine

The Dean must act upon the recommendation of the Council within five working days of receiving the recommendation. The Dean may accept or reject the recommendation of the Council, in whole or in part, or may remand the matter to the Council for further fact-finding, including additional testimony if appropriate. If additional fact-finding is requested by the Dean, such fact-finding, including additional testimony, shall be taken and a recommendation issued in accordance with procedures and time limits previously set forth.

The decision of the Dean must be communicated promptly to the accused and the Co-Chairmen of the Council.

6.Appeal: Appeals Committee a. Notification of Appeal

The accused may appeal the decision of the Dean of the School of Medicine as a matter of right. If the accused wishes to appeal, he or she must notify the Dean of his or her request for appellate review within five working days of receiving the decision of the Dean of the School of Medicine. The Dean must convene the Appeals Committee within five working days of receiving the request for appellate review. b. Composition of Appeals Committee

Appellate review of the Dean's initial decision is the responsibility of the Appeals Committee. This Committee consists of sic members. In the case of an appeal arising from an allegation against a medical student the Student Body is represented by the presidents of the sophomore, junior, and senior classes. In the case of an appeal arising from an allegation against a resident, he or she will be represented be three residents chosen at large by the Council. The Faculty is represented by one Representative chosen by the party asserting the appeal, one Representative chosen by the Dean of the School of Medicine, and one Representative chosen by the five members designated above. This sixth member is the Chairman of the Appeals Committee. c. Appeal Procedure.

The task of the Appeals Committee is to review the initial decision of the Dean on the proceedings and recommendations of the Council of Professional Conduct. The Appeals Committee reviews the transcript of the Council proceedings and may hear further arguments by the parties. However, the Appeals Committee is prohibited from soliciting or considering any new evidence. Any new evidence would be referred to the Council on Professional Conduct. The proceedings of the Appeals Committee are confidential. Written notes of the proceedings are transcribed by an appointed secretary and are maintained in confidence by the Chairman. No tape recorders are permitted at any hearing of the Appeals Committee. LSUHSC Emergency Medicine Residency Handbook 09-10 20

d. Recommendation of the Appeals Committee.

After reviewing the transcript and hearing arguments, if appropriate, the Appeals Committee deliberates privately and determines, within two working days, the recommendation to be submitted to the Dean of the School of Medicine. The Chairman of the Committee shall submit the written recommendation of the Committee, the basis for its recommendation, and a transcript of the notes of the proceedings, to the Dean within two working days of the Committee's decision. A member of the Appeals Committee who dissents from the recommendation of the Committee may submit the reasons for his or her dissent in writing at the time the recommendation of the Committee is submitted to the Dean.

7. Final Disposition: Dean, School of Medicine

The Dean must render a decision within five working days of receiving the recommendation of the Appeals Committee. This decision must be communicated promptly to the accused, the Chairman of the Appeals Committee, and the Co-Chairmen of the Council on Professional Conduct. The disposition of the case by the Dean of the School of Medicine after appeal is final. If a student is exonerated of all charges, all written records of the proceedings of the Council on Professional Conduct and the Appeals Committee, if applicable, are destroyed. If a student is not exonerated of all charges, all written records of the proceedings of the Council and the Appeals Committee will be maintained in confidence by the Associate Dean for Student Affairs and Records for five years after final disposition of the case.

Ombudsman

The ombudsman for LSU house officers is Dr. Thomas Alchidiak. He is an unbiased liaison who will confidentially discuss any issues you have concerning academic grievances. His contact information is:

Thomas Alchediak, M.D. Director of Medical Staff Affairs and GME, MCLNO Cell: 504-669-6822 [email protected] LSUHSC Emergency Medicine Residency Handbook 09-10 21

MCLNO Quality of care statement

MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS The Medical Center of Louisiana at New Orleans

Employees and affiliates of the Medical Center of Louisiana at New Orleans (MCLNO) make a difference in the lives of thousands of patients on a daily basis. Each MCLNO employee, physician, student, contract worker, and volunteer is expected to provide quality patient care services in a safe, courteous, and professional manner.

If you identify any quality of care or safety issues please report them to management and/or administrative representatives so that they can be addressed immediately. I ask that you allow the MCLNO management and administrative staff the opportunity to address/resolve quality of care or safety issues within the organization, but you may also report your findings to the following agencies:

Louisiana State University Health Care Services Division (888) 652-7699 (toll free)

State of Louisiana Department of Health and Hospitals (866) 280-7737

Joint Commission (800) 994-6610 www.icaho.orq

Disciplinary actions will not be taken against employees, physicians, students, contract workers, and volunteers who report safety and/or quality of care concerns.

Dwayne Thomas Chief Executive Officer 2/28/2008 MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS. 2021 PERDIDO STREET. NEW ORLEANS, LOUISIANA 70112 PHONE: 504.903.3000. FAX: 504.903.2837. WWW.LSUHOSPITALS.ORG LSUHSC Emergency Medicine Residency Handbook 09-10 22

Job Description - EM house officer

. All house officers enrolled in the LSUHSC Emergency Medicine Residency training program function under the direct supervision of Emergency Medicine board certified faculty physicians. . Emergency Department attendings are ultimately responsible for supervision of the House Staff while they are performing clinical activities as part of their Graduate Medical Education.

House Officer I The intern will spend approximately 3 months at University/MCLANO ED, 1 month in Ochsner’s ED and one month in the Ped ED at West Jefferson during the first clinical year. The intern is expected to evaluate and manage patients presenting to the emergency department under the direct supervision of the emergency medicine (EM) faculty and senior resident. All patients should be discussed with the supervising physician and/or senior resident before any treatment or tests are ordered, unless patient care is in jeopardy. The intern should focus on the fundamentals of emergency care including performing a focused history and physical, and developing an appropriate differential diagnosis and basic treatment plan.

. Patient care and management within the Emergency Department include the following procedures with indirect faculty supervision or upper level resident supervision: venous and arterial blood sampling, venous cannulation, nasogastric tube placement, splinting of extremities, simple laceration repair, incision and drainage of subcutaneous abscess, foley catheterization, extremity anesthesia, local anesthesia, slit lamp operation, and supervision of medical students. . Additionally, first year house officers may perform and interpret waived tests which include vaginal wet preps, microscopic urinalysis, urine pregnancy tests, interpretation of stool for occult blood, and rapid Strep tests. . The following procedures may only be performed under direct faculty supervision: endotracheal intubation, tube thoracostomy, paracentesis, thoracentesis, central line placement, pulmonary artery catheterization, arthrocentesis of the knee, arthrocentesis of the shoulder/wrist/ankle, transthoracic pacing, transvenous pacing, electronic defibrillation, major trauma resuscitations, major medical resuscitations, relocation of joint dislocations, sexual assault exams, conscious sedation, vaginal deliveries, on line medical control, and cricothyroidotomy. . During their first year of training, house officers complete rotations in the emergency department, medicine wards, surgical wards, anesthesia, OBGYN, medical intensive care units, and community emergency departments.

House Officer II The resident will spend approximately 7 months in the emergency department at UH/MCLANO, 1 month at either West Jefferson or Ochsner and 1 month in the Peds ER at OLOL. The second year resident is expected to evaluate and manage patients presenting to the emergency department under the direct supervision of the emergency medicine faculty and/or senior resident. The second year resident will have more responsibility and autonomy in the ED after successful completion of their internship, and is expected to learn how to function as a charge resident. Second year residents will be able to initiate management and treatment decisions before their initial discussions with their supervising physicians. The second year resident is expected to manage multiple patients of varying different acuity levels thus learning appropriate organizational and patient flow skills. The second year resident is expected to recognize and stabilize unstable ED patients especially arriving by ambulance. They will also participate in the management of the airway on trauma, medical and pediatric code patients, and act as the team LSUHSC Emergency Medicine Residency Handbook 09-10 23

leader of trauma codes. The second year resident will be expected to provide appropriate on-line medical command for ground EMS units.

. At the House Officer II level, the resident functions as a junior charge resident. The resident continues to have primary patient care responsibilities of the House Officer I, but also assists the upper-level charge residents in the management and supervision of interns and medical students and leading rounds in the Emergency Department. . Responsibility for on-line medical control for local EMS services begins during the second year of training. . The following procedures may be performed with faculty supervision: rapid sequence induction and endotracheal intubation with sedatives and paralytic agents, conscious sedation, tube thoracostomy, cricothyroidotomy. . During their second year of training, house officers rotate in the ED and with EMS services as well as at Children’s Hospital in the pediatric ED.

House Officer III The resident will spend a approximately 7 months in the ED at UH/MCLANO, one month at either West Jefferson or Ochsner, and one month in the Pediatric ED at Children’s Hospital. Third year resident will have more responsibility and autonomy than the second year resident in patient care decision making. The resident is still responsible for involving the ED attending physician as early as possible during the patient’s care. The Third year resident is expected to supervise junior level housestaff and medical students rotating in the emergency department. The third year resident will be expected to provide appropriate on-line medical command for ground EMS units.

. Graded responsibilities increase in the third year of training. The resident continues to have primary patient care responsibilities, but assumes the role of the upper-level charge resident, in managing patient through-put in the ED. . The upper-level charge resident responsibilities include online medical control of ems, working knowledge of all patients in the ED, including those awaiting a bed in the Main ER, leading rounds, and supervising junior charge residents, interns and medical students in the ED. . Patient care and management within the Emergency Department to include all of the procedures granted to a House Officer Two including the supervision of lower level residents. . During their third year of training, house officers complete a rotation in MICU.

House Officer IV The resident will spend approximately 4 months in the ED at UH/MCLANO, one month at either West Jefferson or Ochsner, and one month in the Pediatric ED at OLOL. Fourth year residents will have more responsibility and autonomy management and patient flow in the emergency department. The resident is still responsible for involving the ED attending physician as early as possible during the patient’s care is expected to supervise junior level housestaff and medical students rotating in the emergency department. The fourth year resident will be expected to provide appropriate on-line medical command for ground EMS units. . Patient care and management within the Emergency Department to include all of the procedures granted to a House Officer Three including the supervision of lower level residents. During their second year of training, house officers complete rotations on toxicology, and the emergency department. . During the PGY4 year residents are strongly encouraged to commit their elective time to a focused area of expertise with a goal of developing a niche in the arena of Emergency Medicine. LSUHSC Emergency Medicine Residency Handbook 09-10 24

HOUSE OFFICER CONTRACT

2007-2008 HOUSE OFFICER AGREEMENT OF APPOINTMENT

BETWEEN (print or type name)

______AND

BOARD OF SUPERVISORS OF LOUISIANA STATE UNIVERSITY AND AGRICULTURAL AND MECHANICAL COLLEGE

(Hereinafter referred to as “University”), herein represented by Charles Hilton, M.D., Associate Dean of Academic Affairs, Louisiana State University School of Medicine in New Orleans, ______Head, Department of ______, Louisiana State University School of Medicine in New Orleans, and ______, Program Director of the ______Program in the Department of ______, Louisiana State University School of Medicine in New Orleans.

This Agreement of Appointment shall be for one training year effective (date) ______and ending (date) ______in the Program of ______through the Department of ______.

DEFINITIONS: For purposes of this Agreement of Appointment, the following terms shall have the meaning ascribed thereto unless otherwise clearly required by the context in which such term is used: House Officer – The term “House Officer” shall mean and include interns, residents and fellows. Program – The term “Program” shall mean a Resident and Fellow Training Program of University. Program Director – The term “Program Director” shall mean the University faculty physician who shall be appointed by University to assume and discharge responsibility for the administrative and supervisory services related to a Program for a Department at University, as set forth in this Agreement of Appointment. One or more Program Directors may be appointed with respect to each Program. HOUSE OFFICER RESPONSIBILITIES: (Department specific responsibilities may be appended to this document) House Officers are responsible for patient care, teaching, and scholarly activities as discussed at orientation, detailed in the House Officer Manual, and specified in Departmental Guidelines, which are available in House Officers’ Department’s Office. Specific daily responsibilities will be assigned to House Officers on the call schedule and in day-to-day work team meetings.

LSUHSC Emergency Medicine Residency Handbook 09-10 25

The position of House Officer involves a combination of supervised, progressively more complex and independent patient evaluation and management functions and formal educational activities. The Department on a regular basis will evaluate the competence of Officers and confidential records of the evaluations will be maintained as departmental property to which House Officers have access.

House Officers shall provide patient care commensurate with their level of advancement; competence and privileges, under the supervision of appropriately credentialed attending teaching staff. House Officers’ general obligations include:

 Providing safe, effective and compassionate patient care.  Documentation of care by appropriate and prompt maintenance of medical records, orders, and notes.  Developing and understanding of ethical, socioeconomic and medical/legal issues, and cost containment measures in the provision of patient care.  Participation in the educational activities of the training program and assumption of responsibility for teaching and supervising other residents and students.  Participation in institutional orientation and education programs and other activities involving the clinical staff.  Participation in institutional committees and councils to which House Officers are appointed and invited.  Performance of these duties in accordance with the established practices, procedures and policies of the University, its programs and clinical departments, and those of other hospitals or institutions to which the House Officer is assigned.  Meeting and maintaining Louisiana State Board of Medical Examiners requirements for a permit for physicians in training or unrestricted medical licensure.

FACULTY RESPONSIBILITES

The supervising faculty as appointed by the department of will be responsible for providing adequate supervision of the house officer during the course of their educational experience while rotating at all training sites as embodied by both LSU School of Medicine House Staff Policy and Procedure Manual, and affiliating entity department’s staff policies. Residents will be expected to be supervised in all their activities commensurate with the complexity of care being given and the residents own abilities and experience.

COMPENSATION :

For and in consideration of services rendered under this Agreement of Appointment, compensation will be provided in accordance with the pay scale determined by the managing entity of the Louisiana Public Hospital System.

For a House Officer (level) ______, the salary will be $______for fiscal year beginning ______.

Availability of housing, meals, lab coats, etc. will vary among the hospitals to which House Officers are assigned. House Officer work hours vary within acceptable ranges determined by House Officer Program. House Officers are paid every two weeks, calculated from the above salary expressed as hourly pay for a 7-day workweek of 8 hours per day. INSURANCE : LSUHSC Emergency Medicine Residency Handbook 09-10 26

Health Plans: House Officers are eligible for the same health insurance/HMO plans as those for state employees or for Health Science Center students. Other health insurance may be chosen if desired and paid for by House Officers. As a condition of employment, House Officers agree to maintain one of these health plans or another plan with equal or better benefits.

Disability Insurance: The Graduate Medical Education Office provides Long-term basic disability

Medical Practice Liability Coverage: House Officers providing services pursuant to this Agreement of Appointment are provided professional liability coverage in accordance with the provisions of Louisiana Revised Statutes 40:1299.39 et seq. House Officers assigned as part of their prescribed training under this Agreement of Appointment to facilities outside the state of Louisiana must provide additional professional liability coverage with indemnity limits set by the House Officer Program. House Officers while engaged in activities outside the scope of the House Officer program, are not provided professional liability coverage under LSA-R.S. 40:1299.39, unless said services are performed at Louisiana public health care facilities.

LEAVE:

Vacation Leave: House Officers are permitted 21 days (three 7 day weeks) of non- cumulative paid vacation leave in the first year, and 28 days (four 7 day weeks) per year thereafter, subject to Departmental policy. All vacation must be used in the year earned and may not be carried forward. All vacation leave not used at the end of the calendar year is forfeited.

Sick Leave: House Officers are permitted 14 days (two 7 day weeks) of non-cumulative paid sick leave per year. Extended sick leave without pay is allowable, at the discretion of the Department and in accordance with applicable law.

Maternity/Paternity Leave: To receive paid maternity leave, House Officers must utilize available vacation leave (up to 21 or 28 days depending on the House Officer level) plus available sick leave (14 days), for a total of up to 42 days. Department Heads and/or Program Directors may grant extended unpaid maternity leave as appropriate and in accordance with applicable law. Paternity Leave: To receive paid paternity leave, House Officers must utilize available vacation leave and may qualify for unpaid leave under applicable law. Under special circumstances, extended leave may be granted at the discretion of the Department Head and/or Program Director and in accordance with applicable law.

Educational Leave: House Officers are permitted 5 (five) total days of educational leave to attend or present at medical meetings.

Military Leave: House Officers are entitled to a total of 15 (fifteen) days of paid military leave for active duty. All military leave, whether paid or unpaid, will be granted in accordance with applicable law. Leave of Absence: Leave of absence may be granted, subject to Program Director approval and as may be required by applicable law, for illness extending beyond available sick leave, academic remediation, licensing difficulties, family or personal emergencies. To the LSUHSC Emergency Medicine Residency Handbook 09-10 27

extent that a leave of absence exceeds available vacation and/or sick leave, it will be leave without pay. Make up of missed training due to leave of absence is to be arranged with the Program Director in accordance with the requirements of the Board of the affected specialty. The Department and University reserve the right to determine what is necessary for each House Officer for make-up including repeating any part of House Officer Program previously completed.

The Office of Graduate Medical Education must be notified of any sick leave extending beyond two weeks. Weekends are included in all leave days. Each type of leave is monitored and leave beyond permitted days will be without pay. Makeup of training time after extended leave is at the discretion of the Department Head and/or Program Director and governed by applicable law.

Family Leave All House Officers who have worked for LSUHSC for twelve (12) months and 1,250 hours in the previous twelve (12) months, may be eligible for up to twelve (12) weeks of unpaid, job-protected leave in each twelve (12) month period, in accordance with the requirements of the Family Medical Leave Act of 1993 (FMLA).

LSU HEALTH SCIENCE CENTER DRUG PREVENTION POLICY : The unlawful possession, use, manufacture, distribution or dispensation of illicit drugs or alcohol on University property, in the work place of any employee or student of University, or as any part of any functions or activities by any employee or student of University is prohibited.

LSUHSC has adopted a pre-employment drug screening requirement and a drug and substance abuse policy that includes provisions for employee drug-testing. Acceptance of this offer constitutes acceptance of LSUHSC drug screening policy as a condition for employment and adherence to all related institutional policies that may be implemented now or in the future. This offer is contingent on satisfactory completion of a drug screen.

OUTSIDE ACTIVITIES ( Moonlighting )

Professional activity outside the scope of the House Officer Program, which includes volunteer work or service in a clinical setting, or employment that is not required by the House Officer Program (moonlighting) shall not interfere in any way with the responsibilities, duties and assignments of the House Officer Program. Residents must not be required to moonlight. It is within the sole discretion of each Department Head and/or Program Director to determine whether outside activities interfere with the responsibilities, duties and assignments of the House Officer Program. Before engaging in activity outside the scope of the House Officer Program, House Officers must receive the approval of the Department Head and/or Program Director of the nature, duration and location of the outside activity. Foreign Medical Graduates sponsored for clinical training as a J-1 by ECFMG are not allowed to moonlight or perform activities outside the clinical training program. LSUHSC Emergency Medicine Residency Handbook 09-10 28

OUT-OF-STATE SERVICE If rotating to an out-of –state institution, House Officers agree to follow the rules, regulations, and/or by-laws of that institution. Educational objectives and the level of compensation will be established between the institution and the appropriate Department Head. Malpractice coverage must be arranged other than that provided by LSA-R.S. 40:1299.39.

SUPPORT SERVICES FOR HOUSE OFFICERS: Confidential counseling, medical and psychological support services are available through the LSU School of Medicine Campus Assistance Program (“CAP”) for the house officer voluntarily seeking assistance.

PHYSICIAN IMPAIRMENT POLICY: House Officers who work at University are expected to report to work in a fit and safe condition. A House Officers who is taking prescription medication(s) and/or who has an alcohol, drug, psychiatric or medical condition(s) that could impair the House Officer’s ability to perform in a safe manner must contact the Louisiana State Medical Society’s Physicians’ Health Program, whose mission is to assist and advocate for physicians who are impaired or potentially impaired as approved by the Louisiana State Board of Medical Examiners. If a House Officer knows of a physician or colleague who House Officer reasonably believes may be impaired or potentially impaired, House Officer may report that physician to the Physicians’ Health Program. A House Officer who is reasonably believed to be impaired or potentially impaired, but refuses to avail him/herself of assistance shall be reported to the Campus Assistance Program and/or the Physicians’ Health Program for evaluation.

CANCELLATION AND RENEWAL OF AGREEMENT OF APPOINTMENT House Officer Agreement of Appointments are valid for a specified period of time no greater than twelve (12) months. During the term of this Agreement of Appointment, the House Officer’s continued participation in the House Officer Program is expressly conditioned upon satisfactory performance. This Agreement of Appointment may be terminated at any time for cause. Neither this Agreement of Appointment nor House Officer’s appointment hereunder constitute a benefit, promise or other commitment that House Officer will be appointed for a period beyond the term of this Agreement of Appointment. Promotion, reappointment and/or renewal of this Agreement of Appointment is expressly contingent upon several factors, including, but not limited to the following: (i) satisfactory completion of all training components; (ii) the availability of a position; (iii) satisfactory performance evaluation; (iv) full compliance with the terms of this Agreement of Appointment; (v) the continuation of University’s and House Officer Programs’ accreditation by the Accreditation Council for Graduate Medical Education (“ACGME”); (vi) University’s financial ability; and (vii) furtherance of the House Officer’s Program. LSUHSC Emergency Medicine Residency Handbook 09-10 29

Termination and non-renewal of this Agreement of Appointment shall be subject to appeal in accordance with the provisions delineated in the House Officer Manual.

INSTITUTION/HOUSE OFFICER PROGRAM CLOSURE/REDUCTION

If University itself intends to close or to reduce the size of a House Officer program or to close a residency program, University shall inform the House Officers as soon as possible of the reduction or closure. In the event of such reduction or closure, University will make reasonable efforts to allow the House Officers already in the Program to complete their education or to assist the House Officers in enrolling in an ACGME accredited program in which they can continue their education.

SUMMARY SUSPENSIONS

University, Program Director, or designee, Department Head, or designee, each shall have the authority to summarily suspend, without prior notice, all or any portion of House Officer’s appointment and/or privileges, whenever it is in good faith determined that the continued appointment of House Officer places the safety or health of patients or University personnel in jeopardy or to prevent imminent disruption of University operations.

GRIEVANCE PROCEDURES:

Policies and procedures for adjudication of House Officer complaints and grievances related to action which result in dismissal or could significantly threaten a House Officer’s intended career development are delineated in the House Officer Manual. Complaints of sexual harassment and/or other forms of discrimination may be addressed in accordance with the policy delineated in the House Officer Manual.

DUTY HOURS:

Duty hours must be in accordance with the institutional and ACGME policies. The house officer agrees to participate in institutional programs monitoring duty hours. Questions about duty hours should be directed to the LSUHSC Graduate Medical Education Office or Ombudsman listed in the House Officer Manual, when they can not be resolved at the program level.

By signing this Agreement of Appointment, House Officer affirms that House Officer has read and agrees to all the terms and conditions delineated in the House Officer Manual. In addition House Officer agrees to comply with any and all University policies or procedures as are from time to time adopted, authorized and approved by University. This Agreement of Appointment is not valid until it is executed by: (i) the House Officer; (ii) the Program Director, or designee; (iii) the Department Head or designee; and (iii) the Associate Dean for Academic Affairs or designee. LSUHSC Emergency Medicine Residency Handbook 09-10 30

This document, with any appendices represents the entire agreement between the parties.

______House Officer Program Director

Date: ______Date: ______

______Department Head Associate Dean for Academic Affairs

Date:______Date: ______LSUHSC Emergency Medicine Residency Handbook 09-10 31

Pay Scales - LSUHSC House Officer

2008-2009 Academic Year

PGY1 $44,168 PGY2 $45,467 PGY3 $47,125 PGY4 $49,029 PGY5 $50,720 LSUHSC Emergency Medicine Residency Handbook 09-10 32

Emergency Fund for Residents

Guidelines for use of Emergency Fund for Residents/Fellows

The Emergency Fund for Residents/Fellows provides LSUHSC house officers with money in cases of emergency. In order to ensure that proper procedures are followed when using the Emergency Fund the following guidelines must be adhered to when requesting use of the Emergency Fund. Emergency funds are limited. This fund is not to be used for "advance salary" money. Requests should be for true financial emergencies. The GME Office will keep all requests confidential.

An Emergency Fund Request for Payment may be in either of two categories--Loan or Grant. Loans are interest free, if approved by the Assistant Dean for Academic Affairs, and must be paid back in one lump sum payment as soon as possible within one (1) year. In exceptional circumstances, grants are given with no expected return payment from the Resident if approved by the Assistant Dean for Academic Affairs.

Non payment of loan by a resident after the time period of one (1) year will result in notification of Department Head and Departmental Residency Director by the GME Office staff. A decision will then be made by the Department Head and/or Residency Director who will determine the resolution of the loan and any penalty for the Resident.

The Steps for Requesting the Emergency Fund are as follows:

1. Resident notifies his Departmental Residency Coordinator or his Residency Program Director about the Emergency situation.

2. Departmental Residency Coordinator or his Residency Program Director gives Resident an Emergency Fund Request For Payment Form (attached for departmental duplication).

3. Resident completes the Emergency Fund Request For Payment Form and Resident obtains signatures of his Residency Director or Department Head (or Acting Head in case Department Head is away.) approving of Resident request.

4. Resident presents approved Request For Payment Form to the Office of Graduate Medical Education, Room 237, Medical School Building, 1542 Tulane Avenue, for final approval or denial by the Assistant Dean for Academic Affairs.

5. If Request for Payment Form is approved by the Assistant Dean for Academic Affairs, the GME Office staff will contact the Resident to notify him when the check will be ready for pick up. Loan Repayment: When loans are paid back, the Resident must complete a Loan Repayment Form (attached for departmental duplication). The completed Form and Payment should be delivered to the Office of Graduate Medical Education. Checks should be made payable to the LSU Medical Center Foundation. LSUHSC Emergency Medicine Residency Handbook 09-10 33

House Officer Selection and Eligibility LSUHSC

House Officer selection criteria must conform to the guidelines of the Accreditation Council for Graduate Medical Education (ACGME) General Requirements. House Officers are selected by program directors from an applicant pool in the National Residency Matching Program (NRMP) or from NRMP Specialty Matching Services programs.

First year House Officers must participate through the NRMP programs. Only in the absence of an NRMP matching program in a particular discipline or at an advanced level of appointment, may candidates compete and be appointed individually. Such candidates must meet all the ACGME General Requirements for selection of House Officers.

