ER/COC Rotation

This G1 rotation is a combination of experience in the ED and the COC outpatient environments.

Resident continuity clinic: Wednesday PM (please confirm with the Resident Medicine Clinic prior to starting the rotation); a three week minimum notice, given to Anne is required if you are planning on taking vacation time.

The first two weeks are in the ED:

Contact: Nate Bowler through the ED at 612-863-4233

Subspecialty clinic: Not applicable

Conference: Not applicable

Schedule:

Monday, Tuesday, Wednesday (avoiding conflicts with afternoon continuity clinic), Thursday, and Friday: ED time will be determined in advance of each residents block and communicated to the resident by Lisa Callies and/or Nate Bowler, conference time is as usual

Performance Expectations:

The resident is expected to be in the emergency department for their shift. All patients should be staffed with the appropriate emergency department MD and subsequently entered into Excellian. The resident should stop seeing new patients about one hour before their shift ends to allow for a timely conclusion to the shift. Residents should sign-out patients to the appropriate emergency MD only if necessary.

For uniformity, the hours of this rotation may not be altered except on the day of the annual picnic in June. You must sign-in each day and give advanced notice to Dr. Bowler if vacation time is planned.
Keep prescription pads in the physician’s area only. Maintain a team approach to patient care. Include nurses in your decisions and keep them informed of new developments and orders. Maintain open communication with patients and family. Keep them informed of delays and additional tests. Report abnormal test results. Guarantee their comfort at all times.

Educational Goals and Objectives:

	Educational objectives	Assessment method
Patient Care	1) Emergency department visits will be performed, staffed, and documented in Excellian 2) Start to learn how to triage and work up patients in this unique setting 3) Start to learn indications for admission, observation, and discharge 4) Demonstrate appropriate communication with primary care physicians and hospital attendings 5) Understand follow up instructions 6) Perform appropriate procedures as able	1) Global faculty assessment 2) Direct faculty bedside observation
Medical Knowledge	1) Review core topics noted below using patient care and supplement with independent reading 2) Understand how life-threatening medical problems present	Global faculty assessment
Practice-Based Learning and Improvement	1) Demonstrate insight into knowledge deficiencies and limitations 2) Use information technology to answer clinical questions	Global faculty assessment
Interpersonal and Communication Skills	1) Refine the skills necessary to present patients and topics informally and formally to another physician or group 2) Maintain a team approach to patient care: discuss plans with nurses and keep them informed of new developments and orders 3) Maintain open communication with the patient and/or family: keep them informed of any delays and additional tests, report abnormal test results, and inform them that their comfort is a high priority	Global faculty assessment
Professionalism	1) Arrive on time and demonstrate time management skills to attempt to finish up patient care by the end of the shift with appropriate signouts as necessary 2) Sign in at the beginning of each shift and give advanced notice to Dr. Nate Bowler if vacation time is planned 3) Wear a white coat and appropriate identification	Global faculty assessment
Systems-Based Practice	1) Understand systems unique to this patient care setting 2) Demonstrate effective and safe patient care hand off to appropriate next setting	Global faculty assessment

Experience in evaluation, diagnosis, treatment and/or triage of multiple emergency syndromes such as

Ophthalmologic problems
Red eye
Eye pain
Visual loss
Trauma to the eye
ENT emergencies
Otalgia
Otorrhea
Epistaxis
Sore throat
Difficulty breathing
Abscesses
Toxicology
Principles of toxicology1
Toxidromes
Common toxicology problems and treatments
Toxicology pearls
Orthopedic topics
General approach to orthopedic injuries
Most common fractures and dislocations
Splinting principles
Orthopedic referral and consultation
Emergency trauma care
General approach to the trauma patient
Primary and secondary survey
Chest trauma
Pelvic fractures
Headache in the emergency department
Goals of management
Ominous headaches
Evaluation and treatment principles
Other topics
Chest pain
Dyspnea
Decreased level of consciousness
Abdominal pain
Psychosis and acute or severe depression
Gastrointestinal bleeding
Low back pain
Alcohol abuse and withdrawal
Sepsis

 Procedures: (Central venous catheters, chest tube)

The second two weeks are in the COC:

Contact for ANGMA-COC:

Tod Worner 952-914-8100
8100 W. 78th Street
Edina, MN

· Reach the COC clinic from the hospital as follows:
Go north on 10th Avenue on the east side of the hospital and go one block to 26th St. Take 26th St. West (one way) to Portland.

· Turn left (south) on Portland and go to 31st street.

· Turn right and 31st St. and go a few blocks and enter 35W south.

· 35W S merges with Cross-town (62), stay to the right and continue west on 62 until you come to highway 169 south. Take this south for a few miles to Valley View Road. After the exit ramp, turn left and cross the highway and then turn right onto the Frontage Road. In a short while this will take you to the clinic.

· Park anywhere in the surface lot. The clinic is the first clinic on the first floor (Suite 100).

COC IM clinic all day Monday through Friday (except for continuity clinic half day at the Medicine Clinic which is scheduled for Wednesday PM for now). The resident will see various physicians’ patients for urgent needs or routine follow up. 

	AM	PM
Monday	ANGMA COC	ANGMA COC
Tuesday	ANGMA COC	ANGMA COC
Wednesday	Grand Rounds ANGMA COC	Medicine Clinic
Thursday	ANGMA COC	ANGMA COC
Friday	ANGMA COC	ANGMA COC

Performance Expectations and Educational Goals and Objectives of ANGMA-COC experience:

	Educational objectives	Assessment method
Patient Care	1) Perform new patient and follow up visits and subsequently discuss their findings and assessments and plans with the designated staff 2) Document the visit details in Excellian 3) Use information technology extensively to support patient care decisions. This includes electronic references and hand-held technology 4) Develop increasing efficiency and ability to triage needs of patient’s medical problems	1) Global faculty assessment 2) Direct faculty bedside observation
Medical Knowledge	1) Review core topics noted below using patient care and didactic opportunities and supplement with independent reading	Global faculty assessment
Practice-Based Learning and Improvement	1) Demonstrate insight into knowledge deficiencies and limitations 2) Use information technology to answer clinical questions	Global faculty assessment
Interpersonal and Communication Skills	1) Refine the skills necessary to present patients and topics informally and formally to another physician or group	Global faculty assessment
Professionalism	1) Give the clinic at least 2 days notice if absence from clinic expected 2) Arrive to clinic on time and finish charting before leaving clinic	Global faculty assessment
Systems-Based Practice	1) Start learning the systems unique to an outpatient setting 3) Start to learn clinical practice guidelines, while recognizing their limitations	Global faculty assessment

Core topics to be covered by patient care if possible or independent reading include the evaluation, diagnosis and treatment of:

Chest pain
Abdominal pain

Heartburn
Headache

Obesity
Low back pain
Depression
Smoking cessation
Alcohol abuse
Hyperlipidemia
Hypertension
Diabetes mellitus
Upper respiratory tract symptoms
Urinary tract infection
Vaginal discharge
Fatigue
Anemia
Red eye
Healthcare maintenance and screening
Prostate health (cancer screening, infection, BPH)
Chronic kidney disease
Secondary prevention of ASCVD

Common musculoskeletal problems
Osteopenia/Osteoporosis
Preoperative evaluation