The educational purpose of this rotation is to teach residents the principles of emergency management of patients who present with a wide variety of acute, subacute and chronic medical, psychiatric, surgical, orthopedic and obstetric and gynecological problems. Residents will diagnose, treat and care for men and women in the setting of the emergency department. They will evaluate and manage these patients under the direct supervision of an attending physician specialized in emergency medicine. We utilize our Somerville and Cambridge campuses for the ED rotation. During the ED rotation senior residents have 3 shifts in the ED and 2 night float shifts in ICU or Wards. This keeps the work-load balanced across inpatient rotations without impacting the elective or ambulatory.
Through the rotation interns and residents will gain the knowledge of the epidemiology and pathophysiology of disease, as well as optimal approach to diagnosis, treatment and follow-up of these diseases. Interns and residents will continue to learn the key role of humanistic and professional values in caring for the sick and injured.
Interns and residents will develop interpersonal and communication skills which allow them to effectively collaborate with the other members of emergency medicine team and effectively provide emergency medical care. They will gather data from all relevant sources, including patient history, physical exam, laboratory data, imaging and other medical documents, consultants from other specialties. They will subject this data to the scientific method of problem solving using available sources of medical knowledge. Based on that, they will make informed patient care decisions under the direct supervision of an attending emergency medicine physician.
The care they provide will be driven by the values of humanism and professionalism. They will learn to function as an integral part of the health care delivery system and will access and utilize health care resources in an efficient and optimal manner.
- Patient Care: Interns and residents will be primary providers for patients they evaluate and treat in the emergency department. Patients will be undifferentiated and not pre-selected. Interns and residents will provide emergency medical care for adult patients with a wide variety of acute, subacute and chronic presentations. Every patient encounter will be directly supervised by Emergency Medicine (EM) Attending 24 hours a day, 7 days a week. Interns and residents will develop the skills to obtain a medical history, do a problem-oriented physical examination, develop differential diagnoses, diagnostic testing strategies and treatment plan. These skills will develop in the context of the time critical management of patients who are both stable and unstable. Interns and residents will learn to assess a patient’s medical status with attention to relevant cultural, socioeconomic, ethical, occupational, environmental and behavioral factors.
- Medical Knowledge: Interns and residents will acquire knowledge of the most common presentations in Emergency Medicine. Interns and residents will learn to treat patients based on etiology, pathogenesis and clinical manifestations of various diseases, drawing from the clinical experience of the supervising Emergency Physicians and evidence-based medicine.
- Practice-based Learning and Improvement. Residents will give and receive feedback regarding processes of care and demonstrate willingness to learn from their own past experience. Residents will implement strategies based on this learning to continually improve the quality of patient care. Interns and residents will develop presentation skills. They will have to present and discuss every case with the EM Attending. Such a discussion includes presentation of history, physical findings, differential diagnosis, diagnostic testing and treatment plan, including a decision whether to admit the patient. Residents will also discuss patients with consultants.
Interns and residents will obtain experience with a wide range of procedures, including lumbar puncture, thoracocentesis, paracentesis, arthrocentesis, airway management, defibrillation, CPR, naso- and orogastric tube placement, central venous cannulation, arterial puncture for ABG analysis, slit lamp exam, incision and drainage of abscesses, and laceration repair.
- Interpersonal and Communication Skills: Interns and residents will continue their professional development through interactions with patients and patients’ families, EM Attending Physicians, nurses and other health care professionals. They will establish and maintain therapeutic and ethically sound professional relationship with patients, patients’ families and other members of emergency medicine team. Interns and residents will use effective listening, nonverbal, questioning and narrative skills to communicate with patients and families. They will interact with consultants in a respectful, appropriate manner. Interns and residents will maintain comprehensive, timely and legible medical records.
- Professionalism: Interns and resident will consistently demonstrate sensitivity, respect, compassion and altruism in relationships with patients, families and members of the emergency medicine team. Interns and residents will demonstrate sensitivity and responsiveness to the gender, culture, age, sexual preferences, socioeconomic status, beliefs, behaviors and disabilities of patients and colleagues. They will adhere to the highest ethical standards including principles of patient confidentiality, academic integrity and informed consent.