House Officers must be (1) graduates of medical schools in the United States and Canada accredited by the Liaison Committee on Medical Education (LCME); (2) graduates of colleges of osteopathic medicine in the United States accredited by the American Osteopathic Association (AOA); (3) graduates of medical schools outside the United States who have received a currently valid certificate from the Education Commission for Foreign Medical Graduates or have a full and unrestricted license to practice medicine in a United States licensing jurisdiction; or (4) graduates of medical schools outside the United States who have completed a Fifth Pathway Program by an LCME-accredited medical school. [A Fifth Pathway program is an academic year of supervised clinical education provided by an LCME-accredited medical school to students who a.) have completed, in an accredited college or university in the United States, undergraduate premedical education of the quality acceptable for matriculation in an accredited United States medical school; b.) have studied at a medical school outside the United States and Canada but listed in the World Health Directory of Medical schools; c.) have completed all of the formal requirements of the foreign medical school except internship and/or social service; d.) have attained a score satisfactory to the sponsoring medical school on a screening examination; and e.) have passed either the foreign Medical Graduate Examination in the Medical Sciences, Parts I and II of the examination of the National Board of Medical Examiners, or Steps 1 and 2 of the United States Medical Licensing Examination (USMLE).] .

All House Officer trainees must have a valid license or permit to practice medicine in the State of Louisiana. Requirements for medical licensure change from time to time. Beginning with medical graduates of 1992, all Louisiana licensure examination is through the United States Medical Licensing Examination (USMLE) three-step pathway. The Louisiana State Board of Medical Examiners will confer unlimited licensure only after the candidate successfully completes the post - graduate year I level and passes the USMLE Step examinations 1 through 3. The examination of the National Board of Osteopathic Examiners and the LMCC Canada examination are not currently accepted by the Louisiana licensing Board.

The Louisiana State Board of Medical Examiners issues temporary training permits to qualified post-graduate year I level trainees. Temporary permits (Visiting Resident Permits) also may be issued for certain foreign medical graduates entering the U.S. on J-1 visas. Foreign citizen trainees must have standard Educational Commission for Foreign Medical Graduates (ECFMG) certification. They must pass the Foreign Medical Graduate Examination in the Medical Sciences (FEMGEMS) and the ECFMG English test. Rules and regulations regarding LSUHSC Emergency Medicine Residency Handbook 09-10 34

trainees with visas frequently change. Examples include which types of visa holders may do clinical training and issues regarding funding sources. When questions arise the GME Office will refer all questions to Ms. Rose Chatelain or her designee for final determination to be sure we are in compliance with all institutional, state and Federal rules and regulations.

Eligible House Officer candidates will be selected on the basis of their preparedness, ability, aptitude, academic credentials, communication skills and personal qualities such as motivation and integrity. The number and apportionment of House Officers will depend on educational opportunities, the patient population, levels of illnesses, types of procedures, number of staff available for supervision, financial resources of in-patient and out-patient care facilities, and recommendations of the Residency Review Committees (RRC). The Institutional Graduate Medical Education Committee and the Academic Dean, supervise the overall number of positions offered and the apportionment of House Officers among services and departments. House Officers are appointed for one year. Contract renewal is subject to mutual written consent of the Department Head and the House Officer. This renewal must be made in a timely manner in accordance with ACGME requirements as outlined in our Policy and Procedure Manual and with dates set by the GME office. LSUHSC Emergency Medicine Residency Handbook 09-10 35

Campus Assistance Program o The Campus Assistance Program is a free service provided by LSU Health Sciences Center in New Orleans to assist employees, faculty, staff, residents, and students in resolving personal or work related problems. o LSUHSC-NO recognizes that everyone, at sometime, needs a “helping hand” or assistance. Whether you have a simple or a complex problem, the Campus Assistance Program can help. o A counselor is on call 24 hours a day to assist in time of crisis. If you feel you have an emergency or need immediate assistance at any time, contact the counselor on call.

You may reach a counselor by calling (504) 568-8888 CAP is located in the Lions Clinic Building on the 6th Floor 2020 Gravier St, New Orleans, LA 70112

Types of Problems CAP is a resource that offers individuals assistance with solving life, school and work problems. Any problems, regardless of severity, that are interfering with one’s peace of mind or personal effectiveness are appropriate to bring to this service. The counselors will work with you to either resolve the problem, or find the resources in the community to help you. The program also offers assistance to supervisors who are working with troubled individuals. Examples of problem areas include:

 Crisis Management  Job Productivity  Mental Health  Career Satisfaction  Interpersonal / Family  Alcohol and Other Drug Use Relationships  Loss / Bereavement  Child / Adolescent Development

 Financial  Workplace Conflict Resolution

Privacy Use of program services is voluntary. All information conveyed during use of the services, including use of the service itself, is confidential.

Services 24-Hour Crisis Line  A counselor is on call 24 hours a day to assist in times of crisis.

Community Information  The Campus Assistance Program maintains up-to-date lists of community resources, treatment programs and agencies. If you are looking for a community resource, Campus Assistance Program will work with you to find the best resource in the community that can help you.

Problem Assessment  A counselor will help you clarify the nature of your problem and develop a plan to resolve your problem.

Short-Term Counseling  Short-term counseling for problem clarification is available through the Campus Assistance Program. If after talking with the counselor, a referral to a specialist within the community is needed, one will be made for the best cost-effective treatment of your problem.

Cost Services are provided at no cost to the client. If a referral is made to a resource outside of the Program, the cost of that service is the responsibility of the client. Such costs may be covered by heath insurance. LSUHSC Emergency Medicine Residency Handbook 09-10 36 LSUHSC Emergency Medicine Residency Handbook 09-10 37

Fitness For Duty And Substance Abuse Policy

Louisiana State University Health Sciences Center (LSUHSC) is governed by and complies with the provisions of the Drug Free Workplace Act of 1988. The applicable provisions are as follows:

The unlawful manufacture, distribution, dispensing, possession and/or use of unlawful drugs at any facility of the Louisiana State University Health Sciences Center is prohibited.

Penalties for violation of this policy could result in written disciplinary action, suspension, demotion, and/or immediate dismissal depending on the severity of the circumstances; or criminal prosecution.

Further, all employees are required to notify the Director of Human Resource Management of any drug related criminal conviction which occurs in the workplace within five (5) days following conviction. The Director will notify the Grants Office so that they may comply with the provision for notice to the federal funding agency within ten (10) days. Notice to the federal contractor should include the sanctions imposed on the employee convicted of a drug work-related crime.

Campus/Employee Assistance Program (C/EAP) is available to all House Officers of LSUHSC. Abiding by this policy and any other drug policy established by LSUHSC or other House Officer training facility, regardless of when promulgated, is a condition of the House Officer’s employment with LSUHSC. (Revised May 2000 by the Campus Assistance Program Office)

FITNESS FOR DUTY POLICY The Louisiana State University Health Sciences Center (LSUHSC) promotes and protects the well being of faculty, staff, residents, students, and patients. Any individual who works or is enrolled at Louisiana State University Health Sciences Center (LSUHSC) is expected to report to work/school in a fit and safe condition. An individual who has an alcohol, drug, psychiatric, or medical condition (s) that could be expected to impair their ability to perform in a safe manner must self report their medical status to their supervisor and provide a signed medical release indicating their fitness for work/school to the Campus/Employee Assistance Program (C/EAP).

LSUHSC requires all faculty, staff, residents, students or other LSUHSC workers who observe an individual who is believed to be impaired or is displaying behavior deemed unsafe at work/school to report the observation (s) to their supervisor for appropriate action. Supervisors are then required to make an administrative referral to the Drug Testing Program and C/EAP. An individual who is referred to C/EAP and found to be impaired must provide C/EAP, prior to returning to work, with a signed medical release indicating they are fit to resume their work or school responsibilities at LSUHSC. LSUHSC will, as a condition of continued employment/enrollment, require an “at risk” individual to maintain a continued care plan either recommended or approved by C/EAP and sign a Continuation of Employment/Enrollment Contract.

This policy applies to all faculty, staff, residents, students, contract and subcontract workers, medical staff, volunteers, laborers, or independent agents who are conducting business on behalf LSUHSC Emergency Medicine Residency Handbook 09-10 38

of, providing services for (paid or gratis), or being trained at LSUHSC. (Revised May 2000 by the Campus Assistance Program Office) LSUHSC Emergency Medicine Residency Handbook 09-10 39

Work Related Injury/Illness

Department: Employee Health Services Policy Title: Work-related Injury/Illness (Excepting Needle Sticks and Exposures Which are Covered by Specific Policies and Procedures) Effective Date: Prior 11/96

Purpose: To outline Employee Health Services policy and procedure for handling the employee who is injured on the job. This policy is set forth to ensure maximum protection of the employee and the Medical Center of Louisiana (MCL) in the event that an accident or exposure, causing illness or injury, occurs while the employee is on duty at MCL.

Policy: The Medical Center of Louisiana offers screening, evaluation and treatment and referral, as indicated, for work-related accidents or illnesses. In the event of a work-related accident or illness, an employee must notify the supervisor if at all possible. An Employee Accident Report Form must be completed and handled as per hospital policy. Employees who are injured after hours or are seriously injured or need prompt medical attention due to such things as loss of blood, loss of consciousness or loss of mobility are immediately sent to the Emergency Room by their supervisor or other appropriate personnel. The Employee Accident Report Form is given to the Emergency Room as soon as possible after any potentially life-threatening needs are attended to. In the event of minor injury, if the employee requests medical attention, the supervisor is to send the employee to Employee Health Services with the Employee Accident Report Form. If the injury is of a more serious or severe nature, the Employee should be sent to the Emergency Room for treatment first.

In cases where medical attention is needed and Employee Health Services is closed or the Employee Health Services physician is not available, the supervisor sends the employee to the Emergency Room with the Employee Accident form. The Emergency Room should notify Employee Health Services of those MCL employees who have been injured on the job. The supervisor and Emergency Room should instruct the employee to report to Employee Health Services at the first available opportunity following treatment for work-related injury in the Emergency Room. Employee Health Services provides follow-up assessment for employees treated in the Emergency Room and will initiate follow-up treatment or referral, as indicated. Emergency Room Patient Discharge Instructions should be brought to Employee Health Services during regular office hours and return follow-up visit.

Employee Health Services provides instructions to injured employee regarding treatment, referral and appointments and return-to-work. Employee Health Services schedules appointments or facilitates the scheduling process for appointments to return to Employee Health or to see other medical care providers. Employee Health Services instructs employee to return with instructions and/or clearances from other medical care providers regarding return-to-work recommendations and to return to Employee Health Services for case-management. Employee Health maintains contact with employees on Workers' Compensation and the Workers' Compensation representative concerning duration of disability for employees.

Employee Health Services gives documentation slip to employee returning with return to work clearance from own physician. Said work clearance paperwork is maintained in confidential Employee Health Services employee file. At the discretion of Employee Health Services, Employee Health Services physician may see employee at return to work. LSUHSC Emergency Medicine Residency Handbook 09-10 40

Dress Code

1. Residents must abide by the dress code of each hospital to which they rotate. 2. The general principles of the programs dress code are listed below.

a. One way a physician indicates his professionalism and his respect for the patient and his family is by his appearance.

b. Residents should present a neat, clean, and professional appearance at all times.

c. Scrubs are acceptable attire in the ED and when on call as are neat pants, skirts and shirts. No sandals or open shoes are allowed for safety reasons.

d. No attire bearing unprofessional messages or pictures is to be worn.

3. Emergency medicine residents spend about 50% of their residency on non-emergency department rotations interacting with residents, faculty, and administrators. The appearance of our residents influences how our entire department is viewed. Residents are encouraged to keep this, in mind when dressing. Events such as conferences are also professional activities and residents should dress appropriately. Shorts, tee shirts, and sandals are not to be worn to conference.

4. Please refer to the MCLNO personal appearance policy below: LSUHSC Emergency Medicine Residency Handbook 09-10 41 LSUHSC Emergency Medicine Residency Handbook 09-10 42 LSUHSC Emergency Medicine Residency Handbook 09-10 43 LSUHSC Emergency Medicine Residency Handbook 09-10 44 LSUHSC Emergency Medicine Residency Handbook 09-10 45 LSUHSC Emergency Medicine Residency Handbook 09-10 46 LSUHSC Emergency Medicine Residency Handbook 09-10 47 LSUHSC Emergency Medicine Residency Handbook 09-10 48 LSUHSC Emergency Medicine Residency Handbook 09-10 49

LIBRARY - LSUHSC

433 Bolivar St., Box B3-1 New Orleans, LA 70112-2223 Help Desk: (504) 568-6102 http://www.lsumc.edu/campus/library/no-lib.htm

Much of the library can be accessed from your LSU Desktop. Go to www.lsuhsc.edu, go to quicklink dropdown menu and click on desktop/psdesktop . Use your assigned username and password that you use to get on the LSU system. The next frame go to “Install web client” and click on Internet explore 4.0 and above (desktop) and follow the instructions in the dialog box.

The Library is excited to announce that access to a whole new set of databases will be provided by software from Ovid Technologies, Inc. Access to the OVID databases is via a Web browser and is available through the library's Web page at http:/www.Isumc.edu/campus/library/no - lib.htm or directly to http://ovid.Isumc.edu. The following databases will be available:

MEDLINE: 1966 present Produced by the U.S. National Library of Medicine, the MEDLINE database is widely recognized as the premier source for bibliographic coverage of biomedical literature. MEDLINE encompasses information from Index Medicus, Index to Dental Literature, and International Nursing, as well as other sources of coverage in the areas of communication disorders, population biology, and reproductive biology. More than 8.5 million records from more than 3,600 journals are indexed.

PsycINFO: 1988-present. Produced by the American Psychological Association, PsycINFO covers the professional and academic literature in psychology and related disciplines, including medicine, psychiatry, nursing, sociology, education, pharmacology, physiology, linguistics, and other areas. PsycINFO's coverage is worldwide, and includes references and abstracts to over 1,300 journals in more than 20 languages, and to book chapters and books in the English language. The database includes information from empirical studies, case studies, surveys, bibliographies, literature reviews, discussion articles, conference reports and dissertations.

HealthSTAR: 1975-present. HealthSTAR contains citations to the published literature on health services, technology, administration, and research. It focuses on both the clinical and non-clinical aspects of health care delivery. The following topics are included: evaluation of patient outcomes; effectiveness of procedures, programs, products, services and processes; administration and planning of health facilities, services and manpower; health insurance; health policy; health services research; health economics and financial management; laws and regulation; personnel administration; quality assurance; licensure; and accreditation.

HealthSTAR is produced cooperatively by the U.S. National Library of Medicine and the American Hospital Association. The database contains citations and abstracts (when available) to journal articles, monographs, technical reports, meeting abstracts and papers, book chapters, government documents, and newspaper articles from 1975 to the present. LSUHSC Emergency Medicine Residency Handbook 09-10 50

Bioethicsline: 1973-present. Produced jointly by the Kennedy Institute of Ethics and the U.S. National Library of Medicine, the BioethicsLine database includes more than 47,000 records of English-language materials on bioethics. Documents are selected from the disciplines of medicine, nursing, biology, philosophy, religion, law, and the behavioral sciences. Selections from popular literature are also included. Covered document types include journal and newspaper articles, monographs, court decisions, bills, laws, and audiovisual materials.

ERIC: 1966-present. Produced by the U. S. Department of Education, ERIC is a national bibliographic database which indexes over 775 periodicals dealing with the subject of education. It is the premier resource for references to these materials. Targeted to teachers, administrators and other education professionals, ERIC combines information from two printed sources: Resources in Education (RIE) and the Current Index to Journals in Education (CUE).

CINAHL: 1982-present. Produced by CINAHL Information Systems, The Nursing & Allied Health (CINAHL) database provides comprehensive coverage of the English language journal literature for nursing and allied health disciplines. Material from over 650 journals are included in CINAHL, covering fields such as cardiopulmonary technology, emergency services, health education, med/lab technology, medical assistance, medical records, occupational therapy, physical therapy, radiologic technology, respiratory therapy, social sciences, surgical technology, and the physician's assistant. Also included are healthcare books, nursing dissertations, selected conference proceedings, standards of professional practice, and educational software. There is selective coverage of journals in biomedicine, the behavioral sciences, management, and education.

CANCERLIT: 1983-present. Produced by the U.S. National Cancer Institute, CancerLit is an important source of bibliographic information pertaining to all aspects of cancer therapy, including experimental and clinical cancer therapy; chemical, viral and other cancer causing agents; mechanisms of carcinogenesis; biochemistry, immunology, and physiology of cancer, and mutagen and growth factor studies. Some of the information in CancerLit is derived from the MEDLINE database. Approximately 200 core journals contribute a large percentage of the 750,000+ records in this database. In addition, other information is drawn from proceedings of meetings, government reports, symposia reports, theses, and selected monographs.

OVID CORE BIOMEDICAL COLLECTION

MD CONSULT- Can be accessed from your LSU Desktop, click on Medical package or go to www.lsuhsc.edu, click INTRANET, click MD Consult. Use your assigned username and password that you use to get on the LSU system. If you are accessing the system out of campus for the first time, after clicking on INTRANET on the next frame click “Desktop ECA client Download” and follow the instructions in the dialog box. LSUHSC Emergency Medicine Residency Handbook 09-10 51

WELLNESS CENTER

The Wellness Center is dedicated to promoting the health and well being of all members of the LSU Health Sciences Center community in a safe and educational environment.

Hours of Operation Contact Information Mon.-Fri. 6:30 am - 8:00 pm 450 S. Claiborne Avenue Sat. 9:00 am - 1:00 pm New Orleans, LA 70112 Sun. Closed Phone: (504) 568-3700 Fax: (504) 568-3720 Email: wellness Amenities

 18,000 square feet Entry granted with a valid LSUHSC or MCLNO I.D.  Cardiovascular equipment: treadmills, Membership Requirements bikes (upright and recumbent), ellipticals, All individuals must show a valid LSUHSC I.D. on the 3rd floor of Stanislaus Hall rowers, and stair for entrance into the Wellness Center. In addition, initially, each individual member climbers must complete an Express Assumption of Risk Release of Liability Form and a  Selectorized weight PAR-Q. equipment: Nautilus Nitro Forms  Plate loaded/free Express Assumption of Risk Release of Liability Form PAR Q weights  A multipurpose room for Free Admission is granted to: group exercise activities, such as group cycling, . LSUHSC Students, Residents, Faculty, and Staff mind body (yoga/pilates . Spouses and Children 16 years or older of LSUHSC Students, Residents, mat), step, resistance Faculty, and Staff training, etc. . *MCLNO Staff ONLY  Lounge area / Wireless . *HCSD Staff ONLY Internet  Spacious locker rooms with shower facilities LSUHSC Emergency Medicine Residency Handbook 09-10 52

HOUSE STAFF CLEARANCE FORM

Each resident completing final rotations (prior to graduation) must have this form processed before a final certificate will be issued. Signatures indicate that your medical records are complete; you have returned lab coats; and you have returned Autovalet Cards.

NAME OF RESIDENT

SCHOOL/DEPARTMENT DATE OF DEPARTURE

Signature Date

MEDICAL RECORD SERVICES Doctor’s Dictation area All records dictated and signed up to including departure date and reassignment form completed.

COAT EXCHANGE

AUTOVALET CARDS

RESIDENCY PROGRAM DIRECTOR

Completed form should be submitted to the Medical Staff Office LSUHSC Emergency Medicine Residency Handbook 09-10 53

MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS MEDICAL RECORD SERVICES CERTIFICATE REQUEST Certificates are awarded only when you have completed entire program –internship, residency and fellowship, if applicable. This form must be approved by your Residency Program Director.

Please complete, as you want your certificate to read. Name:______First Middle Last Degree Status: (circle one) Intern Resident Fellow

School: (circle one) LSU or TULANE

Department:______

Dates:______to______

If any year was in a different program, please provide that information.

Status: (circle one) Intern Resident Fellow

School: (circle one) LSU or TULANE

Department:______Dates:______to______

Permanent forwarding address for mailing certificate:

______

APPROVAL: I have reviewed applicant’s request for MCL certificate and verify that information provided above is accurate.

______Residency Program Director Date CERTIFICATE REQUESTS THAT HAVE NOT BEEN APPROVED BY RESIDENCY PROGRAM DIRECTOR WILL NOT BE PROCESSED. LSUHSC Emergency Medicine Residency Handbook 09-10 54 LSUHSC Emergency Medicine Residency Handbook 09-10 55

POLICIES – Section of EM

Mission Statement

The mission of LSUHSC-New Orleans Emergency Medicine Residency Program is to deliver superior patient care, foster medical education, promote research, and provide service to our community, the LSUHSC system and the specialty of emergency medicine.

GOALS and OBJECTIVES

The overall goal of LSU EM training program is to prepare physicians for the independent practice of emergency medicine. This goal is achieved via teaching the fundamental skills, knowledge, and humanistic qualities that constitute the foundations of emergency medicine practice. Residents, under the guidance and supervision of a qualified faculty, develop a satisfactory level of clinical maturity, judgment, and technical skills, by being exposed to progressive levels of responsibility in clinical experiences that enable effective management of acute care problems. Upon completion of the program, residents will be capable of independently practicing emergency medicine, able to incorporate new skills and knowledge during their careers, and able to monitor their own physical and mental well being. Specific objectives include:

1. Manage life-threatening conditions competently and efficiently 2. Support and stabilize the acutely ill patient and arrange appropriate management and referral 3. Recognize, evaluate and initiate management of non-acute illness and injury. 4. Manage multiple patients concurrently, and establish appropriate treatment priorities. 5. Demonstrate full integration of the ACGME core competencies: a. PATIENT CARE: Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. b. MEDICAL KNOWLEDGE: Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. c. PRACTICE BASED LEARNING & IMPROVEMENT: Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence and improve their patient care practices. d. INTERPERSONAL AND COMMUNICATION SKILLS: Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their families and professional associates. LSUHSC Emergency Medicine Residency Handbook 09-10 56

e. PROFESSIONALISM: Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient population. f. SYSTEMS BASED PRACTICE: Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

Role of the Residency in the Emergency Department

All patient care in the Emergency Department of MCLNO is provided and supervised by the residents and faculty of the LSUHSC Emergency Medicine Residency Program. Emergency medicine teaching faculty from the LSUHSC Emergency Medicine Residency Program are on duty in the department at all times and review the care of every patient treated before that patient is discharged. The faculty provides supervision and teaching of residents, interns and students. All faculty are ABEM eligible or certified. Emergency medicine residents at the PGY 1,2,3, and 4 levels are assigned to the department each month. Emergency medicine residents perform several functions in the department under the supervision of the Emergency Medicine faculty including primary triage of all patients presenting for care, supervision of all patient care activities and teaching of interns from all services assigned to the emergency department and of medical students taking emergency medicine rotations, direction of resuscitation of critically ill or injured patients, arrangement for appropriate consultation, and direction of pre-hospital care via radio communication.

The emergency medicine faculty of the residency program also fills the medical administrative positions in the department such as Director of the Emergency Department and the Director of the Fast Track. The faculty also performs the Quality Assurance and Peer Review functions of the Department. Procedures in the emergency department are supervised by the ED attending physicians.

. LSUHSC Emergency Medicine Residency Handbook 09-10 57

EM Residency Applicants

Selection of residents for LSUHSC Emergency Medicine residency involves all members of the Section of Emergency Medicine. The program directors and chief residents perform the initial screening of applications received via ERAS. Candidates are then invited for an interview and are then interviewed by the program director, associate program director, at least one general faculty member and one chief resident. The applicants go to lunch with EM residents on the day of their interview and attend an informal gathering with the residents the night before their interview. The applicant’s interaction with our residents is the most important aspect of the interview process and is instrumental part in the recruitment of future residents.

Qualified applicants should at least be in their final year of medical school training and have successfully passed USMLE Step 1. USMLE Step 2 is encouraged but not required before interviewing but must be successfully completed to be ranked. A dean’s letter and at least 3 letters of recommendations are required. We participate in ERAS for all applicants. Applicants must be citizens of the United States or possess a green card or J-1 visa. We do not sponsor H-1b visas. Our resident’s appraisal of the applicant, along with our faculty’s impressions and assessments, combined with the applicant’s letters of recommendation, medical school dean’s letter, and personal statement makes up the file for each applicant. All files are then carefully reviewed by the program directors and chief residents, and a match list is compiled for the computerized national match of R-1's. Our residency program participates in the National Residency Matching Program (NRMP) and as such, is obligated to follow all rules and regulations set forth by the NRMP. LSUHSC Emergency Medicine Residency Handbook 09-10 58

Residency Promotions

LSUHSC Emergency Medicine residents are evaluated each year in a formative and summative fashion. These evaluations, in-service exam scores and resident self reflections offer the basis for successful promotion from one year to the next. Residents that do not show appropriate improvement and progress based on a combination of formative and summative evaluations, in-service exam scores and maintenance of residency requirements are required to remediate for 3 month periods with subsequent re-evaluations by the Program Director at those times. The Program Director in conjunction with the resident’s advisor, offer residents focused feedback on their areas of weakness and residents are asked to seek daily feedback on their clinical performance in the Emergency Department. Once residents meet their residency requirements and address their weakness they are promoted to their appropriate class level. Residents who fail to reach the standards after 12 months of remediation are dismissed.

