Appendix C
Emergency Medicine Goals and Objectives
This section includes a comprehensive list of goals and objectives for the subjects listed below. Each objective is followed by the relevant core content item numbers. We are proposing that learning objectives or content items be prioritized to indicate the depth and breadth of knowledge in that area that is required of a specialist in emergency medicine. Therefore we have developed the following weighting system.
A
C, D, E
G
N
O, P, R
T, U, W
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Goals:
- Learn basic principles of leadership and administration.
- Develop an understanding of quality improvement and risk management programs and their application to the operation of an emergency department.
- Develop an understanding of the function of emergency medicine within the institution and its relationship with other departments.
- Develop an understanding of the function of accrediting agencies and their relationship with emergency medicine.
Objectives:
- Discuss the following concepts as they relate to Emergency Medicine: credentialing, career development, recruitment, budgeting, health care financing, managed care, personnel management, public relations, marketing, hospital administration, practice management, contracts, work schedules. (3)
- Discuss cost containment as relates to Emergency Medicine. (2)
- Discuss JCAHO requirements relating to the Emergency Department with emphasis on staffing, equipment and supplies, facility, quality assurance and patient transfer regulations. (3)
- Discuss hospital and Emergency Department administrative organization. (3)
ANESTHESIA
Goals:
- Develop airway management skills
- Develop familiarity with pharmacologic agents used in anesthesia
- Learn standard monitoring techniques
- Learn relevant pre-operative historical and physical exam considerations
- Learn principles of pain management.
Objectives:
- Demonstrate correct use of the bag-valve-mask device. (1)
- Demonstrate knowledge of the anatomy of the upper airway. (1)
- Demonstrate basic familiarity with nasotracheal and endotracheal intubation as well as the indications and complications (1)
- State the dosages, indications and contraindications for inhalation anesthetic agents, intravenous analgesic and anesthetics, and neuromuscular blocking agents. (1)
- Demonstrate ability to use standard monitoring techniques. (1)
- Demonstrate ability to manage a patient on a ventilator. (1)
- Demonstrate knowledge of the principles of regional anesthesia and successfully perform metacarpal, digital, radial, median, ulnar, tibial and sural nerve blocks. (2)
- Demonstrate ability to administer local anesthetics and be familiar with agents, dosing, side effects, and techniques to monitor pain. (1)
- Recognize and manage an obstructed airway. (1)
- Perform conscious and deep sedation under faculty supervision.(1)
- Perform facial nerve blocks to include supra orbital, infra orbital, mental and auricular nerves. (2)
- Demonstrate appropriate judgment regarding the need for airway intervention. (1)
- Demonstrate skill in the use of anesthetics and neuromuscular blocking agents including conscious sedation and rapid sequence intubation. (1)
- Demonstrate ability to obtain a surgical airway. (1)
- Demonstrate ability to perform dental block. (2)
CARDIOVASCULAR
Goals:
- Demonstrate the ability to stabilize patients who present in cardiopulmonary arrest.
- Develop skills in the evaluation of patients who present with chest pain.
- Demonstrate the ability to evaluate, stabilize, treat, and arrange for appropriate disposition of patients with cardiac disease processes.
- Demonstrate the ability to develop a differential diagnosis for patients presenting with cardiac symptomat ology (chest pain, shortness of breath, weakness, palpitations), etc.
- Demonstrate skill in the interpretation of diagnostic modalities (ECG, chest x-ray and cardiac ultrasonography).
- Develop a familiarity with cardiac pharmacologic agents.
- Demonstrate skill at cardiac related procedures: venous line and CVP pressure monitoring, pericardiocentesis, defibrillation and cardioversion, Swan ganz catheterization, and ultrasonography.
- Demonstrate the ability to diagnose, stabilize, and apply thrombolytic therapy to patients presenting with acute early myocardial infarction.