- Systems-Based Practice: Interns and residents will learn to analyze systems of care with the goal of perfecting individual patient care in an evidence-based, efficiency-conscious manner. They will learn to collaborate with other members of the health care system to assist patients in negotiating complex health care delivery systems. Interns and residents will learn appropriate utilization of health care resources in the emergency department.
Emergency Medicine rotation is scheduled as a 2 or 4 week rotation during PGY 1, 2 and 3 years of training in Internal Medicine. Interns and residents are directly supervised by Attending EM Physicians 7 days a week, 24 hours a day.
- Case based teaching. Interns and residents are expected to read and learn about pathophysiology, differential diagnosis and management of clinical problems they encounter in the emergency department. The supervising Emergency Medicine Attending should use every case as a teaching opportunity, utilizing his/her experience, textbooks, review articles and newest literature data. The supervising EM Attending will encourage interns and residents to read about the cases they present.
- Bedside teaching. Interns and residents will learn and improve their physical exam and procedures skills under the direct supervision and guidance of the EM Attending Physician.
- Didactic conferences. The EM faculty teach in the Core Conference series for interns and residents.
Interns: SAT, SUN, MON 9 am – 9 pm (ICU night float on TUES, WED 8pm- 10am) at Somerville Campus
R2/3s: TUES, WED, THURS 12 noon – 10 pm (ICU night float on FRI, SAT 8pm- 10am) at Cambridge Campus
For questions regarding potential modifications to your schedule please be aware: You are expected to be in the ED when you are scheduled to be there without exception. If you have an unavoidable conflict, please coordinate with your chiefs to arrange coverage for the time you are absent.
The program supports the learning and use of feedback techniques as a way to contribute to professional development and improve professional relations among housestaff and other medical personnel. Interns and residents will receive regular feedback from the attendings with whom they work. We encourage residents and attendings to take a few minutes at the end of every shift to review the patients seen by the resident. During these sessions, residents should have the opportunity to ask questions and to get feedback on their performance. Residents will also receive a formal written evaluation at the end of the rotation comprised of a compilation of comments from the attending group. Residents also are asked to evaluate all the attendings with whom they work through our on line evaluation system. Residents are encouraged to contact the academic liaison at any point during their rotation with concerns or comments about their EM rotation, including their assessment of learning values of the rotation, interaction with the other members of emergency medicine team etc.
- Attending to Intern/Resident feedback: EM Attendings directly supervise every case seen by interns and residents in the ED. They review every chart written by interns and residents. Personal informal feedback is encouraged for every case. We also ask that attendings and residents take a few minutes at the end of every shift to go over their list of patients seen. This should be an opportunity to reflect on how the resident is doing in terms of both efficiency and clinical decision making. It also offers residents an opportunity to ask questions about specific cases and review learning points.
- Interns/Residents to attending feedback. The academic liaison for the emergency department meets periodically with a group of interns/residents and the chief resident to get feedback on their experience in the ED. The feedback is mostly focused on educational issues. Residents also have the opportunity at the end of the rotation to evaluate attending performance. They should reserve the last half hour of their last day on shift to complete these evaluations.
Method of Evaluation of Interns and Residents
- Interns and residents are formally evaluated by every EM attending physician once a month during monthly EM attendings meeting.
- These evaluations are summarized in a written evaluation form signed by EM academic liaison. The form reflects the quality of performance during the EM rotation with a focus on areas for improvement. It considers accomplishment in the following domains: patient care; medical knowledge; practice based learning; interpersonal and communication skills; professionalism; system based practice.
- These forms are submitted to interns and residents evaluation committee and placed in the interns’ and residents’ folders.
Evaluation of EM Rotation
- At the end of their rotation interns and residents debrief in person with EM academic liaison. The focus is on learning experience and individual faculty teaching skills.
- At the end of their rotation, interns and residents should use the last hour of their shifts to fill out an evaluation form on every EM attending with a focus on teaching and supervising qualities. These forms go to the DOM Director of Residency and to EM academic liaison for further discussion with a focus on improvement of training.
- Emergency Department library.
- Literature search engines: OVID, MEDLINE.
- On-line resources: Up-To-Date, EMEDICINE,, Harrison’s Online, MD Consult etc.
- Poison Control Center.