EMERGENCY MEDICINE YEAR END COMPETENCIES PGY1 YEAR  These objectives are the criteria that are used to determine a resident’s ability to advance to the next year of residency.  By the end of the PGY-1 year, EM residents are expected to: Core Assessment Competency Objective Competency Method Complete all clinical rotations with satisfactory evaluations PC, MK, ICS Rotation evals Attend at least 70% of all mandatory EM conferences. PF, MK, PBL Attendance sheets Demonstrate EM knowledge by scoring at least 70th percentile MK, PC ABEM exam on the ABEM In-service examination. Demonstrate progression towards competency in the chief SDOT, oral boards, MK, PC complaints of chest pain, syncope and pediatric fever. simulations Obtain documents required for medical licensure. PC, SBP Resident File Properly assist in trauma or medical resuscitations with Simulations, global MK, PC guidance. evals, oral boards Demonstrate the ability to execute admission and discharge, SDOT, global MK, PC, SBP once the disposition is determined. evaluations Residents are expected to maintain timely documentation of Procedure logs, ICS, PC, SBP charts in the ED, medical records and hospital paperwork. med. recs dept. Begin procedure related readings, achieve 80% on post-tests, Procedure logs, PC obtain faculty evaluations and document procedures in RP. simulations, SDOT Demonstrate adequate documentation of procedures with at PC Procedure logs LSUHSC Emergency Medicine Residency Handbook 09-10 59

least 1/5 of ACGME targeted procedures in the RP. Demonstrate adequate documentation of follow-up diagnoses Follow up logs, PC, MK of patients seen in the ED and complete 10 follow-up/year resident portfolios Demonstrate adequate progress with all specified academic Portfolio, lecture PBL, ICS requirements as judged by the program director. evaluations Identify a potential area of need for the residency required SBP Semi-Annual eval. administrative project.(pending) Identify and choose a potential topic for the residency required PBL Semi-Annual eval. academic project. Residents must demonstrate a commitment to carrying out Global evaluations, professional responsibilities, adherence to ethical principles PF 360 evaluations and sensitivity to a diverse patient population. Demonstrate the ability to interact effectively with nurses, Global evaluations, ICS ancillary staff, patients and families. 360 evaluations LSUHSC Emergency Medicine Residency Handbook 09-10 60

PGY2 YEAR  These objectives are the criteria that are used to determine a resident’s ability to advance to the next year of residency.  By the end of the PGY-2 year, EM residents are expected to: Core Assessment Competency Objective Competency Method Complete all clinical rotations with satisfactory evaluations PC, MK, ICS Rotation evals Attend at least 70% of all mandatory EM conferences. PF, MK, PL Attendance sheets Demonstrate improvement in EM knowledge by scoring at MK, PC ABEM exam least 75th percentile on the ABEM In-service examination. Demonstrate progression towards competency in the chief SDOT, oral boards, MK, PC complaints of chest pain, syncope and pediatric fever. simulations Pass USMLE Step 3. Louisiana License, Training Permit & MK, PC, SBP Resident File STEP 3: Properly perform a trauma or medical code resuscitation with Simulations, global MK, PC minimal guidance. evals, oral boards Demonstrate the ability to execute admission, discharge, and SDOT, global MK, PC, SBP transfers once the disposition is determined. evaluations Residents are expected to maintain timely documentation of Procedure logs, ICS, PC, SBP charts in the ED, medical records and hospital paperwork. med. recs dept. Completes all procedure-related readings, achieve 80% on all Procedure logs, PC post-tests, obtain faculty evals and documentation in RP. simulations, SDOT Demonstrate adequate documentation of procedures with at PC Procedure logs least ½ ACGME targeted procedures in RP. Demonstrate adequate documentation of 10 follow-up Follow up logs, PC, MK diagnoses of patients seen in the ED. resident portfolios Demonstrate adequate progress with all specified academic Portfolio, lecture PL, ICS requirements as judged by the program director. evaluations Complete significant progress on the residency required SBP Semi-Annual eval. administrative project. pending Complete significant progress on the residency required PL Semi-Annual eval. academic project. Residents must demonstrate a commitment to carrying out PF Global evaluations, professional responsibilities, adherence to ethical principles 360 evaluations and sensitivity to a diverse patient population. Demonstrate the ability to interact effectively with nurses, Global evaluations, ICS ancillary staff, patients and families. 360 evaluations LSUHSC Emergency Medicine Residency Handbook 09-10 61

PGY3 YEAR  These objectives are the criteria that are used to determine a resident’s ability to advance to the next year of residency.  By the end of the PGY-3 year, EM residents are expected to: Core Assessment Competency Objective Competency Method Complete all clinical rotations with satisfactory evaluations Rotation PC, MK, ICS (meets expectations or above). evaluations Attend at least 70% of all mandatory EM conferences. PF, MK, PL Attendance sheets Demonstrate improvement in EM knowledge by scoring at MK, PC ABEM exam least 78th percentile on the ABEM In-service examination. Demonstrate [progression towards] competency in the chief SDOT, oral boards, MK, PC complaints of chest pain, syncope and pediatric fever. simulations Maintain licensure. PC, SBP Resident File Properly perform a trauma or medical code resuscitation with minimal supervision. Appropriately sequences critical actions Simulations, global MK, PC and identifies interventions required to immediately stabilize a evals, oral boards patient. Manages multiple patients at various, progressive stages of SDOT, global work-up throughout the shift, making appropriate, timely MK, PC, SBP evaluations decisions Residents are expected to maintain timely documentation of Procedure logs, ICS, PC, SBP charts in the ED, medical records and hospital paperwork. med. recs dept. Demonstrate adequate documentation of procedures with at PC Procedure logs least ¾ of ACGME targeted procedures listed in RP. Demonstrate adequate documentation of 10 follow-up Follow up logs, PC, MK diagnoses of patients seen in the ED. resident portfolios Demonstrate adequate progress with all specified academic Portfolio, lecture PL, ICS requirements as judged by the program director. evaluations Complete [significant progress on] the residency required SBP Semi-Annual eval. administrative project. pending Complete [significant progress on] the residency required PL Semi-Annual eval. academic project. Residents must demonstrate a commitment to carrying out Global evaluations, professional responsibilities, adherence to ethical principles PF 360 evaluations and sensitivity to a diverse patient population. Demonstrate the ability to interact effectively with nurses, Global evaluations, ICS ancillary staff, patients and families. 360 evaluations LSUHSC Emergency Medicine Residency Handbook 09-10 62

PGY4 YEAR  These objectives are the criteria that are used to determine a resident’s ability to advance to the next year of residency.  By the end of the PGY-4 year, EM residents are expected to: Core Assessment Competency Objective Competency Method Complete all clinical rotations with satisfactory evaluations Rotation PC, MK, ICS (meets expectations or above). evaluations Attend at least 70% of all mandatory EM conferences. PF, MK, PL Attendance sheets Demonstrate improvement in EM knowledge by scoring at MK, PC ABEM exam least 80th percentile on the ABEM In-service examination. Demonstrate competency in the chief complaints of chest pain, SDOT, oral boards, MK, PC syncope and pediatric fever. simulations Maintain licensure. PC, SBP Resident File Properly perform a trauma or medical code resuscitation. Simulations, global Appropriately sequences critical actions and identifies MK, PC evaluations, oral interventions required to immediately stabilize a patient. boards Manages multiple patients at various, progressive stages of SDOT, global work-up throughout the shift, making appropriate, timely MK, PC, SBP evaluations decisions. Supervises and facilitates patient flow in ED. Residents are expected to maintain timely documentation of Procedure logs, ICS, PC, SBP charts in the ED, medical records and hospital paperwork. med. recs dept. Demonstrate adequate documentation of procedures with at PC Procedure logs least 100% of ACGME targeted procedures listed in RP. Demonstrate adequate documentation of 10 follow-up Follow up logs, PC, MK diagnoses of patients seen in the ED. resident portfolios Demonstrate adequate progress with all specified academic Portfolio, lecture PL, ICS requirements as judged by the program director. evaluations Complete the residency required administrative project. pending SBP Semi-Annual eval. Complete the residency required academic project. PL Semi-Annual eval. Residents must demonstrate a commitment to carrying out Global evaluations, professional responsibilities, adherence to ethical principles PF 360 evaluations and sensitivity to a diverse patient population.. Demonstrate the ability to interact effectively with nurses, Global evaluations, ICS ancillary staff, patients and families. 360 evaluations LSUHSC Emergency Medicine Residency Handbook 09-10 63

Liaison & Oversight Policy

Records of EM resident evaluations are maintained by the EM Program Director. These files are generally available to the individual trainees, training faculty, Program Director. Residents are formally evaluated by the program director and/or faculty advisor twice a year. Both strengths and weaknesses are documented and discussed in the evaluation process as well as plans to remediate any deficiencies. Evaluation of Residents routinely includes comments by multiple evaluators such as the Program Director, clinic faculty, chief resident, and others. Additionally, each House Officer is expected to participate in departmental self-assessment.

The EM residency program maintains a standard of Satisfactory Academic Standing which is maintained on all the off-site and off-service rotations. The program director meets with the director of each rotation on an annual basis and, then electronically on a monthly basis. The director of each rotation completes a standardized evaluation of each rotating EM resident which is promptly reviewed by the program director. The EM residents are also required to complete rotation reviews after completing each rotation. If a unacceptable evaluation score is given by either the director of a rotation or the rotating resident, the EM program director immediately solicits full information and addresses the issue. LSUHSC Emergency Medicine Residency Handbook 09-10 64

Dismissal Policy

PRELIMINARY INTERVENTION Substandard disciplinary and/or academic performance is determined by each Department. Corrective action for minor academic deficiencies or disciplinary offenses which do not warrant remediation as defined below, shall be determined and administered by each Department. Corrective action may include oral or written counseling or any other action deemed appropriate by the Department under the circumstances. Corrective action for such minor deficiencies and/or offenses are not subject to appeal.

PROBATION House Officers may be placed on probation for, among other things, issuance of a warning or reprimand; or imposition of a remedial program. Remediation refers to an attempt to correct deficiencies which if left uncorrected may lead to a non-reappointment or disciplinary action. In the event a House Officer’s performance, at any time, is determined by the House Officer Program Director to require remediation, the House Officer Program Director shall notify the House Officer in writing of the need for remediation. A remediation plan will be developed that outlines the terms of remediation and the length of the remediation process. Failure of the House Officer to comply with the remediation plan may result in termination or non-renewal of the House Officer’s appointment.

A House Officer who is dissatisfied with a departmental decision to issue a warning or reprimand, impose a remedial program or impose probation may appeal that decision to the Department Head informally by meeting with the Department Head and discussing the basis of the House Officer’s dissatisfaction within ten (10) working days of receiving notice of the departmental action. The decision of the Department Head shall be final.

CONDITIONS FOR REAPPOINTMENT Programs will provide notice in writing of the intent to non-renew or non-promote residents 4 months prior to the end of the current contract except in the case when the cause for non-promotion/non- reappointment occurred within the final 4 months. In such cases house officers will be notified in writing with as much notice as possible (revised 6/21/2007)

TERMINATION, NON-REAPPOINTMENT, AND OTHER ADVERSE ACTION A House Officer may be dismissed or other adverse action may be taken for cause, including but not limited to: i) unsatisfactory academic or clinical performance; ii) failure to comply with the policies, rules, and regulations of the House Officer Program or University or other facilities where the House Officer is trained; iii) revocation or suspension of license; iv) violation of federal and/or state laws, 8 regulations, or ordinances; v) acts of moral turpitude; vi) insubordination; vii) conduct that is detrimental to patient care; and viii) unprofessional conduct.

The House Officer Program may take any of the following adverse actions: i) issue a warning or reprimand; ii) impose terms of remediation or a requirement for additional training, consultation or treatment; iii) institute, continue, or modify an existing summary suspension of a House Officer’s appointment; iv) terminate, limit or suspend a House Officer’s appointment or privileges; v) non- renewal of a House Officer’s appointment; vi) dismiss a House Officer from the House Officer Program; vii) or any other action that the House Officer Program deems is appropriate under the circumstances. LSUHSC Emergency Medicine Residency Handbook 09-10 65

DUE PROCESS Dismissals, non-reappointments, non-promotion (revised 6/21/2007) or other adverse actions which could significantly jeopardize a House Officer’s intended career development are subject to appeal and the process shall proceed as follows:

Recommendation for dismissal, non-reappointment, or other adverse action which could significantly threaten a House Officer’s intended career development shall be made by the Program Director in the form of a Request for Adverse Action. The Request for Adverse Action shall be in writing and shall include a written statement of deficiencies and/or charges registered against the House Officer, a list of all known documentary evidence, a list of all known witnesses and a brief statement of the nature of testimony expected to be given by each witness. The Request for Adverse Action shall be delivered in person to the Department Head. If the Department Head finds that the charges registered against the House Officer appear to be supportable on their face, the Department Head shall give Notice to the House Officer in writing of the intent to initiate proceedings which might result in dismissal, non-reappointment, summary suspension, or other adverse action. The Notice shall include the Request for Adverse Action and shall be sent by certified mail to the address appearing in the records of the Human Resource Management or may be hand delivered to the House Officer.

Upon receipt of Notice, the House Officer shall have five (5) working days to meet with the Department Head and present evidence in support of the House Officer’s challenge to the Request for Adverse Action. Following the meeting, the Department Head shall determine whether the proposed adverse action is warranted. The Department Head shall render a decision within five (5) working days of the conclusion of the meeting. The decision shall be sent by certified mail to the address appearing in the records of the Human Resource Management or hand delivered to the House Officer and copied to the Program Director and Academic Dean.

If the House Officer is dissatisfied with the decision reached by the Department Head, the House Officer shall have an opportunity to prepare and present a defense to the deficiencies and/or charges set forth in the Request for Adverse Action at a hearing before an impartial Ad Hoc Committee, which shall be advisory to the Academic Dean. The House Officer shall have five

(5) working days after receipt of the Department Head’s decision to notify the Academic Dean in writing whether the House Officer would challenge the Request for Adverse Action and desires an Ad Hoc Committee be formed. If the House Officer contends that the proposed adverse action is based, in whole or in part on race, sex (including sexual harassment), religion, national origin, age, Veteran status, and/or disability discrimination, the House Officer shall inform the Academic Dean of that contention. The Academic Dean shall then invoke the proceedings set out in the Section entitled “Sexual Harassment 9 Policy” of this Manual. The hearing for adverse action shall not proceed until an investigation has been conducted pursuant to the Section entitled “Sexual Harassment Policy.”

The Ad Hoc Committee shall consist of three (3) full-time clinical faculty members who shall be selected in the following manner:

The House Officer shall notify the Academic Dean of the House Officer’s recommended appointee to the Ad Hoc Committee within five (5) working days after the receipt of the decision reached by the Department Head. The Academic Dean shall then notify the Department Head of the House Officer’s choice of Committee member. The Department Head shall then have five LSUHSC Emergency Medicine Residency Handbook 09-10 66

(5) working days after notification by the Academic Dean to notify the Academic Dean of his recommended appointee to the Committee. The two (2) Committee members selected by the House Officer and the Department Head shall be notified by the Academic Dean to select the third Committee member within five (5) working days of receipt of such notice; thereby the Committee is formed. Normally, members of the committee should not be from the same program or department, In the case of potential conflicts of interest or in the case of a challenge by either party, the Academic Dean shall make the final decision regarding appropriateness of membership to the ad hoc committee.(rev. 7-1-2005) Once the Committee is formed, the Academic Dean shall forward to the Committee the Notice and shall notify the Committee members that they must select a Committee Chairman and set a hearing date to be held within ten (10) working days of formation of the Committee. A member of the Ad Hoc Committee shall not discuss the pending adverse action with the House Officer or Department Head prior to the hearing. The Academic Dean shall advise each Committee member that he/she does not represent any party to the hearing and that each Committee member shall perform the duties of a Committee member without impartiality or favoritism.

The Chairman of the Committee shall establish a hearing date. The House Officer and Department Head shall be given at least five (5) working days notice of the date, time, and place of the hearing. The Notice may be sent by certified mail to the address appearing in the records of the Human Resource Management or may be hand delivered to the House Officer, Department Head, and Academic Dean. Each party shall provide the Committee Chairman and the other party a witness list, a brief summary of the testimony expected to be given by each witness, and a copy of all documents to be introduced at the hearing at least three (3) working days prior to the hearing.

The hearing shall be conducted as follows:

The Chairman of the Committee shall conduct the hearing. Each party shall have the right to appear, to present a reasonable number of witnesses, to present documentary evidence, and to cross-examine witnesses. The parties may be excluded when the Committee meets in executive session. The House Officer may be accompanied by an attorney as a nonparticipating advisor. Should the House Officer elect to have an attorney present, the Department Head may also be accompanied by an attorney. The attorneys for the parties may confer and advise their clients upon adjournment of the proceedings at reasonable intervals to be determined by the Chairman, but may not question witnesses, introduce evidence, make objections, or present argument during the hearing. However, the right to have an attorney present can be denied, discontinued, altered, or modified if the Committee finds that such is necessary to insure its ability to properly conduct the hearing. Rules of evidence and procedure are not applied strictly, but the Chairman shall exclude irrelevant or unduly repetitious testimony. The Chairman shall rule on all matters related to the conduct of the hearing and may be assisted by University counsel. 10 The hearing shall be recorded. At the request of the Dean, Academic Dean, or Committee Chairman, the recording of the hearing shall be transcribed in which case the House Officer may receive, upon a written request at his/her cost, a copy of the transcript.

Following the hearing, the Committee shall meet in executive session. During its executive session, the Committee shall determine whether or not the House Officer shall be terminated, or otherwise have adverse actions imposed, along with reasons for its findings; summary of the testimony presented; and any dissenting opinions. In any hearing in which the House Officer has alleged discrimination, the report shall include a description of the evidence presented with regard to this allegation and the conclusions of the Committee regarding the allegations of discrimination. The Academic Dean shall review the Committee’s report and may accept, reject, or modify the Committee’s finding. The Academic Dean shall render a decision within five (5) working days from LSUHSC Emergency Medicine Residency Handbook 09-10 67

receipt of the Committee’s report. The decision shall be in writing and sent by certified mail to the House Officer, and a copy shall be sent to the Department Head and Dean.

If the Academic Dean’s final decision is to terminate or impose adverse measures and the House Officer is dissatisfied with the decision reached by the Academic Dean, the House Officer may appeal to the Dean, with such appeal limited to alleged violations of procedural due process only. The House Officer shall deliver Notice of Appeal to the Dean within five (5) working days after receipt of the Academic Dean’s decision. The Notice of Appeal shall specify the alleged procedural defects on which the appeal is based. The Dean’s review shall be limited to whether the House Officer received procedural due process. The Dean shall then accept, reject, or modify the Academic Dean’s decision. The decision of the Dean shall be final.

A House Officer who at any stage of the process fails to file a request for action by the deadline indicates acceptance of the determination at the previous stage.

Any time limit set forth in this procedure may be extended by mutual written agreement of the parties and, when applicable the consent of the Chairperson of the Ad Hoc Committee.

SUMMARY SUSPENSIONS The House Officer Program Director, or designee, or the Department Head or designee shall have the authority to summarily suspend, without prior notice, all or any portion of the House Officer’s appointment and/or privileges granted by University or any other House Officer training facility, whenever it is in good faith determined that the continued appointment of the House Officer places the safety of University or other training facility patients or personnel in jeopardy or to prevent imminent or further disruption of University or other House Officer training facility operations.

Within two (2) working days of the imposition of the summary suspension, written reason(s) for the House Officer’s summary suspension shall be delivered to the House Officer and the Academic Dean. The House Officer will have five (5) working days upon receipt of the written reasons to present written evidence to the Academic Dean in support of the House Officer’s challenge to the summary suspension. A House Officer, who fails to submit a written response to the Academic Dean within the five (5) day deadline, waives his/her right to appeal the suspension. The Academic Dean shall accept or reject the summary suspension or impose other adverse action. Should the Academic Dean impose adverse action that could significantly threaten a House Officer’s intended career, the House Officer may utilize the due process delineated above. 11 The Department may retain the services of the House Officer or suspend the House Officer with pay during the appeal process. Suspension with or without pay cannot exceed 90 days, except under unusual circumstances.

OTHER GRIEVANCE PROCEDURES Grievances other than those departmental actions described above or discrimination should be directed to the Program Director for review, investigation, and/or possible resolution. Complaints alleging violations of the LSUHSC EEO policy or sexual harassment policy should be directed to the appropriate supervisor, Program Director, Director of Human Resource Management and EEO/ AA Programs, or Ms. Flora McCoy, Labor Relations Manager (568-742).

Resident complaints and grievances related to the work environment or issues related to the program or faculty that are not addressed satisfactorily at the program or departmental level should be directed to the Associate Dean for Academic Affairs. For those cases that the resident LSUHSC Emergency Medicine Residency Handbook 09-10 68

feels can’t be addressed directly to the program or institution s/he should contact the LSU Ombudsman. (GMEC October 2007) OMBUDSMAN Dr. Thomas Alchediak of MCLANO will serve as an impartial, third party for House Officers who feel their concerns cannot be addressed directly to their program or institution. Dr. Alchediak will work to resolve issues while protecting resident confidentiality. He can be reached at 903-0381. LSUHSC Emergency Medicine Residency Handbook 09-10 69

Satisfactory Academic Standing

The EM residency program maintains a standard of satisfactory academic standing. The program director will assess your standing at minimum twice a year and will notify you if you are not meeting these minimum standards and assist you in formulating a remediation plan. The definition of satisfactory academic standing in our residency includes, but is not limited to the following:

a. Pass assigned monthly open-book CORD exams with a grade of 75 or above-- prior to scheduled deadline. b. Conference (didactic and non-didactic home study) and Journal Club attendance overall 70 percent or more (excluding vacation time) c. Carry out assigned lectures and journal clubs. d. Take and teach BLS, ACLS, PALS or any residency associated course when assigned. e. Meet all scheduling requirements of each monthly rotation. f. Complete all medical records in a timely fashion. g. Meet all ACGME and residency requirements for duty hours. h. Score at or above the national average for your level of training on the National In- Service examination. i. Complete and submit monthly evaluation forms prior to the 15th of next month. j. Maintain a procedure log which is updated at least quarterly. k. Abide by moonlighting policy in the Moonlighting Policy. l. Maintain a minimum performance level of “acceptable” based on monthly rotation evaluations. LSUHSC Emergency Medicine Residency Handbook 09-10 70

Evaluations

Resident Evaluation

 Resident Monthly Rotation Evaluation  Resident 6 Month Faculty Advisor Evaluation  Resident End of the Year Evaluation  Resident 360 Evaluation: filled out by peers, faculty and nurses  Resident Post Graduate Survey and Evaluation

Program Evaluations

 Rotation and Special Topic Evaluations  EM Lecture Evaluation  EM Resident Anonymous Annual Faculty Evaluations  End of the Year Program Evaluation  GME End of the Year Questionnaire  EM Faculty Peer Review LSUHSC Emergency Medicine Residency Handbook 09-10 71

Monthly evaluation of Residents by Faculty

FROM: LSUHSC-New Orleans Emergency Medicine Residency Program (or may be complete online in ResidencyPartner) (504) 903-3594 Fax: 903-0321 TRAINEE ______SERVICE:______DATE OF ROTATION______LOCATION: ______

Scale: (na) Not Applicable, not observed, Unacceptable, Acceptable, Outstanding If Unacceptable or Outstanding, please provide example. MEDICAL KNOWLEDGE : □ □ Inadequate: Does not display understanding □ Acceptable. Has appropriate knowledge □ Outstanding. Superior knowledge & mature n of basic science or clinical information, or base for level of training and is able to relate application of knowledge to clinical setting. a unable to relate knowledge to cases. Does not it to clinical setting. Recognizes life- Consistently able to sequence critical actions for recognize life-threatening conditions. Unable threatening conditions; may require patient care and generate a differential diagnosis to sequence critical actions. assistance in sequencing critical actions. for an undifferentiated patient. Example: Example:

PATIENT CARE: H&P, Differential Diagnosis □ □ Inadequate: Incomplete or inaccurate, □ Acceptable. Usually complete and □ Outstanding. Comprehensive information, n misses major problems. accurate, identifying major & minor thorough, precise. Mature analysis & synthesis of a Unable to make appropriate differential problems with an appropriate differential data by priority, extensive differential diagnosis. diagnosis or problem list. diagnosis list. Example: Example:

PATIENT CARE: Procedural Skills □ □ Inadequate: Doesn’t use proper technique, □ Adequate: Uses proper technique, □ Outstanding. Precise, efficient performance n awkward, bypasses steps, avoids procedures organizes equipment; Occasional difficulty with ease & dexterity, puts patient at ease a or disorganized. with complicated procedures. Example: Example:

PATIENT CARE: Diagnostic Tests & Consultations □ □ Inadequate: Overlooks basic tests, unable to □ Adequate: Orders & interprets diagnostic □ Outstanding. Has planned alternative n interpret results, consults are inappropriate or tests, consults appropriately. strategies based on pending diagnostic test a untimely. results. Consultations are timely and well- Example: coordinated with plan of care. Example:

PATIENT CARE: Decision-making □ □ Inadequate: Decisions are risky, unsafe or □ Adequate: Decisions typically accurate □ Outstanding. Mature, safe, decisions based on n inappropriate. and safe, uses common sense. Able to triage sound integration of data & reason. Prioritizing a Example: patients and problems by level of acuity. and critical actions are consistently appropriate. Example:

PRACTICE-BASED LEARNING: Evidence Based Medicine And Self-Education □ □ Inadequate: Doesn’t know patients, no □ Adequate: Supplements patient care with □ Outstanding. Extensive supplemental reading, n reading or online learning evident. current literature, textbooks or online knows disease process of own and other patients. a Example: readings. Example:

PRACTICE-BASED LEARNING: Teaching □ □ Inadequate: Does not participate in teaching □ Adequate: Participates in teaching □ Outstanding. Develops teaching opportunities, n students or other residents. opportunities. Actively teaches students & motivates, and teaches with enthusiasm and a Example: junior residents, motivates learning. dedication. Example: SYSTEMS-BASED PRACTICE: Resource Utilization □ □ Inadequate: Unable to formulate an □ Adequate: Management and discharge □ Outstanding. Management plan is typically n appropriate, resource- or cost-effective plan is appropriate for patient, with comprehensive, precise, and resource- & cost- a management plan. consideration given to patient and hospital effective. Example: resources. Example:

PROFESSIONALISM: Work Habits □ □ Inadequate: Poor attendance, shirks □ Adequate: Attends required activities, □ Outstanding. Consistently attends extra n responsibility, frequently late, prolonged accepts responsibility, usually punctual and functions, displays leadership role, highly a absence on shifts. Prevaricates. organized. Occasionally performs extra efficient. Stays late to help. Example: functions, showing some independent Example: initiative. LSUHSC Emergency Medicine Residency Handbook 09-10 72

PROFESSIONALISM: Insight And Self-Assessment □ □ Inadequate: Doesn’t accept criticism, □ Adequate: Accepts constructive criticism, □ Outstanding. Assesses own limitations & n displays little insight. appropriately asks for assistance and responds constructively to feedback. a Example: feedback. Example:

PROFESSIONALISM: Ethical and cultural sensitivity

□ □ Inadequate: Not responsive to patient’s □ Adequate: Responsive to patient’s age, □ Outstanding. Consistently acts as an n age, culture, disability or gender issues. culture or gender issues. Demonstrates outstanding role model, demonstrating a Unaware of patient as a person. respect, compassion and integrity. compassion and integrity in response to cultural, Example: gender, age or disability issues. Example:

INTERPERSONAL & COMMUNICATION SKILLS: Team Member □ □ Inadequate: Doesn’t work well with others. □ Adequate: Maintains good working □ Outstanding. Highly regarded by team. n Alienating, disrespectful to nurses, peers, relationship with team. Respected by nurses, Consensus-builder. Role model. a consultants. peers, consultants. Example: Example:

INTERPERSONAL & COMMUNICATION SKILLS: Verbal, nonverbal and documentation skills □ □ Inadequate: Unable to create or sustain a □ Adequate: Creates and sustains □ Outstanding. Excellent verbal, nonverbal and n therapeutic or ethical relationship with therapeutic and ethical relationships with writing skills. A role model a patients. Ineffective listener. Unacceptable patients and families. Effective listening, Example: documentation. verbal, nonverbal and writing skills. Example:

SUMMARY RATING:

□ □ Inadequate □ Adequate □ Outstanding n a

EVALUATOR: ______SIGNATURE______DATE:

ADDITIONAL COMMENTS:______LSUHSC Emergency Medicine Residency Handbook 09-10 73

Annual evaluation of Faculty by Residents

RESIDENT EVALUATION OF EMERGENCY MEDICINE FACULTY SECTION OF EMERGENCY MEDICINE, LSU HEALTH SCIENCES CENTER, NEW ORLEANS

ATTENDING:

RATING SCALE: Please use the following 1-5 numbered rating scale. You may use decimal points. 1) Unsatisfactory 2) Marginal 3) Satisfactory 4) Good 5) Outstanding

CLINICAL PERFORMANCE: 1. Overall knowledge ______2. Clinical judgement ______3. Communicates effectively with patients, staff, etc ______4. Availability during shifts ______5. Organization/administration of department ______6. Is generally available during clinical shifts ______7. Teaches while working clinical shifts ______8. Sees patients while working clinical shifts ______

CLINICAL TEACHING: 9. Quality of teaching skills ______10. Encourages questions and discussion ______11. Provides appropriate supervision for resident=s level ______12. Promotes practical application of knowledge ______13. Conducts regular patient rounds ______

DIDACTIC TEACHING: 14. Provides regular lectures ______15. Attends conference/journal club ______16. Quality of lectures ______17. Didactic knowledge of Emergency Medicine ______18. Provides/offers assistance with research ______

ROLE MODEL: 19. Approaches responsibilities with enthusiasm ______20. Demonstrates a genuine interest in residents ______21. Displays professional and ethical behavior ______22. Maintains good relations with house staff ______

OVERALL CONTRIBUTION TO RESIDENCY PROGRAM:

ADDITIONAL COMMENTS:

LIST AT LEAST ONE AREA WHERE THIS ATTENDING COULD IMPROVE: LSUHSC Emergency Medicine Residency Handbook 09-10 74

Evaluation of Rotations by Residents

Rotation:______

Unacceptable Acceptable Outstanding n/a Patient Pathophysioloy Charting, documentation, administratio n Faculty Supervision Faculty Teaching Efforts Nursing/ancillary Support Duty hours Balance between service & education Clear goals & objectives

Please comment on any rating of unacceptable: ______

Anything that you think should be improved? ______LSUHSC Emergency Medicine Residency Handbook 09-10 75

Evaluation of Program by Residents (part of year-end self eva)l.