Objectives:
- Demonstrate the ability to perform an appropriate history and physical examination on the patient presenting with cardiac symptomatology. (1)
- List items elicited from the history of patient with chest pain to suggest a risk for cardiac etiology. (1)
- Discuss limitations in differentiation of cardiac chest pain from non-cardiac pain in patients with risk factors. (1)
- Describe the pathophysiology of cardiac ischemia, acute angina chest pain, and acute myocardial infarction. (1)
- Describe the typical electrocardiograph findings of patients with myocardial ischemia, subendocardial infarction and myocardial and transmural infarction. (1)
- Discuss differential diagnosis of atypical chest pain. (1)
- Discuss atypical presentations for acute cardiac ischemia and myocardial infarction. (1)
- Discuss the sensitivity and specificity of ancillary studies for chest pain presentations including EKG, chest x-ray, cardiac enzymes, and arterial blood gases. (1)
- Differentiate between stable and unstable angina and outline the initial treatment of patients with unstable angina including the use of nitrates, beta blockers, calcium channel blockers, etc. (1)
- Discuss the concept of "silent" myocardial infarction and ischemia. (1)
- Differentiate between transmural versus subendocardial infarction. (1)
- Discuss the significance of acute complete atrio-ventricular block with inferior myocardial infarction versus anterior myocardial infarction. (1)
- Demonstrate knowledge of AHA recommendation for the treatment of acute ventricular fibrillation, ventricular tachycardia, asystole, pulseless electrical activity, atrial flutter and fibrillation, junctional ectopy, pre-exitation, supraventricular tachycardia, and bradycardia, sick-sinus syndrome, atrial ventricular blocks (first degree, second degree and third degree) and bundle branch blocks. (1)
- Describe the clinical findings of cardiogenic shock and outline therapy for cardiogenic shock. (1)
- Differentiate cardiogenic shock from other etiologies for shock. (1)
- Describe the clinical presentation for pericardial disease and outline the appropriate initial therapy and management for pericardial disease. (1)
- Describe the presentations for myocardial infarction and their association with vessel involvement. (1)
- List the indications, contraindications and complications of thrombolytic therapy for acute myocardial infarction. (1)
- Describe the clinical presentation, etiologies for pathophysiology of, and current therapy for acute congestive heart failure. (2)
- Describe the valvular anatomy of the heart and list etiologies for valvular heart disease. (2)
- Describe the clinical findings of a mitral valve prolapse, valvular aortic stenosis, aortic regurgitation, tricuspid stenosis, tricuspid regurgitation, and pulmonary stenosis, and discuss management of each of these valvular abnormalities. (2)
- List complications of prosthetic cardiac valves and appropriate emergency department management. (1)
- Differentiate between congestive cardiomyopathy, hypertrophic cardiomyopathy and restrictive cardiomyopathy and discuss therapy for each. (2)
- Define myocarditis and describe the EKG findings and acute management of myocarditis. (2)
- Discuss the pathophysiology of acute pulmonary embolism and the predisposing factors for pulmonary embolism. (1)
- Discuss the sensitivity and specificity of the various tests used to diagnosis pulmonary embolism including arterial blood gases, EKG, chest x-ray, etc. (1)
- Discuss the sensitivity and specificity of ventilation perfusion scan in acute pulmonary embolism.
- Outline treatment for acute pulmonary embolism. (1)
- Differentiate between acute hypertensive emergencies, hypertensive urgency, and uncomplicated hypertension. (1)
- Discuss the indications for treatment of hypertension in the emergency department. (1)
- Describe the syndrome of hypertensive encephalopathy. (1)
- Outline the treatment for acute hypertensive emergency and differentiate treatment in the setting of thoracic aortic dissection. (1)
- Differentiate between primary agents for hypertensive emergency to include their advantages and disadvantages. (1)
- Describe the clinical presentation of acute mesenteric ischemia and discuss the inherent difficulties in the diagnosis as well as the emergency department management. (1)
- Discuss the pathophysiology, etiology, and overall morbidity and mortality of patients presenting with acute aortic dissection. (1)
- Explain the emergency department management of acute aortic dissection. (1)
- Differentiate between expanding, ruptured, and dissecting aortic aneurysms. (1)
- Describe the pathophysiology and clinical presentation for acute peripheral ischemia and outline the emergency department management. (1)
- Differentiate between superficial and deep venous thrombosis. (1)
- Outline the emergency management of acute thrombophlebitis. (1)
- Discuss the pathophysiologic connection between thrombophlebitis and pulmonary embolism. (1)
- Discuss the use of thrombolysis in acute thrombophlebitis. (2)
CRITICAL CARE AND RESUSCITATION
Goals:
- Develop the ability to rapidly evaluate, diagnose, stabilize, and disposition critically ill patients.