The residency

What do you like best about our residency? What would you like to see changed about our

Yearly residency requirements

Have you met with your advisor this year?

Are all ACGME required procedures logged into Residency Partner? Have all your monthly evaluations been Have you submitted all scholarly activities and lectures to be filed in your portfolio? Does your conference attendance (including home study modules and journal club) exceed 70%? Have you completed the Core Competencies?

Have you submitted your 20 patient follow-ups? Are you in compliance with the ACGME mandated duty-hour maximum of an average of 60 hours per week (in ED), and 1 day off in 7, and minimum 10 hours off between shifts? LSUHSC Emergency Medicine Residency Handbook 09-10 76

6 month Evaluation of each Resident by Advisor

Resident: ______Date: ______HO-I HO-II HO-III HO-IV

Monthly Evaluations July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June Rotation Eval

Current National In-Service Examination score: ______Goal for next year______

Residency Partner Data (Obtain from EM Coordinator prior to meeting) . Conference attendance above 70% Yes No . Procedure Log up to date Yes No . Compliance with duty hours Yes No If answer “no” to any of above, please refer to Dr. Haydel immediately

Scholarly Activity: Topic: ______Faculty: ______Progress:

Completed: Y N

Short-term goals:

Long-term goals:

Plans for PGY4 subspecialty track:

Resident comments, suggestions, requests, input:

Recommendations to resident:

Signatures: ______Faculty Resident LSUHSC Emergency Medicine Residency Handbook 09-10 77

Yearly Eval and Final Exit Evaluation of Resident by Program Director

PGY1 Meeting Date______

Medical Knowledge: In-service score: ______Goal for next year:______Plan:______Mean monthly CORD test score:______70% conference attendance: yes no Medical Knowledge Monthly evals: inadequate _____ adequate ______outstanding ______Medical Knowledge 360 degree: inadequate _____ adequate ______outstanding ______Medical Knowledge Self evaluation: inadequate _____ adequate ______outstanding ______Medical Knowledge action plan initiated: no yes______

Patient Care: Patient Care monthly Evals: inadequate _____ adequate ______outstanding ______Procedure log vs ACGME targets inadequate _____ adequate ______outstanding ______Patient care Self evaluation: inadequate _____ adequate ______outstanding ______Patient care 360 degree: inadequate _____ adequate ______outstanding ______Patient Care action plan initiated: no yes______

Practice-Based Learning & Improvement: Journal Club attendance 70 %: yes no 20 patient follow-ups completed: yes no PB learning monthly evals: inadequate _____ adequate ______outstanding ______PB learning Self eval: inadequate _____ adequate ______outstanding ______PB learning 360 eval: inadequate _____ adequate ______outstanding ______PB learning action plan initiated: no yes ______

Systems Based Practice: SBP Monthly Evaluation: inadequate _____ adequate ______outstanding ______SBP 360 degree inadequate _____ adequate ______outstanding ______SBP Self evaluation: inadequate _____ adequate ______outstanding ______Systems Based Practice action plan initiated: no yes ______

Professionalism: Professionalism monthly evals: inadequate _____ adequate ______outstanding ______Prof 360 degree inadequate _____ adequate ______outstanding ______Prof Self evaluation: inadequate _____ adequate ______outstanding ______Conference attendance >70 % yes no Professionalism action plan completed: no yes ______

Interpersonal Communication Skills: ICS monthly evals: inadequate _____ adequate ______outstanding ______ICS 360 degree: inadequate _____ adequate ______outstanding ______ICS Self evaluation: inadequate _____ adequate ______outstanding ______ICS action plan completed: no yes ______

Resident signature______Program Director______LSUHSC Emergency Medicine Residency Handbook 09-10 78

PGY 2 Meeting Date______

Medical Knowledge: In-service score: ______Goal for next year:______Plan:______Mean monthly CORD test score:______70% conference attendance: yes no Medical Knowledge Monthly evals: inadequate _____ adequate ______outstanding ______Medical Knowledge 360 degree: inadequate _____ adequate ______outstanding ______Medical Knowledge Self evaluation: inadequate _____ adequate ______outstanding ______Medical Knowledge action plan initiated: no yes______

Patient Care: Patient Care monthly Evals: inadequate _____ adequate ______outstanding ______Procedure log vs ACGME targets inadequate _____ adequate ______outstanding ______Patient care Self evaluation: inadequate _____ adequate ______outstanding ______Patient care 360 degree: inadequate _____ adequate ______outstanding ______Patient Care action plan initiated: no yes______

Practice-Based Learning & Improvement: Journal Club attendance 70 %: yes no 20 patient follow-ups completed: yes no PB learning monthly evals: inadequate _____ adequate ______outstanding ______PB learning Self eval: inadequate _____ adequate ______outstanding ______PB learning 360 eval: inadequate _____ adequate ______outstanding ______PB learning action plan initiated: no yes ______

Systems Based Practice: SBP Monthly Evaluation: inadequate _____ adequate ______outstanding ______SBP 360 degree inadequate _____ adequate ______outstanding ______SBP Self evaluation: inadequate _____ adequate ______outstanding ______Systems Based Practice action plan initiated: no yes ______

Professionalism: Professionalism monthly evals: inadequate _____ adequate ______outstanding ______Prof 360 degree inadequate _____ adequate ______outstanding ______Prof Self evaluation: inadequate _____ adequate ______outstanding ______Conference attendance >70 % yes no Professionalism action plan completed: no yes ______

Interpersonal Communication Skills: ICS monthly evals: inadequate _____ adequate ______outstanding ______ICS 360 degree: inadequate _____ adequate ______outstanding ______ICS Self evaluation: inadequate _____ adequate ______outstanding ______ICS action plan completed: no yes ______

Resident signature______Program Director______LSUHSC Emergency Medicine Residency Handbook 09-10 79

PGY 3 Meeting Date______

Medical Knowledge: In-service score: ______Goal for next year:______Plan:______Mean monthly CORD test score:______70% conference attendance: yes no Medical Knowledge Monthly evals: inadequate _____ adequate ______outstanding ______Medical Knowledge 360 degree: inadequate _____ adequate ______outstanding ______Medical Knowledge Self evaluation: inadequate _____ adequate ______outstanding ______Medical Knowledge action plan initiated: no yes______

Patient Care: Patient Care monthly Evals: inadequate _____ adequate ______outstanding ______Procedure log vs ACGME targets inadequate _____ adequate ______outstanding ______Patient care Self evaluation: inadequate _____ adequate ______outstanding ______Patient care 360 degree: inadequate _____ adequate ______outstanding ______Patient Care action plan initiated: no yes______

Practice-Based Learning & Improvement: Journal Club attendance 70 %: yes no 20 patient follow-ups completed: yes no PB learning monthly evals: inadequate _____ adequate ______outstanding ______PB learning Self eval: inadequate _____ adequate ______outstanding ______PB learning 360 eval: inadequate _____ adequate ______outstanding ______PB learning action plan initiated: no yes ______

Systems Based Practice: SBP Monthly Evaluation: inadequate _____ adequate ______outstanding ______SBP 360 degree inadequate _____ adequate ______outstanding ______SBP Self evaluation: inadequate _____ adequate ______outstanding ______Systems Based Practice action plan initiated: no yes ______

Professionalism: Professionalism monthly evals: inadequate _____ adequate ______outstanding ______Prof 360 degree inadequate _____ adequate ______outstanding ______Prof Self evaluation: inadequate _____ adequate ______outstanding ______Conference attendance >70 % yes no Professionalism action plan completed: no yes ______

Interpersonal Communication Skills: ICS monthly evals: inadequate _____ adequate ______outstanding ______ICS 360 degree: inadequate _____ adequate ______outstanding ______ICS Self evaluation: inadequate _____ adequate ______outstanding ______ICS action plan completed: no yes ______

Resident signature______Program Director______LSUHSC Emergency Medicine Residency Handbook 09-10 80

PGY 4 Meeting Date______

Medical Knowledge: In-service score: ______Goal for next year:______Plan:______Mean monthly CORD test score:______70% conference attendance: yes no Medical Knowledge Monthly evals: inadequate _____ adequate ______outstanding ______Medical Knowledge 360 degree: inadequate _____ adequate ______outstanding ______Medical Knowledge Self evaluation: inadequate _____ adequate ______outstanding ______Medical Knowledge action plan initiated: no yes______

Patient Care: Patient Care monthly Evals: inadequate _____ adequate ______outstanding ______Procedure log vs ACGME targets inadequate _____ adequate ______outstanding ______Patient care Self evaluation: inadequate _____ adequate ______outstanding ______Patient care 360 degree: inadequate _____ adequate ______outstanding ______Patient Care action plan initiated: no yes______

Practice-Based Learning & Improvement: Journal Club attendance 70 %: yes no 20 patient follow-ups completed: yes no PB learning monthly evals: inadequate _____ adequate ______outstanding ______PB learning Self eval: inadequate _____ adequate ______outstanding ______PB learning 360 eval: inadequate _____ adequate ______outstanding ______PB learning action plan initiated: no yes ______

Systems Based Practice: SBP Monthly Evaluation: inadequate _____ adequate ______outstanding ______SBP 360 degree inadequate _____ adequate ______outstanding ______SBP Self evaluation: inadequate _____ adequate ______outstanding ______Systems Based Practice action plan initiated: no yes ______

Professionalism: Professionalism monthly evals: inadequate _____ adequate ______outstanding ______Prof 360 degree inadequate _____ adequate ______outstanding ______Prof Self evaluation: inadequate _____ adequate ______outstanding ______Conference attendance >70 % yes no Professionalism action plan completed: no yes ______

Interpersonal Communication Skills: ICS monthly evals: inadequate _____ adequate ______outstanding ______ICS 360 degree: inadequate _____ adequate ______outstanding ______ICS Self evaluation: inadequate _____ adequate ______outstanding ______ICS action plan completed: no yes ______

Resident signature______LSUHSC Emergency Medicine Residency Handbook 09-10 81

Program Director______

Final summary

Date started residency______Graduation date______

The graduation requirements met for: Medical Knowledge: yes no Patient Care: yes no Practice Based Learning: yes no Systems Based Practice: yes no Professionalism: yes no Interpersonal Communication Skills yes no

Based on the observations of the program director and faculty of the LSU Emergency Medicine Residency Program, this resident has demonstrated sufficient professional ability to practice independently and is eligible to take the ABEM boards.

Resident signature & date ______Program Director & date ______

Comments - ______LSUHSC Emergency Medicine Residency Handbook 09-10 82

The ACGME which oversees all residency review committees has recommended that residents be taught and evaluated using 6 core competencies. At LSUHSC-New Orleans, the Emergency Medicine residency program uses the following parameters to evaluate our residents within the 6 core competencies.

1. Medical Knowledge: Residents must demonstrate knowledge about established and evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to patient care. Residents are expected to demonstrate an investigatory and analytic thinking approach to clinical situations and to know and apply the basic and clinically supportive sciences which are appropriate to their discipline. We use the monthly CORD tests, the annual National inservice and monthly resident evaluations to evaluate medical knowledge and each year a Medical Knowledge (MK) action plan is developed by the program director and the resident.

2. Patient Care: Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Residents are expected to: 1. communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families 2. gather essential and accurate information about their patients 3. make informed decisions about diagnostic and therapeutic interventions based on patient information, preferences, up-to-date scientific evidence, and clinical judgment 4. develop and carry out patient management plans 5. counsel and educate patients and their families 6. use information technology to support patient care decisions and patient education 7. perform competently all medical and invasive procedures considered essential for the area of practice 8. provide health care services aimed at preventing health problems or maintaining health 9. work with health care professionals, including those from other disciplines, to provide patient-focused care

We use core competency based monthly evaluations and the yearly 360 degree evaluation to measure the ability of a resident to provide acceptable patient care. Any deficiencies are addressed in a Patient Care (PC) action plan developed by the program director and the resident.

3. Practice Based Learning and Improvement: Residents must be able to investigate and evaluate their patient care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Residents are expected to: 1. Analyze practice experience and perform practice-based improvement activities using a systematic methodology 2. Obtain and use information about their own population of patients and the larger population from which their patients are drawn 3. Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems 4. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other information on diagnostic and therapeutic effectiveness 5. Use information technology to manage information, access on-line medical information; and support their own education 6. Facilitate the learning of students and other health care professionals

We evaluate our residents performance in the area of Practice Based Learning and Improvement by participation in our monthly Journal Club, completion of assigned online problem based learning tasks, teaching ACLS, PALS and/or ATLS, completion of monthly patient follow-ups and death summaries and monthly resident evaluations. Any deficiencies are addressed in the year-end evaluation and a Problem Based Learning (PBL) action plan is developed by the program director and the resident.

4. Systems Based Practice: Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Residents are expected to: 1. Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources LSUHSC Emergency Medicine Residency Handbook 09-10 83

2. Practice cost effective health care and resource allocation that do not compromise quality of care 3. Advocate for quality patient care and assist patients in dealing with system complexities 4. Partner with health care managers and health care providers to assess, coordinate

We evaluate our resident’s progress in the area of Systems Based Practice by means of the monthly resident evaluations and the yearly 360 degree evaluation. Any deficiencies are addressed in the year-end evaluation and a System Based Practice (SBP) action plan is developed by the program director and the resident.

5. Professionalism: Residents must demonstrate a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population. Residents are expected to: 1. Demonstrate respect, compassion and integrity 2. Demonstrate a commitment to ethical principles 3. Demonstrate sensitivity and responsiveness to patients’ culture, age, gender and disabilities

We evaluate Professionalism in our residents via the 360 degree evaluation and monthly evaluations, and maintaining conference attendance of 70%. Any deficiencies are addressed in the year-end evaluation and a Professionalism (P) action plan is developed by the program director and the resident.

6. Interpersonal and Communication Skills: Residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients families, and professional associates. Residents are expected to: 1. create and sustain a therapeutic and ethically sound relationship with patients 2. use effective listening skills and elicit and provide information using effective nonverbal, explanatory, questioning, and writing skills 3. work effectively with others as a member or leader of a health care team or other professional group

We evaluate Interpersonal and Communication Skills in each resident via the monthly evaluations, yearly 360 degree evaluation and punctuality for assigned shifts. Any deficiencies are addressed in the year-end evaluation and an Interpersonal and Communication Skills (ICS) action plan is developed by the program director and the resident. LSUHSC Emergency Medicine Residency Handbook 09-10 84

Faculty Advisors

Evaluation of Resident Documents Policy Residents must meet once a year with their faculty advisors to review their evaluations, discuss their research project, present their procedure books, and generally give feedback regarding their experiences and performance in the residency. An evaluation must be filled out, signed and placed in the Resident file following each meeting,

HO I year –twice a year, HO II year - at six months HO III year - at six months HO IV year - at six months`

All house officers will meet with the Residency Program Director to review goals, procedures and future direction annually. Faculty advisor assignments for all residents are listed every year. LSUHSC Emergency Medicine Residency Handbook 09-10 85

Procedure and Patient Experience Documentation

Each resident must document patient experiences and procedures during residency. The program must be able to demonstrate to its accrediting agency that you receive adequate experience. You will also be asked to document your experience for future employers. This is considered part of your residency portfolio and will be reviewed quarterly by the program director.

Residents without documentation of patient care experience will not be allowed to proceed to next house officer level or graduate from the residency program. The residency director will not certify your competence for your future employers if you have not documented adequate competency in emergency medicine procedures.

Typical procedures that requiring minimal representation in procedure logs include intravenous access, foley catheter placement, nasogastric tube placement, gastric lavage, extremity splinting, simple suturing, simple incision and drainage, institution of mechanical ventilation. Typical procedures requiring maximal representation include chest tubes, intubation rapid sequence intubations, pediatric and adult sedation, central line placement, cricothyroidotomy, throracotomy, fracture/dislocation reduction, urethrogram, cystogram, complex lacerations, complex incision and drainage, intravenous pacemaker placements, trauma resuscitation, cardiac arrest resuscitation, complex medical resuscitation, rape examinations, obstetrical deliveries, and foreign body removal. Supervision and instruction of procedures should be documented on the web based worksheet (Residency Partner).

Procedures And Resuscitations –ACGME goals Numbers include both patient care and laboratory simulations

Adult medical resuscitation 45 Adult trauma resuscitation 35 ED Bedside ultrasound # Cardiac pacing 06 Central venous access 20 Chest tubes 10 Procedural sedation 15 Cricothyrotomy 03 Dislocation reduction 10 Intubations 35 Lumbar Puncture 15 Pediatric medical resuscitation 15 Pediatric trauma resuscitation 10 Pericardiocentesis 03 Vaginal delivery 10 The primary responsibility for the determination of procedural competency rests with the program director and the faculty. The RRC accredits programs, and does not certify or credential individuals. ACGME2007 # See ultrasound guidelines below. LSUHSC Emergency Medicine Residency Handbook 09-10 86

Ultrasound The ACEP policy statement recommends that an emergency physician receive didactic training and hands-on experience to become proficient in bedside emergency ultrasound. There are six commonly recognized "primary applications" for bedside emergency ultrasound. These applications, and the minimum number of training exams ACEP recommends for proficiency are outlined below:

Primary Application Training Exams FAST (Focused Abdominal Sonography in Trauma) 25 RUQ 25 Renal 25 AAA 25 Cardiac 25 Early pregnancy transabdominal 25 transvaginal 25 The ACEP guidelines further state that in order for a training scan to count towards credentialing, the findings of the scan must be confirmed by direct supervision, over-read of saved images, other confirmatory testing (ultrasound, CT, MRI, etc.), or clinical outcome. These must be documented on residency partner.

The residency is required to make a statement about each resident's competency in certain procedures.

 Please remember to document all procedures, including simulation and cadaver labs in Residency Partner .  You must complete all readings and Cord post-tests before the end of PGY2.  You are required to submit, at minimum, documentation that you have completed the ACGME targets before you graduate.

We have provided yearly targets to help you stay on track. In addition, you must submit formal evaluations of some procedures, which will be kept in you LSUHSC Emergency Medicine Residency Handbook 09-10 87

Common Procedures Removal of rust ring Tooth replacement The following are Procedures and Skills Hemodynamic Techniques Integral to the Practice of Emergency Arterial catheter insertion Medicine from the Model of the Clinical Central venous access 1.Femoral Practice of Emergency Medicine 2.Femoral 3.Jugular 4.Subclavian Airway Techniques 5.Umbilical Airway adjuncts 6.Venous cutdown Cricothyrotomy Intraosseous infusion Heimlich maneuver Peripheral venous cutdown Intubation Blood and Component Therapy Administration 1.Nasotracheal Obstetrics 2.Orotracheal Delivery of newborn 3.Rapid sequence 1.Abnormal delivery Mechanical ventilation 2.Normal delivery Percutaneous transtracheal ventilation Other Techniques Anesthesia Excision of thrombosed hemorrhoids Local infiltration Foreign body removal Digital block Gastric lavage Regional nerve block Gastrostomy tube replacement Sedation - analgesia for procedures Incision/Drainage Physical restraints Diagnostic Procedures Sexual assault examination Anoscopy Trephination, nails Arthrocentesis Wound closure techniques Bedside ultrasonography Wound management Cystourethrogram Universal Precautions Lumbar puncture Resuscitation Nasogastric tube Cardiopulmonary resuscitation (CPR) Paracentesis Neonatal resuscitation Pericardiocentesis PALS & ACLS Peritoneal lavage Adult and Pediatric ATLS Slit lamp examination Thoracentesis Skeletal Procedures Tonometry Fracture/Dislocation immobilization techniques Genital/Urinary Fracture/Dislocation reduction techniques Bladder catheterization Spine immobilization techniques 1.Foley catheter Thoracic 2.Suprapubic Cardiac pacing Testicular detorsion 1.Cutaneous Head and Neck 2.Transvenous Control of epistaxis Defibrillation/Cardioversion 1.Anterior packing Thoracostomy 2.Cautery Thoracotomy 3.Posterior packing/Balloon placement Laryngoscopy Needle aspiration of peritonsillar abscess LSUHSC Emergency Medicine Residency Handbook 09-10 88

Follow-up/ Inpatient Course/ Autopsy Follow-Up Log report: ______ED RESIDENT FOLLOW-UP ______SHEET ______Initials: ______MR#: ______

Case Details: Final Diagnosis: ______Education Point: ______Patient Feedback / Satisfaction: ______ED Resident: ED Diagnosis: ______Must submit 10 patient follow-up forms per ______year, including ED expirations referred to ______ME/coroner. Follow-up can be achieved via ____ the cliq system. To obtain an autopsy report done at MCLANO, email Dr. Robin Return to mail box of Dr. Detiege McGoey in the Dept of Pathology ([email protected]) with the patient’s name and medical record number. The follow up documentation will be through Residency Partner. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 89

Residency Partner

RESIDENCY PARTNER COMPUTER SOFTWARE PROGRAM House Officer will be required to comply with institutional policy regarding duty hours monitoring / recording through the use of Residency Partner Computer Program. House Officer must record their duty hours for ACGME compliance by entering the data in the Duty Hours Module of Residency Partner. Periodic monitoring will be done to ensure that duty hours are being logged into the system.

Residency Partner is the official web-based system for tracking all resident and fellow demographic information and rotation schedules. It is also used by residents to complete duty hours, procedure logs and evaluations.

Information for residents, fellows and attendings:

 Residency Partner login  Quick Start Card  Resident frequently asked questions

For procedures: login to residency partner, go to “cases”, click on “new”, put in correct date, institution and supervisor; the default will be “Emergency Medicine” and “ACGME”. Under ACGME procedures you will find the main procedures you should be logging. If the procedure is not listed under ACGME, then look under ER. Please use the ACGME link preferentially and just write in under comments any specifics. (ie, “central venous access” is an ACGME procedure, then you can type in “femoral” or “subclavian” under comments). You can input more than one procedure per patient, but when you are finished inputting each procedure MAKE SURE you click “Add CPT to Experience” and then click “Save” when you are finished with that patient.

Information for Program Directors and Coordinators

 Gumbo server login  Residency Partner user's guide  Residency Partner frequently asked questions

Request Residency Partner Support - get help with obtaining access to Residency Partner.

. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 90

Educational Stipend

The program has a Fund for the EM residents, which is managed by LSU. A total of $1,000.00 is allotted to each resident for conference expenses and medical texts aside from those that the program provides. You must obtain ADVANCED approval by Dr. DeBlieux to use these funds.

The residency program will reimburse residents participating in conferences as presenters of case reports and research above the allotted $1,000.00. Meetings located outside of the continental U.S. are evaluated on a case-by-case basis.

In order to obtain reimbursement for books, palm pilots, software and subscriptions, the original receipts must be turned in to the coordinator of the section of emergency medicine. This is different from the forms for travel and the travel reimbursement. Laptops and personal computers CANNOT be covered by the stipend.

For travel expenses and conference fees reimbursement, the request MUST be made 1 month BEFORE the conference, NOT afterwards (or you may not be paid). Information that should accompany the request is the following:

1. Name and location of the conference.

2. Date of conference.

3. Registration Fee.

4 . Airfare.

5. Official brochure of conference.

PLEASE NOTE:

The amount of money that is reimbursed for travel expenses is determined by state regulations and may only partially cover airfare, food and lodging expenses.

In order to receive money, residents must be in good standing and must not have any outstanding obligations to the residency program. All procedure logs, rotation evaluations, rotation study guide answers, remedial assignments, faculty resident meetings, etc. must be completed before checks can be issued. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 91

Travel Forms https://intranet.lsuhsc.edu/forms/ Get the Prior Approval Request For Travel Form PDF format, and Travel Expense Voucher Form PDF format For air travel you need to pay with the LSU corporate credit card VISA Application Form for Corporate Travel Card PDF format LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 92

Mailboxes/ Email

Residents have a mailbox in the residency office on the 5th floor which serves as a major means of communication in the program. Residents are expected to check their box daily and are required to do so once a week in order to receive important memos and messages on a timely basis. Ignorance of assigned activities due to failure to check your mailbox will not be considered a legitimate excuse. The boxes in the residency office are for program communications only. Please have journals and other mail sent to your home or your mailbox in the Mailroom in the basement of the hospital. If you have email and wish to have your memos delivered via this method as well as your traditional mail box notify the secretary of your request. Each resident is required to maintain an active LSUHSC email account. You are required to check your LSUHSC email at least once a week. Official LSU communications are provided by LSU email. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 93

Beepers

You are LOANED a beeper for your use during your residency. The beepers are leased by and coordinated through LSU which gives a certain number to each residency program. The program is given the responsibility of issuing beepers to you and receiving them back from you at the end of your residency in order to reissue them to incoming residents. You are responsible for the proper care and use of the beeper and for returning it in working condition to the residency whenever requested.

If your beeper is stolen, lost, or broken, you must report this immediately to the residency program. A $50 charge is assessed to the resident by the medical school to replace the beeper. A check for $50.00 payable to LSU Medical Center should be given to the residency program secretary who will forward it with appropriate paperwork in order to obtain a new beeper.

Replacement batteries are available in the Residency Office.

The residency program must be able to reach you by phone or beeper at all times . LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 94

Vacation

Each HO I receives 3 weeks of vacation which must be taken in one 2-week period and one 1-week period. The 1-week vacations must be taken during the first or last week of the month and the 2-week vacations during the first or second half of the month, not during the middle. HO II, II, and IV receive (2)two week vacations totaling 28 days. Interns and Residents who request vacation during the second half of February must be in town to take the National InService Exam which is given near the end of the month. Interns and Residents may not request vacation during the last half of December.

Indicate your first and second choices for each of your vacation periods..

Two-week Vacation Two-week Vacation lst choice ______(month) (1st or 2nd half) (month) (1st or 2nd half)

2nd choice ______(month) (1st or 2nd half) (month) (1st or 2nd half)

We will try to honor your requests but cannot guarantee that you will receive the choices indicated above.

Yearly Schedule Requests

Vacation requests -Vacation will be assigned based on seniority.

Once the annual schedule has been published, NO changes are allowed, other than due to extraordinary circumstances. (Example: marriage, or birth of a child).

Concerns or questions regarding the annual schedule should be addressed in writing to the Residency Director.

If a schedule change is made an official notification will be sent to the Residency Director, the LSU payroll, the resident and the resident file. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 95

ED Schedules

1. Seniority: Preference will be given to 5th years, then 4th years, then 3rd years concerning upper level schedules. Please be mindful of this when choosing your selections. The scheduling chief has data sheets on all residents in the program, and will be tracking your choices, special requests, schedule given, disaster calls, etc. The purpose is to accommodate all, while maintaining parity within the schedule.

2. Final Schedule: The final schedule for a month will be finished by the 1st of the month prior. After the final schedule is made, the scheduling chief will not make changes to your schedule unless speaking with you first. If glaring concerns arise or if someone is pulled off the rotation, then the chief will have to readjust the schedules. Otherwise, the only changes made to a monthly schedule after being finalized will be switches among residents or switches make only after consultation with that individual resident/s.

3. Resident Switches: When a switch occurs, the switch must be emailed to the Scheduling Chief. BOTH RESIDENTS MUST EMAIL THE CHIEF THE SWITCH. Please always remember when you are working, as forgetting that you are working will not be tolerated by any of the Chiefs or the program director. Missed shift will result in (at minimum) making up that shift and being assigned an additional penalty shift. Once the switch is made and both residents have emailed me, then the switch is final and valid. The responsibility of the shift is then on the resident who accepted the shift, not the original resident who was working the shift. If both residents do not email me, then the responsibility of the shift lies with the resident who is on the original schedule. When switching occurs, be mindful that 2nd years can only switch with 2nd years. 3rd 4th and 5th s can switch with each other. The only exception is if the 2nd year switches a shift with an upper level into an area where second years are allowed. As long as there exists a 3rd and 4th year in the MER at all times, then the switch can occur.

4. Penalty Shift: This is something we all would like to avoid. Penalty shifts will be assigned at the discretion of the disciplinary chief resident and the program director. A penalty shift will be assigned to a resident exhibiting inappropriate behavior. This includes but is not limited to not showing up for an assigned shift without calling, forgetting that you were working a shift, two unexcused absences from conference in a quarter, being on disaster call and being unable to be found for an activation, or other inappropriate behavior that will be interpreted on a case-by-case basis LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 96

Disaster Call

Purpose: To provide a uniform, consistent approach for coverage of emergency department (MER & FT) resident shifts left vacant or uncovered due to sudden illness, personal emergencies and scheduled leave of absences, including maternity and paternity leave. Disaster call may be activated for the community ED rotations and Acadian Helicopter Shifts, if necessary. Typically, if a resident must miss a shift in the community or on Acadian, they can make it up that same month. Disaster call may also be activated for the MICU.

Description: The back-up call system will be addressed by two mechanisms: standard back-up policy and extended backup policy. These systems will remedy short-term and long-term absences, respectively. The short-term policy will be utilized for absences less than five days, while the extended policy will be invoked for absences of five days or greater.

*Standard Back - Up Policy

Residents on off service rotations such as, Elective, Toxicology, and all others may be scheduled for Disaster Call. If at all possible, and if the resident is needed to report for ED back-up work, that resident will not be required to do more than 2 days of ED work. The residents providing back-up coverage will be PGY II, III, IV.

*Extended Back - up Call Schedule

If the resident's absence extends beyond the coverage of the standard back-up schedule, the extended to five days or greater or unexpectedly is extended to five days or greater, one resident will be pulled from his/her rotation to cover the remaining portion of the month or the entire month if the absence is anticipated prior to the first of the month. The resident will be pulled from the rotation from which he or she is most expendable and which impacts ACGME training requirements the least. The order of preference is the same as listed for the standard back-up policy.

*In the event of no emergency medicine coverage of the above listed off-service rotations, the Residency Director and the Assistant Residency Director, in conjunction with the chief residents, will select an appropriate resident, or residents, for back-up coverage.

Qualifying situations: Situations deemed appropriate for the use of the disaster call schedule are inclusive, but not limited to, the following events:

. Illness . Family death . Maternity/ Paternity leave (as defined by LSU under the Family Medical Leave Act) . Suspension of hospital privileges . Personal hardship (evaluated on an individual basis) . Emotional hardship/illness (as defined by LSU Human Resources Dept) LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 97

Program Benefits:The program and administration will benefit from a pre-determined back-up call schedule. In the event of a crisis, the solution is available prior to the problem. This should negate late scheduling difficulties and most conflicts, while maintaining the pre-determined resident man-power needs of all areas of the emergency department.

Resident Benefits:The resident working in the emergency department will benefit from a secured resident work force in the emergency department. No resident will ever be expected to assume the responsibilities and work load of two residents. The resident requiring time off will not be responsible for making up shifts for the back-up call residents. This debt is forgiven by each resident functioning as the back-up call resident while rotating on the above mentioned services. No resident will be allowed to abuse the use of the back-up call schedule system. However, if a resident requests coverage from another resident for a shift in the emergency department for personal reasons not deemed appropriate for official back-up coverage, the resident must repay that shift to the covering resident. Furthermore, if a resident has an un-excused absence from a shift in the emergency department, he or she must repay the covering resident for the shifts covered. Residents repaying back-up call residents must work the same number of hours which were covered during their absence.

Disaster Call Scheduling

1.Disaster Call schedules will be made in accordance with the monthly ED Schedule. Any special requests concerning disaster call should be made 6 weeks prior to the month. The number of calls taken per month will be dependent on seniority and needs of the schedule. A full month disaster call can result in a maximum of 5 calls, and a ½ month of disaster call can result in a maximum of 3 calls. If extra coverage is required beyond this, residents working an ED month may have to take 12-24 hours of disaster call per month. These situations are rare but may arise.

2. Covering Rotations: Residents on the following rotations will be on disaster call for that particular month: Elective, Toxicology and Administration. 1st years do not take disaster call. Disaster call is taken by 2nd, 3rd, 4th and 5th years only.

3. Time Covered: REMEMBER, the disaster call day starts at 7am, the morning of your date, and ends at 7am the next day. This coincides with the shifts. Even though M3 and F3 shifts go into another day, they started on the previous day.

4. Disaster Activations: . A disaster call activation will be made by the Chief Resident on call that day. . The resident with an emergency is to call the Chief Resident pager- 423-2537. Always call this pager when an emergency occurs or for any disaster activation. . The Chief on call will have a copy of the schedule and disaster call and activate the disaster resident. . If you are on call, it is your responsibility to have your pager on AT ALL TIMES. . If you are unable to be found while on disaster call, this will result in a penalty shift. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 98

. The chief residents will serve as back-up disaster call in case two activations occur in one day. Each chief will take one week of back-up call per month. This year, each chief will be taking 3 months of back-up disaster call throughout the year.

5. Disaster switches: Email all switches to the Scheduling Chief Resident and copy ALL parties involved in the switch.

Disaster Call & Duty Hours

Under no circumstances, will disaster duties exceed ACGME duty hour guidelines. See Duty Hours - Emergency Medicine

LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 99

Code Grey – Hurricane Guidelines

These guidelines have been setup in coordination with the Directors of Emergency Preparedness, Dr. Aiken and Dr. Hardy, for the 2008 Hurricane season.

 Category 1 Hurricane — winds 74-95 mph--No real damage to buildings.  Category 2 Hurricane — winds 96-110 mph--Some damage to building roofs, doors and windows. Some trees blown down.  Category 3 Hurricane — winds 111-130 mph (Katrina at landfall) Some structural damage to small residences and utility buildings. Large trees blown down. Terrain may be flooded well inland.  Category 4 Hurricane — winds 131-155 mph. Major erosion of beach areas. Terrain may be flooded well inland.  Category 5 Hurricane — winds 156 mph and up. Complete roof failure on many residences and industrial buildings. Some complete building failures with small utility buildings blown over or away. Flooding causes major damage to lower floors of all structures near the shoreline. Massive evacuation of residential areas may be required.

Definitions:

 Media Definitions (what you will see on the news) o A HURRICANE WATCH- you could experience hurricane conditions within 36 hours. o A HURRICANE WARNING -winds of at least 74 mph are expected within 24 hours or less.

 Hospital Definitions: o Code Grey- Hurricane . Code Grey Watch: expected landfall 96 hours (4 days out) . Code Grey Warning: expected landfall 72 hours (3 days out) . Code Grey Activation: expected landfall 48 hours until 24 hours after landfall . Code Grey Recovery: 24 hours after landfall . Code Grey Evacuation: Hospital evacuation may be required and will be coordinated by the Directors of Emergency Preparedness.

Overview:

. At the beginning of each academic year, the chief residents will develop a list of residents for the activation and recovery teams. . Assignment to the activation team is strictly voluntary and will provide coverage for hospital and off-sites areas that we will cover during a storm. . The activation team is committed to be in-house 48 hours before landfall and will stay until the recovery team arrives. . When a Code Grey is initiated, the chief residents will assign residents currently rotating in the UH ED, toxicology, administration and local electives to the activation team and recovery team. . The activation team consists of 9 residents. (3/shift in the ED, 2/shift off-site coverage) . The recovery team consists of 9 residents—this will allow equal time off for the activation team after the storm threat has passed. In theory, the recovery time period will cover the same amount of time as the activation time period. . Residents will be assigned to 12-hour shifts either in the ED or at an off-site staging area. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 100

. Potential Off-Site Staging Areas: Lakefront airport, Convention Center, etc, to be assigned by the Directors of Emergency Preparedness. . Residents not assigned to either team are expected to be available during the recovery period for unexpected assignments. . The recovery team is expected to be prepared to report for duty 24 hours after landfall. . EM residents in the MICU and TICU will follow the MICU and TICU protocol for activation and recovery. . Residents on community ED rotations will be released from duty at the onset of Code Grey Activation for Category 3 or above. . All interns will must follow the guidelines on the service where assigned that month—in general, expect to be released from duties, if not needed to help in evacuation of patients on your service in the setting of a Category 3 or above storm. . The EM offices on the 5th floor UH will act as the Residency Central Command Center and will be staffed by the program director and a chief resident during the Code Grey Warning phase.

Section of Emergency Medicine Telephone Activation Tree

The purpose is to facilitate the flow of information from the Program Director to all members of the residency. The tree will be activated at the onset of Code Grey Watch, and at least every 12 hours thereafter, until termination of the Code Grey, or termination of recovery. It is the responsibility of every faculty member to provide the Program Director with 2 reliable telephone numbers, and 1 alternative email address. Please sign up for the LSU emergency notification alert system: http://www.lsuhsc.edu/alerts/

In addition, Dr. Haydel will serve as EM section communication officer during code grey activations. It is anticipated that she will evacuate at the onset of code grey activation, and establish a location from which she can act as a central point of contact and will disperse updates via email and cell phone text messaging. In the event of a major storm with hospital service disruption, the program directors, program coordinators and chief residents will meet at a pre- assigned location to continue with the oversight of the residency. In the event that communications are compromised the yahoo website will be updated regularly, and temporary access will be given to family members and friends that identify themselves as looking for information about a specific resident on the activation team: http://health.groups.yahoo.com/group/LSUEM/

Phone Tree: Elder PGY4s Chief Pager Stevens PGY3s Haydel Zorub PGY2s & Avegno Cole PGY1s IM/EM Chief McKay IM/EM residents on EM side LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 101

Timeline

Under the direction of the Section Chief, the program director will activate the notification tree, based upon the anticipated time required for residents to secure their homes and initiate their personal hurricane plans. This will be no later than initiation of the hospital wide plan.

. 96 hours to landfall (Code Grey Watch) o Program Director and Chief Residents meet and establish the command center for residency in 5th floor EM offices. o A list of the Activation team must be sent to the medical director's office as soon as a Code Grey Watch is announced. o Activation Team notified in order to pack and prepare for activation. . 72 hours to landfall (Code Grey Warning) o Activation Team physically checks into hospital to obtain arm bands, call rooms, parking passes and discuss plan of action with Chiefs and Program Director in EM office/5th floor. After checking in, the activation team may leave the hospital to continue home preparation and packing. o 12-hour shifts implemented in order to facilitate preparations. . 48 hours to landfall (Code Grey Activation) o Activation Team must remain in-house until recovery team arrives. o Community ED residents released from duty if Cat 3 or above. o Non-essential interns released from duty at UH.

Advanced Personal Preparation: Each resident is urged to formulate a personal hurricane preparation plan. This should include: . A list of critical actions that must be accomplished during the short time available before the storm, such as securing pets, evacuation of family, securing the home. . A list of items to pack, including 10-14 days of clothing, non-perishable food, water, bedding. . A list of items that should be purchased in advance, such as rechargeable lights and batteries, a power inverter for your car (to recharge cell phones, lights, radios when the electricity fails), toiletries. . A list of items needed to return to work during recovery, assuming that the city will be without power and water at the time return to work is required. . Secure professional paperwork, licenses, personal photos, etc in ziplock bags.

What to expect if you stay at UH during a Cat 3 or above storm: Power will go out and generators will go on. Generator power means no a/c, no elevators, no pumps in the basement, no pumping of water up to upper floors. No sewer system and no drinkable tap water. Upper floor windows will be blown out by strong winds. Communication within the hospital will be compromised, and communication with people outside the hospital will be almost nonexistent: The pager system and intranet can be expected to fail. Cell towers will be lost—although text messaging may remain intact for some. Patients and equipment will have to be moved from the first floor to the second floor if flooding occurs. Residents in the hospital will provide care to inpatients and walk-ins until the hospital is evacuated or the recovery team arrives. Residents assigned to off- site areas will provide care to patients who are at the staging areas awaiting evacuation. If the hospital is closed due to damages, the Recovery teams will be assigned (with faculty) to other sites to provide emergency care until the hospital can be reestablished. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 102

Advanced Life Support Programs Policy

Revised May, 2004 All Emergency Medicine and Emergency Medicine/Internal Medicine combined program Residents must maintain certification at the provider level for Basic Life Support Healthcare Provider (BLS-HP), Advanced Cardiac Life Support (ACLS), Pediatric Advanced life Support (PALS), and Advanced Trauma Life Support (ATLS). BLS, ACLS, and PALS courses are provided through the LSU Emergency Medicine / American Heart Association Community Training Center. ATLS courses are provided through Tulane University Hospital Life Support Office. Certification in each of these courses must be completed before December 31 of the intern year, and maintained throughout residency. The costs of initial provider courses are covered by the residency program. ATLS re-certification course costs are the responsibility of the resident. Failure to attend a scheduled provider course without the prior approval of the Residency Director will result in rescheduling of the course at the resident’s expense.

All residents are required to become certified as ACLS and PALS instructors. Normally, Emergency Medicine house officers (PGY-I) receive ACLS and PALS instructor courses during intern orientation. Transferees or those who have an excused absence from these courses must complete a course before December 31 of the intern year. Instructor status is maintained throughout residency by participation in a minimum of 2 ACLS courses each year. At each course, the resident must provide 1 lecture and teach the corresponding small group session. Instructor and provider status are kept current by meeting the teaching requirement and successfully completing the ACLS provider test every 2 years, before expiration of the current instructor card. (It is the responsibility of each resident to complete re-certification before expiration of his/her current instructor card. The AHA does not allow a grace period under any circumstances. Failure to re- certify will require that the resident take a full provider and instructor course again.) Additionally, all residents are encouraged to certify as an instructor in 1 of the 2 other disciplines (ATLS, BLS).

ATLS Instructor programs are offered through Tulane University Hospital Department of Community Education. Participation in the instructor program is by invitation of the Residency Program Director. Instructors may sign a contract with Tulane agreeing to provide service as an instructor in lieu of paying course tuition. The cost of the course is usually paid after teaching at 4-5 courses. Instructors must teach a lecture and corresponding small group session at least once per year. At the end of each 4 year cycle, an instructor in good standing may take the ATLS provider test to renew provider and instructor status. Schedules for ATLS courses are available through Tulane at 588-2212.

Scheduling of instructors for ACLS, PALS, and BLS courses is the responsibility of the Chief Residents and the Training Center Coordinator. Failure to teach at an assigned course without prior notice will result in disciplinary action. (In the event that a resident encounters an unforeseen emergency that interferes with a scheduled course, he must notify the responsible Chief Resident 72 hours in advance of the course. Excuses less than 72 hours in advance require the approval of the Director of the CTC, or the Residency Director. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 103

Confirmation of compliance with this policy is required at each faculty advisor interval evaluation. Failure to satisfy the policy requirements will result in disciplinary action, at the discretion of the residency director. Disciplinary action may include suspension of moonlighting privileges and additional life support teaching responsibilities. Revision 05/08/04 RS

Addendum – ACLS/PALS Course Directors (effective July 2004) ACLS/PALS teaching and scheduling are an important part of resident education, community outreach, and chief responsibility. Previously, however, non-chief residents with a real interest in ACLS/PALS had little opportunity for initiative or responsibility. The following change seeks to improve resident investment in the ACLS/PALS courses without compromising the courses’ quality.

Chief Residents will continue to make the overall master schedule for the year of who teaches what when. Every month, the 4th (and possibly 3rd) year resident on elective will be that month’s ACLS/PALS director. This resident is responsible for reminding residents scheduled to teach and assigning a lecture/small group slot to each; touching base with Nona and Kathleen in the immediate pre-course period to confirm room locations etc.; supervising resident lectures; and filling in when there is a gap in one of the lectures or stations. Directors will each receive a handout with information and a timeline that would have to be completed and turned in to the Chief Residents at the completion of the course for documentation and quality assurance purposes. Being the director would count as one’s ACLS/PALS requirement for the year – chiefs would oversee the activities of the director and remain “on-call” as double back-up for lectures, etc.

Chiefs, in coordination with the monthly ACLS/PALS director, would handle any disciplinary issues related to residents not showing up to teach, not doing a good job, etc. Any failure to teach when assigned and properly notified ahead of time would result in an extra ED shift (as noted above).

Commencing January 2001, interval faculty advisor/resident evaluations will include confirmation that the resident has:

 successfully completed provider courses in ACLS, PALS, and ATLS.  achieved instructor status in ACLS.  achieved instructor status in BLS, PALS, or ATLS.  met all teaching requirements as specified by the AHA or ACS for maintenance of instructor status.

Commencing January 2001, the penalty for noncompliance with the stated policy may include actions outlined above, including suspension of moonlighting privileges.

Questions or comments regarding this policy should be directed to a Chief Resident, or to the Program Director. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 104

Moonlighting Policy

All residents must read and sign the attached acknowledgement to confirm that you are aware of and understand the residency program's policies regarding moonlighting.

1. Although it is recognized that supplemental income from moonlighting is used by residents to offset financial obligations from undergraduate and medical school training, moonlighting activities can in no way be permitted to compromise your school functions as a House Officer or to detract from your learning experience.

2. Moonlighting is permitted for emergency medicine residents who maintain a satisfactory academic status (see section on Liaison & Oversight Policy) and meet all their residency associated clinical and teaching responsibilities. Specifically, residents who wish to moonlight must: a. Take and pass monthly cord exams by the prescribed completion dates. b. Adhere to all conference attendance policies. Any absence due to moonlighting will result in a permanent loss of moonlighting privileges. c. Take and teach BLS, ACLS, PALS or any residency associated course when assigned. d. Meet all scheduling requirements of each monthly rotation. Schedules will not be will not modified to accommodate moonlighting commitments. e. Complete all medical records in a timely fashion. f. Meet any and all requirements that may be set forth regarding moonlighting. g. Pass the National In-service Exam with a score of 75% or more.

3. Residents may not enter into any contractual agreements to provide any type of medical service on a regularly scheduled basis as this would interfere with the resident's clinical duties. Contracts which do not require regular and consistent moonlighting may be acceptable and should be submitted to the program director for approval.

4. Any resident who has been placed on probation may not moonlight during the probation period and for at least three months thereafter. Permission of the residency director must be obtained before moonlighting.

5. Per ABEM regulations, no resident will be allowed to work more than 6 consecutive days. All residents must have 10 hours of rest between duty periods. Failure to abide by these agreements will result in loss of moonlighting privileges and possible disciplinary action. Moonlighting hours must be documented in Residency Partner. (see ACGME governed Resident Duty Hours and the Working Environment)

6. It is recognized that the residency position is offered with the understanding that this residency is the primary and central responsibility of the house officer. Where moonlighting activity is perceived to interfere with a resident's performance, the resident will be required to stop the activity.

7. Should sub-par resident performance related in any way to moonlighting be identified, or if RRC duty hour violations occur (Paragraph 5) due to moonlighting, or if moonlighting activity is not accurately reported in Resident Partner, the resident will be put on academic probation and a remediation plan will be implemented by the program director.

8. Residents should understand that they are protected by state of Louisiana malpractice coverage only when performing residency assigned duties, and not when engaged in moonlighting.

ACKNOWLEDGEMENT OF MOONLIGHTING POLICY

I have read and understand the Emergency Medicine Department's Moonlighting Policy and agree to accept the terms and conditions set forth in such policy.

Name______Signed______Date______LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 105

Call Room

A call room is available for you to use if you would like to rest after a night shift. It is Call Room #5 and is shared with the MICU. Please obtain the key from the chief residents if you would like to use the room. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 106

Sick Leave

Residents are awarded sick leave as a fringe benefit of their employment. In order to use this benefit, the following policy must be adhered to while on all rotations:

. The resident must notify the Chief Resident (Pager # 423-2537) immediately in order to activate disaster call. . The resident must notify the residency director in writing of any and all sick leave taken on any rotation within one week of the day(s) missed. . The resident must notify the residency director and the staff on duty at his emergency department rotation site by phone of his illness as early as possible before the assigned shift. . On inpatient services, the resident should notify both the chief resident of the service and the resident's immediately supervising resident by phone as early as possible before the assigned duty. . In order to obtain an excused absence from a scheduled shift due to illness, the resident MUST REPORT to the ED where they are assigned to see the staff person on duty who will help the resident manage his illness and email the residency director.

Shifts missed due to illness do not need to be "made up" if the above policy is followed unless, in the opinion of the residency director and the director of the service, the resident received an educational experience due to a prolonged illness. The American Board of Emergency Medicine also has minimum time requirements which must be met if the resident is to be eligible to take the board exam.

Failure to adhere to this policy will result in the missed shifts being considered an unauthorized absence. The missed time must be made up and disciplinary action taken. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 107

Conference Attendance Policy (July 2008 update) Didactic Resident Conference is 7am-11am, each Wednesday University Hospital Basement Classroom

Journal Club is 7pm-10pm the 2nd Thursday of each month.

Conference and journal club attendance is mandated by the Emergency Medicine Residency Review Committee. Conference is comprised of 4 hours of didactic lectures per week and 4 hours of non-didactic learning per month. The non-didactic learning is comprised of 2 hours of Journal Club and 2 hours of computer based learning modules each month. Go to the LSU EM home page and click on “home study” to reach the schedule. The learning modules may be done earlier than the month scheduled, but no later than 1 month after the scheduled month.

Emergency Medicine Residents must attend 70 % of conferences (didactic and non-didactic).

You are excused from conference and journal club while you are Vacation.

If you have difficulty being released from your clinical duties, address this problem immediately with the chief residents or Program Director. If you think conference attendance is in violation of your duty hours, please notify the Program Director immediately.

Attendance Goals: Our goal is > 80% lecture attendance, when accounting for vacation and excused absences. The RRC requires 70% minimum attendance throughout the year, without considering excused absences.

 If less than 80%: The program director will notify the resident  If less than 70%: The program director will notify the scheduling chief to assign penalties: -65-69%: Extra Disaster Call Shift -60-64%: Extra Disaster Call Shift AND Extra Fast Track Shift  If less than 70% three consecutive months or if <60% two consecutive months: The resident will be required to meet with the program director to determine a remediation plan. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 108

Monthly CORD Exam

(7/08 updated)

Re: Monthly CORD Exams

The online monthly in-service exams must be completed by the day scheduled for discussion. The exams will be scheduled at least one month in advance and are “open book”. Residents who score less than 75% will be assigned additional questions in that topic.

Failure to complete more than three exams on time during one academic year will result in probation and a letter in the permanent file.

2007-08 November 28: HEENT December 18: EMS Jan 31: Musculoskeletal Feb 29: Trauma Mar 31: Procedures Apr 30: Cardiovascular May 31: Anesthesia June 30 OB

2008-09 July: Neuro Aug: NeuroSurg Sept: Cutaneous Oct: Pediatrics Nov: Toxicology Dec: Environmental Jan: Endocrine Feb: Mock Inservice Mar: ID April: Abd/GI May: Admin June: Research LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 109

Journal Club

2nd Thursday each Month 7:00 pm

The purpose of Journal Club is to discuss articles relevant to Emergency medicine. Whether these articles are "good" or "bad" is not important. What is important is to gain an understanding of research design, statistics, and interpretation of data. Hopefully this will enable you to gain a better understanding of the article: you read as well as help you in your own research projects.

Journal Club Procedures will be as follows:

a. The purpose of Journal Club is to discuss articles relevant to Emergency medicine, and to gain an understanding of research design, statistics, and interpretation of data. b. Dr Slaven is the director of Journal Club c. Each year one of the Chief Residents coordinates Journal Club dinner and makes the annual schedule of resident leaders and presenters. d. A PGY3 resident is assigned each month to be the Leader and select a topic and articles (approved by Haydel) and lead the discussion. e. 2-3 other residents will be Presenters and present the articles using the critique template which follows and is posted on the yahoo website. f. Articles will be distributed via email and the yahoo website one week prior to Journal Club: http://groups.yahoo.com/group/LSUEM/ g. Unless excused or working, attendance and preparation are required. h. Failure to present for Journal Club may be grounds for disciplinary action.

Responsibilities of the Journal Club Leader:

The Leader of each Journal Club will be assigned by the chief residents prior to the start of each academic year. As Leader, be sure that you are able to attend on your assigned date.

Pick an appropriate topic for your Journal Club Month. A list of suggested topics is posted on the yahoo website: http://groups.yahoo.com/group/LSUEM/ If you need assistance in choosing your topic, you can speak with any of the program directors. Your topic must be approved by Dr. Haydel three weeks prior to journal club. Once your topic has been approved, you must choose 3 articles pertaining to your topic. These articles must then be submitted to Dr. Haydel for final approval two weeks prior to journal club.

After your articles are approved, select one article for yourself to present, then assign the other two articles to the other two presenters designated on the schedule.

Your articles must be submitted for approval at least two weeks prior to the Journal Club Date.

Once approved, submit your 3 articles to the section secretary for distribution to the residents and staff. Please indicate the Journal Club Month on each article, as well as the order of presentation of your 3 articles. For example, "Article #1- July 2002 Journal Club, etc." LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 110

Journal Club Presenter Responsibilities

Make sure that you are off the night of your respective presentation date. Request to be off when putting in your monthly schedule requests.

Stay in touch with the Leader of your Journal Club, so that you can receive your article well in advance.

Adhere to the Standard Journal Club Presentation Format (Journal Club Literature Critique Form)

Finally, the Journal Club Chief Resident is responsible for organizing dinner and the location for each Journal Club. The section secretary will notify all of the location each month once things are lined up. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 111

Journal Club Literature Critique Form

Article title and journal:

Study objectives:

Hypothesis:

Outcome measures(dependent variables):

Methods Design features Design type _ Observational Randomized no yes: _ Case-control Blinded no yes: (single or double) _ Cohort Prospective or Retrospective _ Experimental Controlled no yes : _ Cross-over _ Other: ______

Sample: Number of data points or sample size (n) ______Inclusion criteria: Exclusion criteria: Treatment (independent variables):

Sampling type: __ convenience _ consecutive _ randomized _ systematic __other:

Describe each treatment group and indicate number (n) for each:

Data type: __nominal (named ie yes, no) __ordinal (ordered, numbers) ___interval (specific differences) Statistics: What statistical analysis is used?

Are the statistics used appropriate for the data?

What are the confidence intervals?

Results: Is the hypothesis accepted or rejected? Does the study answer the question asked? How could the study be redesigned to better answer the question asked? Were adverse effects of treatment, limitations to the study, and intention to treat discussed?

Conclusions: Is the study biased? Are conclusions supported by the data? Is the study good or not? Does it affect your practice? LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 112

M & M Presentations

The following will be presented in a PowerPoint Presentation.

This is a “Question – Answer” case with HPI, H&P, Labs, ED course:

First Slides: HPI, Physical exam The first question: What is the differential diagnosis?

Other questions: (Diagnostic) What tests would you order? (Management)Appropriate actions would include?

Second Slides: Course of action, what happened to the patient.

Presenting resident will summarize the case

At this point a member of the audience will be ask to critique the management of the case. Was this the proper course of action?. Would you have done something different?. Why?.

Last Slides: two questions: (Clinicopathologic questions) Referenced, relevant and pertinent question to the case presented. (No true or false, No all the above.) In A, B, C, D, E best single answer format.

Example:

64 y/o Hispanic male arrives to the ED c/o Left flank pain of sudden onset of one hour duration. PMH. - Left kidney stone 2 yr. ago. and Hypertension. Social - Smoker 1 ppd x 30 yr., retired. Meds. - blood pressure meds. NKDA. PE - BP 90/60, 72, 98.2, 26. The patient appears in severe pain, can't get comfortable on the stretcher. HEENT - Gr II HTN retinal changes, Neck - no JVD, Lungs -Clear, Heart - rr, no murmur, Abd. - diffusely tender, quiet, Rectal - neg hemetest. Pulses - 1+ Symmetric.

Q. #1. Differential Diagnosis: Nephrolithiasis Diverticulosis Ruptured Viscus Leaking/Ruptured AAA Ischemic Bowel

Q. #2 Diagnostic: ABC"s EKG IV x 2 - Fluid bolus, Labs 02 high flow Q. #3 Management:

Stat Surgical Consult LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 113

Clinical course: (Presenting Resident) This patient was admitted to the monitor cubicle, primary assessment, IV x 2 started, blood drawn for CBC, Chem., high flow 02, cardiac monitor, Secondary assessment. Pressure support with Dopamine, IV fluids. A CT scan of the Abdomen was done 1 hour latter. The patient was taken from the CT table to Surgical OR due to the patient's clinical deterioration and died while in Surgery.

Audience Critique: (Designated by Staff Present or Chief Resident) After initial resuscitation of the patient and the initial ancillary tests this patient should have been moved to the OR for immediate Surgical intervention. Even Though the mortality of a ruptured AAA is over 80% this patient could have had a better chance if there would not have been a delay in administering pressure support drugs and obtaining a CT scan.

Q. #4 Clinicopathological:

1.) The most common presentation of AAA is?

a. painless, pulsatile mass found on routine exam b. tearing flank pain, like kidney stone c. patient usually dead on arrival e. chest pain f. nausea, vomit and abdominal cramping

Answer: a

2.) Indications for CT in pt's with AAA

a.) unstable patients with no inmediate surgeon available b.) in differentiating pancreatitis from ruptured AAA with pt's V S P-130, BP- 90/60, R- 20 c.) patients suspected of having chronic contained rupture d.) at surgeon's request for preparative planning in ruptured AAA e.) in differentiating AAA vs. appendicitis in pregnant female with history of Hypertension and tobacco use.

Answer c

Ref. Tintinalli, Emergency Medicine - A Comprehensive Guide, 4th ed. ch.59 LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 114

Medical Records 1. Residents should make every attempt to complete their medical records while the patient is still in the hospital by signing student notes, verbal orders, H & Ps, etc.

2. Medical Records will notify the resident if he or she has delinquent charts. The resident should correct this situation immediately. The hospital' JACHO accreditation is jeopardized by a large number of delinquent medical records. Residents who do not complete delinquent charts within the allowed period will be suspended by the Medical Director without pay.

3. To avoid this, residents should make an appointment with Medical Records to complete these charts immediately upon notification. Residents should not just "drop by" to complete charts or they will have to wait while charts are pulled.

. Residents are responsible for creating legible medical records that will be useful as documentation for patient care and billing purposes. Residents are required to use their name stamp or to print their name and 5 digit identification number under their signature on all medical records. They should date and time all medical record entries. . Medical Records guidelines pertain to all hospitals that EM residents rotate through during their residency.

Electronic Signature

Medical records in Electronic Signature is an official requirement for our residency. This will allow residents to sign any dictated document from any computer. They will not have to come in to the hospital to sign records and they will be able to sign their UH discharge summaries, etc., while rotating at any other hospital. It will be convenient for them and will keep them off the suspension list for delinquent medical records.

Please contact Ms. Jones in medical records to obtain your electronic signature: [email protected] LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 115

LSU EM Reading Topics 2008-09

 Topics are all on an 18-month cycle (6 quarters) and have been adjusted for the 2008-09 year; quarter 5 starts July 2008.  Subjects are organized by quarter with the number of total pages in parenthesis—You can complete an entire text in an 18-month cycle.  Note the bottom of these tables is a list of topics that are fair game for every quarterly exam.  All three major ER texts are represented by edition (Tintinalli, Rosen, and Harwood-Nuss). The new Adams text will be added ASAP.  This list will also be posted to the LSUEM yahoo group.  The national inservice is the third Wednesday of every February (Feb 25, 2009).

QUARTER 5 – July 1st to September 30, 2008 HARWOOD- TINTINALLI TINTINALLI ROSEN TOPIC ADAMS NUSS 4TH 5TH EDITION 6th EDITION 5TH EDITION EDITION 138-140 (2) 89-109(21) 252-256 (4) 119-154 (35) Neurology 1415-1490 (75) 983-1138 574-587(14) 1369-1436 (67) 1433-1540 (7) 592-631(40) 1441-1448 (7) 743-753 588-592(5) Neurosurgery 1491-1493 (2) 1437-1440 (3) 765-783 974-980(7) 969-977 1807-1846 (39) 1541-1582 (41) Psychiatry 1907-1948 (41) 1891-1895 (4) 2511-2554 (43) 2035-2144 634-653(20) 1900-1907 (7) 2591-2615 (24) 487-490(4) Abuse and 1847-1864 (67) 2171-2186 1949-1966 (17) 821-891 (70) 1192-1193(2) Assault 1912-1917 (5) 1415-1429 1268-1274(7) 93-97 Ethics 99-101 (3) 2725-2766 (41) 2199-2214 1807-1812(6) 2187-2192 Dermatology 1571-1608 (37) 1507-1536 (29) 1635-1664 (29) 1999-2013 656-684(29) Skin / Soft Tissue 1891-1906 (15) 1769-1806 (37) 737-820 (83) 1961-1999 712-717(6) TOTAL 187 274 373 161

QUARTER 6 – October 1st to December 31th 2008 HARWOOD- TINTINALLI TINTINALLI ROSEN TOPIC ADAMS NUSS 4TH 5TH EDITION 6TH EDITION 5TH EDITION EDITION 71-93 (22) 82-106 (24) 1130-1267(138) Pediatrics 749-942 (193) 181-210 727-908 (181) 2218-2397 (79) 1274-1434(161) 1972-2062 (90) Environmental 1227-1326 (99) 1175-1282 (107) 1435-1499 1720-1780(61) 2698-2704 (6) 48-51 (3) Hematology 1365-1407 (42) 1319-1362 (43) 788-822(35) 1665-1700 (35) 2091-2145

Oncology 1408-1414 (6) 1363-1368 (5) 1701-1713 (12) 822-828(7) Allergy, 242-246 (4) 1583-1634 (51) Immunology, 1139-1206 686-703(18) 1882-1884 (2) 2491-2510 (19) Rheumatology TOTAL 346 358 289 373 420 LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 116

QUARTER 1 – January 1st- March 31th 2009 ROSEN HARWOOD- TINTINALLI ROSEN TOPIC TINTINALLI 6TH EDITION ADAMS NUSS 4TH 5TH EDITION TH 5TH EDITION 6 EDITION EDITION Subject index Geriatrics 1896-1899 (3) 2485-2490 (5) 2824-2830 p1870 2001-2211 167-171(5), 174- Infectious 943-1056 115-118 (3) 177(4) 909-1014 (5) 1825-1959 Disease (113) 1785-1971 (186) 178-185(8) 706-785(80) 1572-1605 Urology 631-654 (23) 606-632 (26) 1400-1432 (32) 418-453 1556-1572 1207-1270 128-168 (40) 149-178 (29) 1524-1555 453-467(15) Renal/ 1360-1399 (39) 611-630 (19) 593-605 (12) 1922-1933 830-835(6) Acid Base 1714-1723 (9) 655-660 (5) 633-646 (13) 884-888(5) 1327-1364 1955-1974 Endocrine 1283-1318 (35) 1724-1784 (60) 1717-1824 835-878(44) (37) 1985-2000 TOTAL 237 123 334 203

QUARTER 2 – April 1st to June 30, 2009 HARWOOD- TINTINALLI TINTINALLI ROSEN TOPIC ADAMS NUSS 4TH 5TH EDITION 6TH EDITION 5TH EDITION EDITION Gastroenterology/ 178-218 (30) 497-606 (9) 487-592 (105) 289-455 340-416(77) General Surgery 1234-1359 (125) Ophthalmology 1501-1517 (16) 1449-1463 (14) 907-927 (20) 211-233 112-148(37) 1518-1538 (20) 1464-1475 (11) 233-247 ENT 928-937 (9) 163-195(33) 1556-1564 (8) 1494-1506 (12) 265-277 247-265 OMFS / Dental 1539-1555 (16) 1476-1493 (17) 892-907 (15) 150-163(14) 277-288 Pre-Hospital Care 1-38 (38) 1-60 (60) 2616-2649 (33) 97-111 1782-1791(10) Bonus Chap 1 &2 607-610 (3) 85-92 661-668 (7) 53-59 Radiology 1865-1890 (35) 1494-1500 (6) 753-765 1967-1982 (15) 1253-1257 689-692 TOTAL 138 254 232 171

QUARTER 3 – July 1st to September 30, 2009 HARWOOD- TINTINALLI TINTINALLI ROSEN TOPIC ADAMS NUSS 4TH 5TH EDITION 6TH EDITION 5TH EDITION EDITION Wound Care 281-340 (59) 287-332 (45) 1961-1972 912-921(10) 1739-1881 (42) 233-241 (8) 534-572(39) Orthopedics 1651-1768 (17) 867-977 1885-1890 (5) 467-736 (269) 1022-1099(78) 1133-1138 43-55(13) Procedures 102-117 (15) 124-131 (7) 28-32 (4) 111-132 1155-1161(7) 1961-1973 LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 117

783-850 Trauma 1609-1738 (39) 1537-1650 (13) 242-466 (24) 890-1124(235) 953-961 TOTAL 160 82 305 258 382

QUARTER 4 – October 1st to December 31st, 2009 HARWOOD- HARWOOD- TINTINALLI TINTINALLI ROSEN TOPIC NUSS 3RD NUSS 4TH 5TH EDITION 6TH EDITION 5TH EDITION EDITION EDITION 141-148 (7) Pulmonary/ 219-251 (32) 155-161 (6) 6-42(37) 443-496 (53) 455-505 Critical Care 437-486 (49) 938-1010 (72) 198-243(46) 1908-1911 (3) 61-70 (9) 169-214 (45) 132-137 (5) 162-177 (15) 513-664 58-61(4) Cardiology 341-442 (102) 179-202 (23) 1011-1233 (222) 665-740 246-303(58) 333-436 (103) 79-101 (22) 102-123 (21) 2-27 (25) Anesthesia 251-280 (29) 3-37 1823-1841(19) 257-286 (29) 2555-2590 (35) 1565-1570 (5) 94-98 (4) Obstetrics 680-713 (33) 2398-2484 (86) 1271-1340 494-533(40) 664-690 (26) 669-679 (10) 647-663 (16) 1341-1415 Gynecology 219-232 (13) 470-491(22) 714-736 (22) 691-726 (35) 1429-1434 TOTAL 321 362 474 218 226

ALL QUARTERS – Material fair game for any of the in-service exams ROSEN HARWOOD- TINTINALLI TINTINALLI ROSEN TOPIC 6TH EDITION ADAMS NUSS 4TH 5TH EDITION 6TH EDITION 5TH EDITION EDITION 1057-1226 1015-1174 1499-1674 Toxicology 2063-2217 (154) 2325-2480 1436-1718(283) (169) (59) 1675-1716 Medicolegal 2199-2214 1812-1822(11) 2650-2657 (7) Admin 2673-2697 (24) 2145-2221 1798-1802(5) 2705-2724 (19) Research 2658-2672 (14) Appendix 1 39-78 (39) 118-127 (29) 33-47 (14) Resuscitation 215-238 (23) 52-81 (29) 39-179 6-55(50) 239-241 (3) 107-114 (7) 247-250 (3) Ultrasound 737-748 (11) 85-92 index p1907 TOTAL 277 59 268 349 18 MONTH 1,666 1,512 2,275 1,723 1,912 TOTAL

Haydel July 2008

LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 118

Research Requirement Every resident is required to participate significantly in a research project or scholarly activity in order to successfully complete the residency program. The residency director will not certify eligibility to take the ABEM exam unless this requirement has been met. Our goal is that residents will gain an understanding of the research process by participating in an entire project from origination of a hypothesis through submission of the completed article to a peer review journal. We realize that not every resident may have the opportunity to perform each step involved in a particular project. However, the Resident Research Director must agree that the resident's participation has been adequate and significant and must certify this on the following form before the resident completes the program. It is the resident's responsibility to meet at least yearly with the Resident Research Director to review progress on fulfillment of the research requirement. Those residents not inclined to do clinical research might be eligible to spend time in the neuroscience laboratory and receive credit for this research requirement.

All rotations approved as research electives must have evaluation forms completed for the prescribed time by the supervising faculty advisor. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 119

Resident's Research Proposal And Progress Form

Resident: Faculty:

Proposal for Project:

Literature Search:

Methods:

IRB Form:

Data Gathering:

Statistical Analysis:

Progression With Abstract:

Plans to Submit to national meeting:

Manuscript Preparation:

Submit Manuscript:

Research Requirement Satisfied LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 120

Chief Resident Responsibilities

Scheduling residents for PALS, ATLS, ACLS IGMEC – Graduate Medical Education Committee delegate monthly meeting LSU Residency fair, junior medical student residency day Journal Club ED daily Schedule ED intern schedule Graduation dinner Discipline Social/Wellness Coordination Research Coordinator Trauma Conference SE-SAEM conference coordination Annual review of goals and objectives for each rotation ED conference coordinator Quarterly newsletter Black book annual review Cadaver Lab National Inservice Exam preparation/pearls EM resident application review Interview Coordination

Chief Resident Questionnaire Third year residents are asked to respond to the following questions.

Please comment on the existing chief resident’s responsibilities. Would you suggest additions, deletions, or other changes?

What do you think are the three most important issues facing the EM residency program and how would you resolve these issues?

If considering becoming a Chief Resident, what would be your overall goal?

If considering becoming a Chief Resident, why do you think you are suited for the position of Chief Resident? LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 121

Residency Curriculum

The EM residency curriculum is composed of several components.

1. The Clinical Rotations as described in the Rotation Guide (Guidelines To Rotations/Goals & Objectives) 2. The Weekly didactics, following a comprehensive 18 month curriculum (LSU EM Reading Topics 2008-0) 3. The Assigned readings that correspond to the 18 month curriculum (LSU EM Reading Topics 2008-0) 4. The House officer year Special Topic Sessions 5. Supplementary Advanced Life Support, Hazmat Training.

The didactics and reading 18 month curriculum is based upon the Model Curriculum for Emergency Medicine, the RRC for Emergency Medicine Training Guidelines and the ABEM certification goals.

Model For Emergency Medicine

Link to the Model Curriculum for Emergency Medicine Residency Training: http://www.saem.org/model/intro.htm

LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 122

Reference Book Loan-Out Policy

1. Medical center of Louisiana Library -reference books are not to be removed -computer cd's - can be accessed from many different terminals; can’t be checked out -EM main residency office -books may be checked out for 3 day intervals. -sign out sheet can be obtained by the section secretary 2. Slidell memorial hospital -emergency room -books are not to be removed 3. Ochsner medical library -books are not to be removed LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 123

Medical License

For up-to-date information on Louisiana Medical License go online to www.lsbme.louisiana.org

Louisiana License, Training Permit & STEP 3:

All LSUHSC House Officers must have a valid license or permit to practice medicine in the State of Louisiana. The Training Permit is only available during the PGY1 & PGY2 years (24month period) when the resident has not yet taken and passed STEP 3 USMLE. From the LSBME website, “The applicant who has not taken and passed the USMLE Step 3 prior to the expiration of the PGY1 or PGY2 permit may not be licensed by the LSBME until such time that the applicant has taken and passed the USMLE Step 3” House Officers who fail to pass Step 3 by the start of PGY3 will be assigned non-clinical duties until a valid Medical License has been obtained. Non-clinical rotations consist of any unused vacation and non-clinical elective rotations for that training year. Once all non-clinical rotations have been completed, the resident will be assigned to a leave-without-pay status and will be dismissed from the EM program if the resident fails to obtain a Louisiana Medical License within three months of starting the leave of absence.

Step 3 Checklist

 You must take and pass Step 3 prior to beginning your PGY3 year, therefore the EM residency requires you to complete the application process during your PGY 1 year. Prior to applying to take Step 3, you must meet the following requirements:

 Pass both USMLE Steps 1 and 2 (CK and CS).  FMGs must obtain certification by the ECFMG.

. Once you choose a month to take Step 3, you will need to begin the application process 4-8 weeks prior to the chosen month. Once you finish the process you will have 3 months to take the exam. . USMLE Step 3 Applicants Can Simultaneously Apply for Credentials Verification o The Federation Credentials Verification Service offers a service to USMLE candidates who complete their Step 3 application online. As a convenience to examinees, information entered on their Step 3 online application can be used to begin a personalized FCVS Physician Information Profile that contains their primary-source verified credentials. The state of Louisiana requires applicants for full licensure to complete the FCVS. . Apply for Step 3 via the website at FSMB - Click on Exam Services the Step 3 Homepage LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 124

 Check to make sure you are eligible for Louisiana License State Requirements - See 2007-08 guidelines below:

APPLICATION FOR POSTGRADUATE LICENSURE REQUIRED STATE BOARD ATTEMPT LIMIT TIME LIMIT TRAINING WHEN APPLYING FOR REQUIREMENTS STEP 3

LOUISIANA Unlimited attempts Unlimited None YES You must check with the state at USMLE Step 1. medical board to determine licensure application processing Four attempts at times. Your Step 3 application can USMLE Step 2. not be approved until we receive approval from the state medical Four attempts at board. If we have not received USMLE Step 3. approval by September 5, 2008, your Step 3 application will be cancelled.

State Licensure After you have applied for you state license, it will come in the mail automatically after the state receives your passing scores on Step 3.

Minimum Time Limit for Completing Full license rules Postgraduate Number of attempts at Licensing Examination Licensing Examination Sequence Training Required Louisiana (504) 568-6820 No limit at Step 1or COMLEX Level 1; 4 1 year; 3 years License fee $382.00 attempts each at Steps 2 and 3 or COMLEX No limit on the USMLE or COMLEX IMG non-refundable Levels Requires FCVS

DEA number

 Apply for state CDS license first . Cost: $20 and needs to be mailed in.  Once you have been approved for the state license, you can apply for a Federal DEA number . Select Form 224. Cost: $551 - will only take credit card if you do it online, otherwise mail it in with a check.

NPI number

 Goto http://www.cms.hhs.gov/NationalProvIdentStand/  Tips for filling out the form: o The primary address should be LSUHSC 433 Bolivar NO,LA 70112 o The mailing address may be your program office o Use the program office phone number LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 125

o The taxonomy code is "Student in an Organized Health Care/Education/Training Program" o Once they have their NPI numbers, then need to link it to Louisiana Medicaid, especially to write scripts @ http://www.lamedicaid.com/provweb1/Hipaa/npi.htm

Notary

Ms. Kathy Muslow, provides notary services each Wednesday from 12:00 noon to 1:00 PM for university business only. [email protected] 568-5135

On July 1, 2008 all House Officers MUST have a valid Louisiana State Board of Medical Examiners (LSBME) permit (GETP, PGY 1, PGY2, PGY3, or any other valid LSBME permit), or license to practice Medicine in Louisiana and begin or continue residency/fellowship training.

In April, at the quarterly Coordinator’s meeting, Medical License information from residency partner was handed out showing the expiration dates of each House Officer’s permit or license, along with a document from the LSBME explaining the items needed to receive and renew each type of permit, along with USMLE Step 3 information. This information was distributed to avoid the submittal of late or no information to LSBME for initial permit/license or renewal of permits.

For the past few days we have printed LSBME License/Permit data from Residency Partner and cross referenced it against the information on the LSBME website. There are MANY New Hire House Officers with no permit/license information on the LSBME website and MANY Continuing House Officers with Permits that will expire June 30, 2008 or shortly thereafter. We know LSBME is in the process of updating many files on the website but there are also many House Officers that have not submitted renewal fees or documents to LSBME

Yolanda Lundsgaard

Coordinator GME

LSUHSC School of Medicine LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 126

2020 Gravier St, Ste B

New Orleans, LA

(504) 568-3407

FAX: (504) 599-1453

LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 127

Guidelines To Rotations/Goals & Objectives

Rotations and Scheduling

1. All rotations at all hospitals begin on the first day of the month, regardless of the day of the week. The only exception to this is the month of January for which the Medical Director of MCLNO sets the first day in order to provide opportunity for all residents to have time off for either Christmas or New Years. This date will apply to all hospitals and rotations.

2. Schedule requests must be submitted as delineated in the Rotation Guide. Be sure to request off the days you are assigned to take or teach advanced life support courses or to take In-Service Examination.

3. Failure to report to work any assigned shift at any hospital or any service may result in suspension or dismissal. Residents are required to notify the emergency medicine staff person on duty at the hospital and the chief resident on duty (chief pager 423-2537) and the chief resident of the non-emergency department service to which they are assigned in advance if they are unable to report for duty. The resident must notify the residency office by phone on the day of the absence and the Residency Director in writing within one week of the reason of absence.

In case of illness, residents are required to report to the emergency department for diagnosis and management.

4. Residents are expected to be punctual for their shifts. Repeated tardiness will result in disciplinary action. Residents may not leave early without permission from the supervising attending.

LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 128

UH/ MCLANO Emergency Department

Dr.______,

You are assigned to the UH ED, for the month of______.

Orientation: Mandatory for all interns, (day, night or off shift) at 7am on the first day of the month. (see section below for orientation review for residents)

Schedule: A choice of a prearranged schedule will be available on a first come first serve basis around the middle of the month preceding your schedule rotation in the emergency medicine office. Please see Kathy or the scheduling chief for schedule template.

Responsibilities: Interns and Residents are expected to manage their individual patients as well as assist in other areas as needs arise. It is the expectation that the intern and resident will work in harmony with the ER RN to accomplish all tasks.

Follow-ups: you are required to complete 2 follow-ups per month while in the ED and to request autopsy results on all deaths while you are in the ED. Follow-up can be achieved via the cliq system. To obtain an autopsy report, email Dr. Robin McGoey in the Dept of Pathology ([email protected]) with the patient’s name and medical record number. The follow up documentation will be through Residency Partner. (See Follow-Up Log)

EMS Guidelines: NOHD

In addition to the above educational activity, the resident will ride with New Orleans EMS, on those days designated by the schedule during the time spent in the emergency department. Each shift is 10-12 hour shifts –generally from 11 am to 11 pm from Sunday to Thursday, 2 p.m. – 2 a.m. Friday and Saturday. During this period, it is his/her responsibility to provide medical control and aid with care and stabilization at the scenes of ambulance calls. For the purpose of gaining an insight into the ongoing activities of the paramedics, some individuals may be assigned to ride along on a shift with one paramedic crew. Also the resident may be assigned to cover major events for the Superdome and the City of New Orleans, such as Mardi Gras, New Year’s Eve, etc. Each resident is responsible for picking up the uniform and the instructional manual at the beginning of the rotation. This manual has didactic information as well as information of how to get to NOHD, who to report to, rules and regulations of the rotation.

Conference: All resident are expected to attend conferences on the appropriate day.

Extras: All procedures must be recorded and turned in at the end of the month.

Supervision: You will be supervised by board certified Emergency Medicine physicians. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 129

Evaluations: Daily evaluations.

Meals: Provided by UH.

What follows are the goals and objectives for the MCLANO 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 MCLANO University Hospital. The year of training may include PGY 1-5.

MCLANO EMERGENCY DEPARTMENT RESIDENT ORIENTATION General  Be on time for start of your shift.  Dress and act professionally. (see Dress Code)  Place a note on every chart.  Work with other residents and nurses to enhance patient flow in the ED and Fast Track.  Notify attendings as soon as possible of disposition problems caused by lab, X-ray, or consultant delays.  Make frequent rounds with attendings and discuss management of complex cases prospectively.

Educational  Give lectures as assigned by chief residents. (see M & M Presentations)  Supervise and teach junior residents, interns, and students through their patient care experiences.  Provide a written evaluation of each intern you work with using the form provided to you at the end of the month. o If an intern shows a consistent pattern of problems in any area including punctuality, attendance, attitude, knowledge, skills, or interpersonal relationships, notify Dr. DeBlieux, the EMS director immediately so that intern can be counseled. o No intern should receive a below average evaluation (4 or below) in any area without having feedback and an opportunity to improve. o Interns from other services such as OB-GYN and Pediatrics are allowed to attend their required Continuity Clinic one half-day per week when assigned to the ED. Surgery residents are allowed to attend conference on Saturday morning. They must "sign-out" with the emergency medicine resident before leaving to ensure continuity of patient care.  Attend conference as required by Conference Attendance Policy (see Conference Attendance Policy)  Document all procedures on Residency Partner (see Residency Partner)  Maintain a patient list with major diagnosis.  Document at least 20 patient follow-ups per year.(Follow-Up Log)  Request autopsy results on all deaths: email Dr. Robin McGoey in the Dept of Pathology ([email protected]) These reports count toward your 20 patient follow-ups per year for your portfolio.

Documentation LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 130

. Document the initial time the patient was seen, . Document the times consults placed and answered. . Time all progress notes, procedure notes, and other significant events such as LOPA referrals, child abuse referrals, etc. . Time all orders for lab, X-ray, medication, and other treatment. . If you use a separate order sheet, write "See separate order sheet" in orders section on route sheet. . Chart documentation must be legible and must conform to HCFA/AMA Guidelines. . The appropriate boxes indicating patient disposition and condition at discharge must be checked and time and date of discharge filled in. . Residents are to write the initial documentation of history, physical exam, medical decision-making, and management for all Room 4/Trauma Bay patients and all Crisis Cube/Monitor Bay patients including procedure notes. The resident who runs the resuscitation is to complete the chart. . Consultants must document a written consult when they first evaluate the patient. If additional studies such as CT scans are requested, that should be included in the initial written consult. The consult can be updated and completed by the consultant when all studies are complete. The initial consult should address on-going management issues, e.g., steroids for possible spinal injury. . Be sure all imaging studies have been reviewed by a radiologist before discharging any patient and that documentation of results indicates this review. . The Diagnosis box on the route sheet must always be filled in. . When a patient leaves AMA or deserts during treatment or is a "No Answer x 3", this status must be recorded in the Diagnosis box on the route sheet, e.g., Diagnosis #1 Scalp laceration, Diagnosis #2 Desertion. . An AMA form must be completed in layman's language and signed by the patient, the resident, and a witness for all AMA patients. Written discharge instructions should always be given to AMA patients and should indicate that patient has been encouraged to return at any time to complete treatment.

Orders . All X-ray and lab slips must have the intern or resident's name and the attending's name in the "ordering physician" blank. . ICD-9 codes are mandatory on the lab and x-ray requests. The ECD-9 code list is located on the back of each billing sheet attached to the medical chart. . All X-ray and lab slips must have an appropriate indicator in the-"reason for study" box. o The indicator must be a sign or symptom such as ankle pain, chest pain, or shortness of breath. "R/O" diagnoses and such things as "MVA" or "S/P fall" are not acceptable. o ICD- 9 codes are required on all x-ray and lab requests. . Residents must use their name stamp below their signature on every medical record.

Consultation . Be familiar with the various consult policies, e.g., faces, hands, MICU, spinal injuries, cellulitis, etc. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 131

. Don't delay consults for lab results or other reasons when the need for consultation is clear from the initial history and physical exam. . Document time of consult and time answered on ED medical record in space provided. . All consults must be written on the hospital's consultation form.

Rapid Sequence Intubation . The decision to use RSI, the selection of protocol, drug dosages, and the actual orders must be by the attending physician. . Nurses cannot accept orders for RSI from a resident. . The entire RSI procedure is supervised by the ED attending who makes all decisions regarding RSI. . Interns may not participate in RSI. . RSI must be documented on the chart in a procedure note and the RSI CQI form must be completed by the resident and signed by the resident and attending physician.

Medical Control . Medical Control calls should be answered immediately. . Medical Control must be provided by an HO 2 or greater level resident. . Interns may observe but may not provide medical control. . Remember, all medical control calls are recorded.

Sexual Assault . Residents must give this exam priority as forensic evidence disappears rapidly in these patients. . Ovral is used for pregnancy prophylaxis when UPT negative. o Physician must document counseling of patient regarding risks and benefits. o Two pills are given in the ED and 2 are dispensed BY the physician to the patient to be taken in 12 hours. o The physician must write "Ovral 2 pills dispensed to patient by M.D. to be taken in 12 hours." in the Orders section of the chart. This language is needed by the Pharmacy Department when it undergoes JCAHO review.

Trauma Center . Trauma Center patients are identified by anatomic, physiologic, and mechanism of injury criteria. . All children up to and including 12 years of age must be "Room 4" activation level. . Those patients greater than 12 years of age meeting only the mechanism criteria can be designated as "Trauma Bay" activation level by the emergency medicine attending physician only. . All adult patients in Region One meeting anatomic or physiologic criteria are "Room 4" activations. Be familiar with the anatomic, physiologic, and mechanism criteria. . All trauma center patients must receive ETOH and urine tox screens. . Responsibility for patient assessment, communication with recording nurse, intubation, and performance of invasive procedures in Room 4 patients is that of the HO 2 or above resident and cannot be "passed down" to interns. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 132

. Be sure all trauma center patients receive a written surgery consult. . Interns may not sign the emergency blood release forms. Only a senior surgery or EM resident or EM or surgery faculty may sign.

Universal Precautions . Residents are expected to use universal precautions (gloves, gown, mask, and eye shield) in the ED whenever performing exams or invasive procedures and to make sure that interns, students, and others under their supervision do so also. . Any intern or resident who sustains a blood or body fluid exposure while on duty should report the exposure to the attending physician, complete a hospital incident report, and get a route sheet to obtain treatment and document the -exposure. Anti-viral treatment is immediately available through Employee Health during the day and in the ED after hours.

MCLANO/UH ED ROTATION GOALS and OBJECTIVES

At the completion of rotations in the MCLANO, the intern/resident will be able to:

1) Perform basic assessment of patients with a variety of moderate and major traumatic conditions.

2) Formulate a differential diagnosis for patients with various kinds of traumatic conditions and mechanisms of injury.

3) Order and interpret appropriate diagnostic laboratory and imaging studies for trauma patients.

4) Understand the interrelationships of the pre-hospital, emergency department, and in- house trauma team and perform as a team member of the emergency department trauma team.

5) Competently perform minor procedures such as suturing of lacerations, incision and drainage of the abscesses, insertion of nasogastric tubes and urinary catheters, venipuncture, insertion of peripheral intravenous catheters, lumbar puncture, splinting of fractures and sprains, spinal immobilization.

6) Demonstrate basic understanding of the principles of ACLS resuscitation as applied to persons in cardio-respiratory arrest.

7) Achieve ability to perform an adequate history and physical exam, prioritize conditions, and form a differential diagnosis in adults with acute and chronic medical problems of varying severity presenting to the ED for care.

8) Learn proper methods for stabilization of patients with life threatening conditions such as LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 133

sepsis, respiratory failure, acute MI, CHF, status epilepticus, status asthmaticus, cardiac arrhythmias, severe GI bleeds, and overdose.

9) Learn to evaluate, diagnose and initiate any needed therapy for a variety of specific medical problems such as asthma, seizures, anemia, stroke, GI disorders, urinary tract infections, pneumonias, and other respiratory illness.

10) Learn to evaluate and appropriately manage a variety of patient complaints such as chest pain, abdominal pain, dizziness, headache, syncope, etc.

11) Learn to perform an adequate history and physical exam in female patients with gynecologic problems or problems related to early pregnancy including abdominal bleeding, infection, threatened abortion, and ectopic pregnancy.

12) Learn appropriate use of diagnostic lab and imaging studies for emergency patients and to have basic competence in their interpretations.

13) Learn to use the following diagnostic aids: central venous pressures, pulse oximetry, arterial blood gases, EKG’s.

14) Perform the following procedures with basic competency and to know indications and contraindications: venipuncture, starting an IV or heparin lock, arterial puncture, insertion of a Foley catheter, placement of a central venous line, thoracentesis, paracentesis, lumbar puncture, urinalysis with microscopic, wet prep of vaginal secretions.

15) Become familiar with common medico-legal problems which present in emergency medical practice such as: consent, desertion, AMA, restraints, impaired patients, child or adult abuse or neglect.

16) Be able to arrange appropriate follow-up for discharged patients and give adequate discharge instructions.

17) Learn and use the available contributions of the Social Services Dept. to patient care in the ED and for discharge planning.

18) Learn appropriate medical evaluation of mentally disturbed patients including techniques for restraint and control of violent patients.

Residents and interns will participate in the management of all emergency department patients under the supervision of emergency medicine faculty.

The clinical and didactic experiences used to meet those objectives included daily patient care of the MCLANO Emergency Department patients, along with bedside teaching. The rotating resident is to attend lectures as part of the greater emergency medicine curriculum, as scheduled by the LSU EM residency program. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 134

The feedback mechanisms and methods used to evaluate the performance of the resident include daily self and faculty evaluations. 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 surgery and emergency medicine. The residents will have access to the resources of the hospital including call rooms, the LSU Medical Library, Emergency medicine texts, medical records and meals.

The clinical experiences, duties and responsibilities the resident will have on the rotation: Residents will act as a part of the Emergency Medicine team under the supervision of a staff physician. The residents will participate in the management of patients in the emergency department.

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 EM faculty prior to patient discharge.

Duty hours for this rotation will not exceed an average of 60hrs/week, call not longer 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. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 135

ANESTHESIA

Dr.______,

You are assigned to Anesthesia for the month of______.

Orientation: Report to the Anesthesia Office on at West Jefferson

Schedule: (Monday through Friday from your first scheduled case until your last scheduled case. Usually 6:15am to 6pm

Responsibilities: Sign out your anesthesia equipment box and readings with Stephanie and Dr. Boyd prior to starting the rotation. All schedule request changes must be accompanied by an approval letter from the program director.

Conference: You are to attend conference and journal club.

Extras: All procedures must be recorded and turned in at the end of the month.

Learning Modules: The following Learning Modules must be completed by the end of your rotation: Emergency Intubations and the Difficult Airway. Each module has an open book post-test (the questions at the end of the module) in residency partner or you can email your answers to Kathy Whittington.

Evaluations: Global Rotation evaluation

Supervision: All intubations, rapid sequence inductions and associated procedures are supervised by anesthesia faculty and CRNA’s.

Meals: The resident’s responsibility.

West Jefferson Medical Center - Anesthesia Rotation

GOALS and OBJECTIVES

What follows are the goals and objectives for the West Jefferson Anesthesia 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 Medical Center. The year of training may include PGY 1-5.

OBJECTIVES: LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 136

To gain the greatest possible mastery of: airway management, placement and the interpretation of non-invasive and invasive monitors, clinical pharmacology and physiology relevant to the administration of as types of anesthesia, techniques of providing general and regional anesthesia.

GOALS:

Residents will participate in the evaluation and management of patients admitted for surgery. Residents will function as a member of the anesthesiology team and assist with the direct management of patients undergoing anesthesia

The clinical and didactic experiences used to meet those objectives include evaluation of pre operative patients, post operative patients, intubation and management of general anesthesia, along with bedside teaching. This rotation experience is part of the greater emergency medicine curriculum, including weekly didactics concerning airway management and topics relating to anesthesia (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 anesthesia and 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 Anesthesia team in a community hospital under the supervision of a staff physician.

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 faculty prior to patient discharge.

Duty hours for this rotation will not exceed an average of 80hrs/week, do not include call, 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. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 137

CHABERT Medicine Wards

Dr.______,

You are assigned to Leonard J. Chabert Medical Center for the month ______.

Orientation: Report for 8:00 a.m. on the first day of the month to the Department of Medicine. You will be brought to Classroom 2, 2nd floor, for orientation. Dr. Thomas Ferguson is the Director (985-873-1207).

Schedule: Daily rounds and in house call not to exceed Duty Hour policy

Housing: One bedroom furnished apartments are available for your use. All the apartments have been recently refurnished. Kitchen utensils are furnished; there are sheets on the bed, and a limited number of towels available in each apartment. You are responsible for leaving housing in good condition with sheets and towels washed when you leave. You are encouraged to make use of the apartment, particularly when you are post-call.

Directions: See attached map and driving directions. The hospital is located at 1978 Industrial Blvd. The hospital directions include a warning to be careful as this entrance has two lanes of traffic and other vehicles cross in front of each other without realizing it. They think it is two-way traffic. To be sure to arrive in time, allow an hour and a half travel time the first time you make the trip.

For assistance along the way, call Maddy Pitre (985-873-1265) of Liz Ferguson (985- 873-1207)

Conference: You are required to attend conference and journal club. You will be released from your duties at 6am after signing out your patients to the nurse practitioner on conference days to be able to come in for conference. Please remind the faculty and other team members that your conference day is on Wednesdays and Journal Club is the second Thursday of each month.

Extras: All procedures must be recorded and turned in at the end of the month.

Supervision: Internal Medicine faculty

Evaluations: Composite evaluation at the end of the rotation

LSU Emergency Medicine Residency Program--Chabert Medicine Rotation

GOALS and OBJECTIVES LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 138

What follows are the goals and objectives for the Chabert Medicine 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 Chabert Hospital. The year of training is assigned in the PGY1 year but may include PGY 1-5.

OBJECTIVES: Gain expertise in the management of adult medical emergencies. Learn the priorities and procedures medicine wards. Become an integral part of the Medicine team.

GOALS: The educational goals include gaining knowledge about initial management and inpatient care of medicine ward patients Participate in daily teaching rounds Evaluate Medicine patients in the Emergency Department Participate in Procedures. Participate in the routine care of Medicine patients Participate in consults to the Medicine Service Follow inpatients through discharge, including discharge planning

The clinical and didactic experiences used to meet those objectives included daily patient care of MEDICINE patients, along with bedside teaching. The rotating resident is encouraged to attend lectures pertaining to the care of the MEDICINE patient. This rotation experience is part of the greater emergency medicine curriculum, also including 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 MEDICINE and emergency medicine. The residents will have access to the resources of the hospital including call rooms, the LSU Medical Library, Hospital medical texts, medical records and the cafeteria.

The clinical experiences, duties and responsibilities the resident will have on the rotation: Residents will act as a part of the MEDICINE team under the supervision of a staff physician. The residents will participate in the initial management and care of MEDICINE 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 MEDICINE faculty daily and prior to patient discharge. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 139

Duty hours for this rotation will not exceed an average of 80hrs/week, call not longer than 24 consecutive hours 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. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 140

CHILDREN’S HOSPITAL

Dr.______,

You are assigned to Children’s Hospital ED for the month of______.

Orientation: Dr. Mangat, the head of the LSU Pediatrics Emergency Medicine Division, will orient you to the ER on the first weekday of the month. It will be held at 8am in Administration Conference Room B on the first floor of Children’s Hospital. If you have any questions for Dr. Mangat, it’s best to contact her by email: [email protected].

Orientation: No formal orientation. Dr. Druby Hebert is the Director (896-9229). The ER # is 896-9474 and the main # is 899-9511.

Schedule: If you do not receive an email from the Peds Chief resident two weeks before starting your rotation, you should page Dr. Durant 423-3213 or Dr. Laroux 423-3232. Their office number is 896-9329. You will work approximately 15 shifts in a month. Please do not schedule a shift during conference or Journal club: each Wed 7a11a or the 2nd Thurs each month 7a10p. You can view your shift schedule at http://www.amion.com. The password is “lsupeds”. If you have any questions or requests, you can call us at (504) 896-9329

Directions: Children’s Hospital is located in Uptown New Orleans, near Audubon Park and Tulane University. Take Henry Clay Avenue off St. Charles Avenue and Magazine Street toward the river and Children’s Hospital will be on the right as you approach the Mississippi River. The address is 200 Henry Clay Avenue.

Conference: You are required to attend conference.

Learning Modules: You must complete the following learning modules and take the post-test within 2 weeks of completing the rotation. You may complete them as early as you like and the tests are open book. You must achieve 80% to get credit for completing the modules. The learning modules can be found under the Home Study link on the LSUEM residency page. The tests will be available on ResidencyPartner, but you can also email your answers to Kathy Whittington ([email protected]) if you have trouble accessing RP.

Modules: 1. The Crying Infant 2. Abdominal Pain

Responsibilities: Daily management of pediatric ED patients.

LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 141

Lab System (CERNER): You will be assigned a unique username for the cerner lab computers; come by the Chief Resident’s office to pick up a form to sign for the lab department. The Chief’s office is at Children’s Hospital in the Ambulatory Care Center on the 2nd floor – room 2304.

Directions: The main ED is located on the first floor of the hospital, follow signs from Tchoupitoulas St. to the ED. You can park in any of the spaces behind the hospital except for the parent spots near the ED. The chief residents also have gate cards to allow you to park behind the gate arm near the ED entrance.

Conference: You are expected to attend EM conference during this rotation. We also have morning report from 8-9am every weekday, except Wednesday, and we have noon conference from 12-1pm every Monday, Tuesday, & Thursday. Attendance to morning report and noon conference is optional.

Extras: All procedures must be recorded during this rotation.

Supervision: You will work side by side with staff pediatricians and residents.

Evaluations: You should receive an evaluation form from your program coordinator. You can give it to one of our EM faculty at the end of the rotation.

Meals: We do not provide meal tickets for residents on ER rotations, but Children’s Hospital has a discount for residents. Residents pay $1.50 for the first $4.00 worth of food, then dollar for dollar after that. All you need to do is tell the cashier that you are a resident & have your ID card handy.

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LSU Emergency Medicine Residency Program Children’s Hospital Pediatric Emergency Department Rotation

GOALS and OBJECTIVES

What follows are the goals and objectives for the CHILDRENS’ 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 CHILDRENS’ Hospital in the Pediatric ED. The year of training may include PGY 1-5.

The educational objectives of the CHILDRENS’ 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. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 142

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 CHILDRENS’ Pediatric ED, along with bedside teaching. The rotating resident is encouraged to attend lectures available at CHILDRENS’ 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. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 143

MICU

Dr.______,

You are assigned to the MICU at University for the month of______.

Schedule: Contact the LSU Medicine Chief Resident 568-5600, 2 weeks prior to your rotation to receive your schedule and/or make any schedule requests. Call: Your call will be every third night. Every attempt will be made to provide each resident with one full weekend off. Weekends are managed by two of the three call teams.

Responsibilities: The MICU residents will function as a team leader responsible for the care of all patients in the MICU. Additionally, the MICU resident is responsible for all consults in MER/AR/FT and floor for MICU admission. The MICU resident must also respond to all codes within the hospital. An intern and possibly medical students will be assigned to your team. The resident is responsible for supervision, education and directions for the call team.

Conference: You must attend EM conference each Wednesday 7a11a and EM Journal Club, which is the 2nd thursday of the month 7p10pm. Please remind your attending and the other teams the day before conference that you should present your patients on rounds first on Wednesdays so that you may attend conference. Dr. DeBoisblanc is aware of this arrangement and will help facilitate it. If you have trouble coming to conference, please notify Dr. Haydel immediately.

Extras: All procedures must be recorded in ResidencyPartner by the end of the month.

Learning Modules: The following Learning Modules, comprised of three articles, that must be completed by the end of your rotation are located on the home study link of the LSU EM website.

PGY1: Surviving Sepsis, Central Lines, and ARDSnet. PGY3: Vent Management, Therapeutic Hypothermia and EGDT.

Each module has an open book post-test that can be done in ResidencyPartner or you can email your answers to Kathy Whittington.

Supervision: The 1st two weeks are staffed by LSU Pulmonary and Tulane Cardiology. The 2nd two weeks are staffed by Tulane Pulmonary and LSU Cardiology.

Evaluations: Compiled from pooling all LSU/Tulane Pulmonary Critical Care faculty and fellows who supervised you throughout the month. The evals are sent via ResidencyPartner.

Location: The MICU is located on the 2nd floor of UH.

LSU Emergency Medicine Residency Program LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 144

MCLANO University Hospital MICU Rotation

GOALS and OBJECTIVES

What follows are the goals and objectives for the University Hospital MICU 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 MCLANO University Hospital. The year of training may include PGY 1-5.

OBJECTIVES: The educational objectives of the MICU rotation is to provide residents with an opportunity to experience and learn about the initial evaluation and management of MICU patients in the community setting and to become proficient in the diagnosis and treatment of: CHF, pulmonary edema, pneumonia, pneumothorax, pulmonary embolus, ARDS, respiratory distress, asthma, COPD, AMI, acute coronary syndrome, cardiomyopathym, pericarditis, HTN, stroke, pancreatitis, acute renal failure, hepatitis, pyelonephritis, acute hepatic failure, toxicologic emergencies, acute drug overdose, consultation, living wills, do not resuscitate, rehabilitation, IV access, induction and paralytic agents. Hemodynamic monitoring, airway and ventilator management, sedative/hypnotic agents. .

GOALS: Residents will act as a part of the MICU team in a community hospital, under the supervision of a staff physician. The resident will participate in the management of MICU patients, to include evaluation, admission management of all MICU requests from the floor and emergency department as well as patients already in the MICU. The resident is responsible for the daily management and disposition planning of all patients admitted by his/her team. Rounds occur daily with the ICU staff, pulmonary fellow and cardiology staff. The resident is responsible for attending and leading all in house cardiac arrests and subsequent management.

The clinical and didactic experiences used to meet those objectives include evaluation of ICU patients, in the ED and in the ICU, along with bedside teaching. This rotation experience is part of the greater emergency medicine curriculum, including weekly didactics concerning critically ill and injured patients (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 ICU care. The residents will have access to the resources of the hospital including call rooms, medical texts, medical records, and meals.

The clinical experiences, duties and responsibilities the resident will have on the rotation: Residents will act as a part of the ICU team in under the supervision of a staff physician. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 145

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 faculty each day and prior to patient discharge.

Duty hours for this rotation will not exceed an average of 80hrs/week, call not to exceed 24 hours, 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. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 146

OBSTERICS

OB-GYN ROTATION at Chabert For Emergency Medicine Residents

Dr.______,

You are scheduled for LSU OB at Chabert:

Director: Dr. Brent Hemelt, Chief OB/GYN @ Chabert OB Contact Person: Tammy Pellegrini ([email protected]) 985-873-2285 Apartment information: Georgette Hartman ([email protected]) 985-873-1285

Housing: One bedroom furnished apartments are available for your use. Kitchen utensils are furnished; there are sheets on the bed, and a limited number of towels available in each apartment. You are responsible for leaving housing in good condition with sheets and towels washed when you leave. You are encouraged to make use of the apartment, particularly when you are post-call.

Directions: The hospital is located at 1978 Industrial Blvd. The hospital directions include a warning to be careful as this entrance has two lanes of traffic and other vehicles cross in front of each other without realizing it. Allow an hour and a half travel time the first time you make the trip. General directions:

1. Take I-10 west for 13 miles (out past the airport) 2. Exit onto I-310 south to Houma/Boutte and go 12 miles 3. Exit onto Highway 90 west to Houma (for 22 miles) 4. Exit (go left) 182 (Houma) on LA-182W/US-90-BR W and go 3.6 miles 5. Turn left at LA-3087 S and go 5 miles 6. Continue on Prospect Blvd 1.1 miles 7. Turn left at Grand Caillou Rd/LA-57 and go 0.7 miles 8. Turn right at Industrial Blvd.

For assistance along the way, call Maddy Pitre (985-873-1265) of Liz Ferguson (985- 873-1207)

Learning Modules: You must complete the following learning modules and take the post-test within 2 weeks of completing the rotation. You may complete them as early as you like and the tests are open book. You must achieve 80% to get credit for completing the modules. The learning modules can be found under the Home Study link on the LSUEM residency page. The tests will be available on ResidencyPartner, but you can also email your answers to Kathy Whittington ([email protected]) if you have trouble accessing RP.

Modules: 1. Early Pregnancy Emergencies 2. 2nd & 3rd Trimester Emergencies

LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 147

LSU Emergency Medicine Residency Program OBGYN Rotation

GOALS and OBJECTIVES

What follows are the goals and objectives for the OBGYN rotation, that will range from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take place at University Hospital. The year of training is assigned in the PGY1 year but may include PGY 1- 5.

OBJECTIVES: Gain expertise in the management of obstetrical and gynecological emergencies. Learn the priorities and procedures of labor and delivery. Become an integral part of the OBGYN team and respond to deliveries along with junior, senior and staff OBGYN’s. Gain exposure to OR sterile techniques and surgical techniques.

GOALS: . The educational goals include gaining knowledge about the progression of normal labor, delivery and immediate post-partum care. The resident will also gain expertise in the initial management of gynecological emergencies. . Participate in daily teaching rounds . Evaluate OBGYN patients in the Emergency Department . Participate in OBGYN Procedures, both in the OR and in Labor and Delivery: the ACGME recommends that you document participation in 10 vaginal deliveries. . Participate in the routine care of OBGYN patients . Participate in consults to the OBGYN Service . Follow inpatient OBGYN patients through discharge, including discharge planning

The clinical and didactic experiences used to meet those objectives included daily patient care of OBGYN patients, along with bedside teaching. The rotating resident is encouraged to attend lectures pertaining to the care of the OBGYN patient. This rotation experience is part of the greater emergency medicine curriculum, also including 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 OBGYN and emergency medicine. The residents will have access to the resources of the hospital including call rooms, the LSU Medical Library, Hospital medical texts, medical records and the cafeteria. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 148

The clinical experiences, duties and responsibilities the resident will have on the rotation: Residents will act as a part of the OBGYN team under the supervision of a staff physician. The residents will participate in the initial management and care of OBGYN 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 OBGYN faculty daily and prior to patient discharge.

Duty hours for this rotation will not exceed an average of 80hrs/week, call not longer than 24 consecutive hours 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.

Addendum: 12/1/2008

The following tasks are expected of every resident that rotates through OB at Chabert:

 The ER resident rounds at the board on L&D daily and resides on the L&D unit during the day to triage, admit and labor patients along with the help of the OB resident and medical students.

 If the ER resident has participated in care of the patient during labor, he or she delivers the baby.

 The ER resident also participates in evening board rounds with the residents and students.

 The students write progress notes on inpatients, so the ER residents don't need to do that.

 The ER resident should also take one call every 7th night and can leave post call at 9AM. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 149

OLOL Pediatric ED

Dr.______,

You are assigned to OLOL Hospital for the month:

Orientation: Orientation to the OLOL Hospital on the first day of the month.

Contact person at GME office: Leigh Salvant ([email protected]) 225-765-7730 Director of ED: Dr. Steve Narang ([email protected]) Schedule requests: Kyle Fitzgerald ([email protected])

Schedule: 15 shifts a month, 9a-7p and 7p-5a

Directions: I-10 west to Baton Rouge (73 miles), Exit 160 Essen Lane go left 0.5 miles, Right on Hennessy Blvd. OLOL: 5000 Hennessy Blvd

Conference: You are required to attend conference and journal club.

Learning Modules: You must complete the following learning modules and take the post-test within 2 weeks of completing the rotation. You may complete them as early as you like and the tests are open book. You must achieve 80% to get credit for completing the modules. The learning modules can be found under the Home Study link on the LSUEM residency page. The tests will be available on ResidencyPartner, but you can also email your answers to Kathy Whittington ([email protected]) if you have trouble accessing RP.

Modules: 1. Febrile Infant (PGY2) 2. ALTE (PGY4) 3. Peds Tox (PGY4)

Extras: All procedures must be recorded and turned in at the end of the month.

Supervision: Provided by OLOL PER faculty.

Evaluations: Compiled and pooled from evaluations of the OLOL faculty.

Meals: Lunch is provided by OLOL Hospital.

LSU Emergency Medicine Residency Program Our Lady of the Lake Pediatric Emergency Department Rotation

GOALS and OBJECTIVES LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 150

What follows are the goals and objectives for the OLOL 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 OLOL Hospital in the Pediatric ED. The year of training may include PGY 1-5.

The educational objectives of the OLOL 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 OLOL Pediatric ED, along with bedside teaching. The rotating resident is encouraged to attend lectures available at OLOL 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 LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 151

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. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 152

OCHSNER ED

Dr.______,

You are assigned to Ochsner Clinic Foundation the month of ______.

Orientation: Report for 7:00 a.m. on the first day of the month to the Emergency department. Dr. Joseph Guarisco is the Director (842-4433). Prior to beginning your rotation, contact Reonda Victor of the Ochsner GME Department (842-4937) to schedule a time to get your ID and parking cards. You will be required to give a $10 refundable deposit for the cards. Detailed information concerning orientation and the rotation are in the Ochsner resident handbook you have been given.

Schedule: You will work 15 shifts per month; half of the scheduled residents will work 16 in months with 31 days. Each resident will be required to work one Friday-Saturday night shift each month.

Directions: Directions to the hospital are included in the Ochsner resident handbook.

Conference: You are required to attend conference and journal club.

Extras: All procedures must be recorded and turned in at the end of the month.

Supervision: Dr. Guarisco and staff physicians provide Supervision.

Evaluations: Compiled and pooled from evaluations by the staff physicians.

LSU Emergency Medicine Residency Program Ochsner Clinic Foundation Hospital Emergency Department Rotation

GOALS and OBJECTIVES

What follows are the goals and objectives for the Ochsner 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 Ochsner ED. The year of training may include PGY 1-5.

The educational goals and objectives for the Ochsner 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, health maintenance organization setting, including the following: LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 153

1) Perform basic assessment of patients with a variety of moderate and major traumatic conditions. 2) Formulate a differential diagnosis for patients with various kinds of traumatic conditions and mechanisms of injury.

3) Order and interpret appropriate diagnostic laboratory and imaging studies for trauma patients.

4) Competently perform minor procedures such as suturing of lacerations, incision and drainage of the abscesses, insertion of nasogastric tubes and urinary catheters, venipuncture, insertion of peripheral intravenous catheters, lumbar puncture, splinting of fractures and sprains, spinal immobilization.

5) Demonstrate basic understanding of the principles of ACLS, PALS and ATLS resuscitation as applied to persons in cardio-respiratory arrest.

6) Achieve ability to perform an adequate history and physical exam, prioritize conditions, and form a differential diagnosis in adults with acute and chronic medical problems of varying severity presenting to the ED for care.

7) Learn proper methods for stabilization of patients with life threatening conditions such as sepsis, respiratory failure, acute MI, CHF, status epilepticus, status asthmaticus, cardiac arrhythmias, severe GI bleeds, and overdose.

8) Learn to evaluate, diagnose and initiate any needed therapy for a variety of specific medical problems such as asthma, seizures, anemia, stroke, GI disorders, urinary tract infections, pneumonias, and other respiratory illness.

9) Learn to evaluate and appropriately manage a variety of patient complaints such as chest pain, abdominal pain, dizziness, headache, syncope, etc.

10) Learn to perform an adequate history and physical exam in female patients with gynecologic problems or problems related to early pregnancy including abdominal bleeding, infection, threatened abortion, and ectopic pregnancy.

11) Learn to evaluate the pediatric patient in the emergency department, including fever of unknown origin and other common pediatric presenting complaints.

12) Learn appropriate use of diagnostic lab and imaging studies for emergency patients and to have basic competence in their interpretations.

13) Learn to use the following diagnostic aids: central venous pressures, pulse oximetry, arterial blood gases, EKG’s.

14) Perform the following procedures with basic competency and to know indications and contraindications: venipuncture, starting an IV or heparin lock, arterial puncture, LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 154

insertion of a Foley catheter, placement of a central venous line, thoracentesis, paracentesis, lumbar puncture, urinalysis with microscopic, wet prep of vaginal secretions.

15) Become familiar with common medico-legal problems which present in emergency medical practice such as: consent, desertion, AMA, restraints, impaired patients, child or adult abuse or neglect.

16) Be able to arrange appropriate follow-up for discharged patients and give adequate discharge instructions.

17) Learn and use the available contributions of the Social Services Dept. to patient care in the ED and for discharge planning.

18) Learn appropriate medical evaluation of mentally disturbed patients including techniques for restraint and control of violent patients.

19) Learn about billing as it pertains to ED patients.

20) Learn about transplant patients.

21) Learn about geriatric presenting complaints.

The clinical and didactic experiences used to meet those objectives included daily patient care in the Ochsner 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 LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 155

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. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 156

SLIDELL ED

You are assigned to Slidell Memorial Hospital for the month:

Orientation: There is no formal orientation for this rotation. Dr. Eddie Lirette and Kumar Amaraneni are the Directors of the Emergency Department at SMH.

Scheduling: You will do sixteen 10-hour shifts each month from 11am to 9pm. Your default schedule is: Monday, Tuesday and Friday, and the first and third Saturday and Sunday of each month. If the aforementioned shifts involve more than sixteen dates in a month, then cap your work hours with the sixteenth shift. If you would like to deviate from this schedule, then you must obtain permission at least two weeks prior to starting the rotation from Dr. Lirette ([email protected]) and submit the approved schedule to Kathy Whittington. ([email protected])

Responsibilities: the daily management of all patients in the ED while on shift.

Directions: Take I-10 East towards Slidell and exit at Gause Blvd (exit #266), the third Slidell exit. Turn left at the light on Gause Blvd. and go approximately 2 miles. The entrance to the ED will be on the left after you pass the red light at the end of the hospital.

Conference: you must attend conference and journal club.

Extras: All procedures must be recorded and turned in at the end of the month.

Supervision: you will work side by side with an Emergency Medicine board certified physician.

Evaluations: Pooled and compiled by Dr. Kumar and Dr. Stafford.

Meals: Provided by SMH.

Slidell Memorial Hospital Emergency Department Rotation

GOALS and OBJECTIVES

What follows are the goals and objectives for the Slidell 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 Slidell ED. The year of training may include PGY 1-5.

The educational goals and objectives for the Slidell 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) Perform basic assessment of patients with a variety of moderate and major traumatic conditions. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 157

2) Formulate a differential diagnosis for patients with various kinds of traumatic conditions and mechanisms of injury.

3) Order and interpret appropriate diagnostic laboratory and imaging studies for trauma patients.

4) Competently perform minor procedures such as suturing of lacerations, incision and drainage of the abscesses, insertion of nasogastric tubes and urinary catheters, venipuncture, insertion of peripheral intravenous catheters, lumbar puncture, splinting of fractures and sprains, spinal immobilization.

5) Demonstrate basic understanding of the principles of ACLS resuscitation as applied to persons in cardio-respiratory arrest.

6) Achieve ability to perform an adequate history and physical exam, prioritize conditions, and form a differential diagnosis in adults with acute and chronic medical problems of varying severity presenting to the ED for care.

7) Learn proper methods for stabilization of patients with life threatening conditions such as sepsis, respiratory failure, acute MI, CHF, status epilepticus, status asthmaticus, cardiac arrhythmias, severe GI bleeds, and overdose.

8) Learn to evaluate, diagnose and initiate any needed therapy for a variety of specific medical problems such as asthma, seizures, anemia, stroke, GI disorders, urinary tract infections, pneumonias, and other respiratory illness.

9) Learn to evaluate and appropriately manage a variety of patient complaints such as chest pain, abdominal pain, dizziness, headache, syncope, etc.

10) Learn to perform an adequate history and physical exam in female patients with gynecologic problems or problems related to early pregnancy including abdominal bleeding, infection, threatened abortion, and ectopic pregnancy.

11) Learn appropriate use of diagnostic lab and imaging studies for emergency patients and to have basic competence in their interpretations.

12) Learn to use the following diagnostic aids: central venous pressures, pulse oximetry, arterial blood gases, EKG’s.

13) Perform the following procedures with basic competency and to know indications and contraindications: venipuncture, starting an IV or heparin lock, arterial puncture, insertion of a Foley catheter, placement of a central venous line, thoracentesis, paracentesis, lumbar puncture, urinalysis with microscopic, wet prep of vaginal secretions. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 158

14) Become familiar with common medico-legal problems which present in emergency medical practice such as: consent, desertion, AMA, restraints, impaired patients, child or adult abuse or neglect.

15) Be able to arrange appropriate follow-up for discharged patients and give adequate discharge instructions.

16) Learn and use the available contributions of the Social Services Dept. to patient care in the ED and for discharge planning.

17) Learn appropriate medical evaluation of mentally disturbed patients including techniques for restraint and control of violent patients.

18) Learn about billing as it pertains to ED patients.

The clinical and didactic experiences used to meet those objectives included daily patient care in the Slidell 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. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 159

TOXICOLOGY

Dr. ______, you are assigned to Toxicology for the month of ______.

Orientation: There is a mandatory orientation for this rotation. Dr. Tuckler is the director of the toxicology rotation. Contact him one week prior to starting the rotation. Orientation occurs on the first day of each month. Vacation and time off are not allowed during the rotation. There is an exit interview on the last day of the rotation that you must attend. All required materials are due at that time.

Scheduling: The majority of your time on this rotation will be spent performing consults, taking call, attending lectures, and giving lectures. When you meet with Dr. Tuckler, you will be given a list of lectures and persons giving you those lectures. It is your responsibility to contact each lecturer and schedule the date and time of each lecture.

Responsibilities: 1. Daily rounds on all toxicology patients in the MER, ICUs and wards. 2. Responding to all ED and in house toxicology consults. 3. Giving intern and resident lectures. 4. Giving one conference lecture. 5. Attendance to the Trauma Conference. 6. Presenting at M & M conference. 7. Attending all emergency medicine conferences and journal club. 8. Availability for Disaster call. 9. Completing a "toxicology case of the month". Report due at the end of the month. 10. Completing one toxicology oral board scenario case. 11. Completing a set of “written board” toxicology questions. 12. Attending an interactive review session of past toxicology cases. 13. Goals, objectives and responsibilities will be given to you during orientation. 14. Meeting with Dr. Tuckler for toxicology teaching.

Conferences: You must attend all conferences.

Extras: All consults and required paper work must be turned in to Dr. Tuckler on the last day of the month.

Supervision: Per Dr. Tuckler

Evaluation: Compiled and pooled from all faculty and Dr. Tuckler.

LSU Emergency Medicine Residency Program MCLANO Toxicology Rotation

GOALS and OBJECTIVES

What follows are the goals and objectives for the MCLANO Toxicology rotation, that will range from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 160

place at the MCLANO University Hospital. The year of training is assigned in the PGY4 year but may include PGY 1-5.

Toxicology is a core component of the Emergency Medicine curriculum mandated by the Residency Review Committee.

1. ROUNDS and CALL at MCLNO

The most important part of your rotation will be DAILY ROUNDS as a stimulus to further your education in emergency toxicology. You are expected to make rounds with the interns and emergency medicine residents caring for poisoned patients. These rounds should be geared to educate the residents and interns as to the appropriate evaluation, treatment, and disposition of the patient, as well as the pathophysiology of the agent or agents causing the overdose. You should be available to the residents to answer questions that may arise regarding treatment of overdoses and perform consults on those patients admitted. Document these rounds by having the ESU staff sign your daily round sheet. Also, document the date, patient's name, hospital number, type of overdose, and location of all patients seen.

In addition YOU WILL BE ON CALL (24 hour call). A schedule will be provided.

You will be required to round with the toxicology staff when they ask you to round with them. You will consult with the staff when you are called for a consult. You will be required to follow patients admitted to the hospital.

DAILY PROGRESS NOTES need to be written and placed in the patient’s chart.

You will also be made familiar with the HAZMAT disaster protocol and you and the staff will be called to come to the hospital in the event of a citywide HAZMAT incident. NO VACATION TIME SHOULD BE PLANNED DURING YOUR TOXICOLOGY MONTH.

YOU ARE REQUIRED TO ATTEND ALL RESIDENT CONFERENCES. NO EXCUSES!!!

You will be required to LECTURE TO THE INTERNS AND RESIDENTS IN THE ED. The subjects of these lectures will be given to you at the beginning of the month. You should also PREPARE A HANDOUT for the interns covering the lecture material. Please provide copies of the lectures to Dr. Tuckler when you check out at the end of the month. The date, time, and subject of these lectures should be documented on the toxicology rotation checklist provided with this packet. You will be REQUIRED TO HAVE A TOXICOLOGY LECTURE LOG SIGNED by all persons attending your lecture. ONE LOG SHEET PER LECTURE

2. MEETINGS: Toxicology meetings will be held with members of the faculty who have a interest in toxicology, namely, Drs. Edward Halton, Keith Van Meter, and Victor Tuckler. You will be provided with a Topics Form, which will list the topics and designate which the faculty will discuss each topic LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 161

with you. It is your responsibility to establish the time and place with each faculty member. Please do not wait till the end of the month to have these lectures. These meetings will provide one-on-one interaction and allow the discussion of varied issues in toxicology.

3. LECTURE: Each resident is expected to give a hour long lecture to the Emergency Medicine residents. The lecture is to be given on the Last Wednesday of the month at 11:00 a.m. The topic of your lecture will be assigned on the first day of the month so that adequate preparation time is available. HANDOUTS AND SLIDES ARE REQUIRED FOR THIS LECTURE. FIVE BOARD TYPE QUESTIONS REGARDING YOUR LECTURE ARE REQUIRED. Please provide a copy of the handout in a floppy disk to Dr. Tuckler. A copy of the handout will be added to the toxicology file. Please meet with the toxicology staff prior to your presentation to review your presentation and discuss possible changes.

4. QUESTIONS: One hundred well documented questions of a national board type are required to be handed in at the end of the rotation. These questions will be discussed at the end of the month with Dr. Tuckler during your check out meeting.

5. PATIENT LOG: YOU WILL NEED TO KEEP A LOG OF ALL PATIENTS SEEN DURING THIS ROTATION. PLEASE LIST THEM ON THE PROVIDED CHECKLIST. Use extra sheet if needed. At the end of the rotation please place all materials to Dr. Tuckler.

6. TOXICOLOGY ORAL BOARD SESSION AND WRITTEN EXAM REVIEW: You will have one oral board scenario practice session with Dr. Tuckler. Please arrange the date and time with Dr. Tuckler. You will also have a review session with Dr. Tuckler over written exam topics and questions.

7. TOXICOLOGY CASE OF THE MONTH You will have one toxicology case to solve during the month. The case will be provided to you at the beginning of the month by Dr. Tuckler. Please answer all the questions, provide a diagnosis, and explain why you reached the diagnosis that you did.

8. TOXICOLOGY CASES REVIEW: You will review toxicology cases with Dr. Tuckler and will be asked to discuss and answer questions regarding toxidromes and pathophysiology.

10. HAZMAT/DISASTER MEDICINE Please contact Dr. Aiken and Dr. Hardy to help with teaching Hazmat and attending Hazmat drills.

11. MONTHLY EVALUATIONS: A final evaluation of your performance and completion of all the above requirements are submitted to Dr. Haydel/Avegno to be put in your file. You are required to turn in to Kathy a LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 162

copy of your lecture, case of the month answers, a copy of the one hundred questions, patient log, sign in sheets, and lectures attended.

For any concerns or questions call Dr. Tuckler at 664-5383. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 163

TRAUMA SURGERY

Emergency Medicine Trauma Surgery Rotation

Dr. ______, you are assigned to Trauma Surgery at LSU Interim Hospital for the month of ______.

You are scheduled for LSU Surgery for the month:

Schedule: Contact the LSU Surgery chief resident 2-3 weeks prior to your rotation to receive your schedule and /or submit a schedule request. All schedule requests should be directed to the Chief Residents.

Responsibilities: Care of University Hospital TICU/Surgery Patients.

Conference: You must attend conference. Dr. Hunt will facilitate this. Please notify your team and the rounding faculty in advance of each conference day, so that you may present your patients first and then come to conference.

Learning Modules: The following two module must be completed with a score of >80% on the open book post-tests within 2 weeks of completing the rotation. The post-test is located in residency partner.

Blunt Trauma Evaluation Trauma Resuscitation

Extras: All procedures must be recorded in residency partner. Please see the section of Procedure and Patient Experience Documentation for ACGME procedure targets. You should document every “room 4” as either an adult or pediatric trauma resuscitation.

Supervision: Provided by LSU Surgery faculty and senior level residents.

Evaluations: Compiled by LSU faculty and senior level residents at the completion of the rotation. The resident is responsible for delivering the evaluation forms to the appropriate faculty or chief resident at the completion of the rotation.

Meals: available at University Hospital.

LSU Emergency Medicine Residency Program MCLANO Surgery Rotation

GOALS and OBJECTIVES

What follows are the goals and objectives for the MCLANO Surgery rotation, that will range from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 164

place at the MCLANO University Hospital. The year of training is assigned in the PGY1 year but may include PGY 1-5.

OBJECTIVES: Gain expertise in the management of surgical emergencies. Learn the priorities and procedures of trauma resuscitation. Become an integral part of the trauma team and respond to all trauma resuscitations along with junior, senior and staff surgeons. Gain exposure to OR sterile techniques and surgical techniques.

GOALS: . Participate in daily teaching rounds . Evaluate Surgical patients in the Emergency Department . Participate in Surgical Procedures, both in the OR and on the floor . Participate in the routine care of Surgical patients . Participate in consults to the Surgical Service . Follow inpatient surgical patients through discharge, including discharge planning

The clinical and didactic experiences used to meet those objectives included daily patient care of the MCLANO Surgical Service Patients, along with bedside teaching. The rotating resident is encouraged to attend lectures available at MCLANO pertaining to the care of the surgery patient. This rotation experience is part of the greater emergency medicine curriculum, also including 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 surgery and emergency medicine. The residents will have access to the resources of the hospital including call rooms, the LSU Medical Library, Hospital medical texts, medical records and the cafeteria.

The clinical experiences, duties and responsibilities the resident will have on the rotation: Residents will act as a part of the Surgery team under the supervision of a staff physician. The residents will participate in the initial management of surgery patients, to include pediatric and adult trauma and general surgery 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 Surgery faculty daily and prior to patient discharge.

Duty hours for this rotation will not exceed an average of 80hrs/week, call not longer than 24 consecutive hours and will include 1 in 7 days off. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 165

This rotation summary has been reviewed and agreed to by the service director and LSU Program Director. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 166

WEST JEFFERSON ED

Dr.______,

You are scheduled for West Jefferson ED from______to ______.

Schedule: Contact the director of the ED, Dr. Chugden ([email protected]) 2-3 weeks prior to your rotation to submit a schedule. Send a copy of your schedule to Kathy Whittington. A resident will do 15 shifts a month; 12noon to 12midnight. No more than one resident per shift. Don't schedule more that half of your shifts on conference or journal club days. Please make a schedule to be posted in their ER prior to the start of the month.

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

Conference: You must attend conference.

Extras: A patient list must be maintained and turned in with your procedure log at the end of the month.

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

Evaluations: Daily evaluations.

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

West Jefferson Medical Center Emergency Department Rotation

GOALS and OBJECTIVES 2007-08

The following are the goals and objectives for the West Jefferson ED rotation, which 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 LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 167

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. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 168

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

Schedule: Two weeks prior to starting, contact Dr. Andrew Mayer ([email protected]) and Kacy Petit in their GME office ([email protected]). You will do 8-hour shifts monday-friday 7a3p, except on wednesdays, when you will attend EM conference 7a11am and then will report to the ED by 12noon and work 12 noon to 8pm.

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

Conference: You must attend conference and Journal Club.

Extras: A patient list must be maintained and turned in with your procedure log at the end of the month.

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

Evaluations: Monthly evaluations.

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

Learning Modules: You must complete the following learning modules and take the post-test within 2 weeks of completing the rotation. You may complete them as early as you like and the tests are open book. You must achieve 80% to get credit for completing the modules. The learning modules can be found under the Home Study link on the LSUEM residency page. The tests will be available on ResidencyPartner, but you can also email your answers to Kathy Whittington ([email protected]) if you have trouble accessing RP.

Modules: 1. Pediatric Emergencies 2. The Nightmare Neonate

LSU Emergency Medicine Residency Program West Jefferson Pediatric Emergency Department Rotation

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 Pediatric ED. 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. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 169

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. LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10 170

ELECTIVE

Dr.______,

You are scheduled for Elective from ______to______.

Schedule: As required by your rotation. The program director and program coordinator must be informed of your selected elective 2 weeks prior to starting the rotation.

Responsibilities: As required by the rotation. Obtain these from the director of the elective rotation you take.

Conference: You are expected to attend conference.

Extras: All procedures must be recorded and turned in at the end of the month.

Available Electives: -Radiology -Critical Care -Pathology (autopsy) -ENT -EMS -Toxicology -Ophthal -Teaching -International EM -OMFS -Dermatology -Hyperbarics -Board Preparation -Research

*Note, all electives must be approved by the residency program director, 2 weeks prior to start of the elective or you will default to University ED.

Evaluations: Responsibility of resident to identify supervising faculty for rotation and obtain summative evaluation sheet.

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