- Learn respiratory, cardiovascular, renal and neurologic physiology and the pathophysiology of trauma, toxins, shock, sepsis, cardiac failure, and respiratory failure that affect critically ill patients.
- Learn the principles of medical instrumentation and hemodynamic monitoring and be able to utilize them in the care of critically ill patients.
- Learn the indications and develop the technical skills needed to perform diagnostic and therapeutic interventions in critically ill patients.
- Learn the rational use of laboratory, radiographic and other diagnostic tests in the management of critically ill patients.
- Understand the etiologies and pathophysiology of cardiac arrest.
- Learn to recognize the dysrhythmias assoicated with cardiac arrest and their treatment.
- Learn the American Heart Association recommendations and develop skill in the performance of standard resuscitative procedures.
- Learn the principles of pharmacotherapy and the routes and dosages of drugs recommended during cardiac arrest and following resuscitation.
- Learn the indications for withholding and terminating resuscitation.
Objectives:
- Demonstrate ability to rapidly perform history and physical exams in critically ill patients. (1)
- Demonstrate the ability to perform the following procedures: oral endotracheal intubation, nasotracheal intubation, cricothyrotomy, needle thoracostomy, tube thoracostomy, central intravenous placement, swan ganz placement, transvenous cardiac pacing, arterial line placement, ABG, and foley catheterization. (1)
- Demonstrate the ability to use and interpret data from ECG monitors, ECGs, cardiac outputs, hemodynamic monitoring, arterial blood gases, pulse oximetry, end tidal CO2 monitors and respirators. (1)
- Describe the dosages, indications and contraindications of pharmacologic interventions for shock, cardiac failure, dysrhythmias, sepsis, trauma, toxins, respiratory failure, hepatic failure, renal failure, and neurologic illnesses. (1)
- Demonstrate the ability to manage a patient on a ventilator. (1)
- Demonstrate appropriate judgement in the management of critically ill patients. (1)
- Demonstrate appropriate prioritization of diagnostic and therapeutic interventions in critically patients. (1)
- Demonstrate ability to diagnose and treat shock, sepsis, fluid and electrolyte abnormalities, cardiac failure, cardiac dysrthmias, renal failure, hepatic failure, and toxicologic emergencies. (1)
- Demonstrate an understanding of the appropriate use of consultants in critically ill patients. (1)
- Demonstrate an understanding of the ethical and legal principles applicable to the care of critically ill patients. (1)
- Demonstate knowledge of the various etiologies of cardiac arrest and the corresponding therapeutic approaches. (1)
- Demonstrate knowledge of the factors affecting blood flow, oxygen delivery and oxygen consumption during cardiac arrest. (1)
- Demonstrate ability to recognize dysrrhythmias associated with cardiac arrest and knowledge of ACLS protocols for their treatment. (1)
- Demonstrate ability to manage the airway during cardiac arrest, including mouth-to-mouth ventilation, bag-valve-mask ventilation, endotracheal intubation, cricothyroidotomy, and recognition of the obstructed airway. (1)
- Demonstrate ability to perform external closed chest cardiopulmonary resuscitation. (1)
- Discuss the dosages, indications and contraindications for pharmocologic therapy during cardiac arrest and following resuscitation. Demonstrate knowledge of the techniques for drug administration including peripheral and central venous, endotracheal, intraosseous and administration. (1)
- Demonstrate ability to safely perform internal and external defibrillation. (1)
- Demonstrate understanding of "Do not resuscitate" orders, advance directives, living wills and brain death criteria. (1)
Goals
- Dvelop ability to recognize and appropriately treat disorders of the skin and mucous membranes.
Objectives
- Demonstrate ability to diagnose and treat dermatitis and eczema. (2)
- Demonstrate ability to diagnose and treat soft issue infections. (1)
- Demonstrate ability to diagnose and treat maculopapular lesions. (2)
- Demonstrate ability to diagnose papular and nodular skin lesions. (3)
- Demonstrate ability to diagnose and discuss the etiologies of erythema. (2)
- Demonstrate ability to diagnose and discuss the etiologies of vesicular and bullous skin lesions. (2)
- Demonstrate ability to diagnose common skin cancers. (3)
- Demonstrate knowledge of the cutaneous manifestations of acute systemic illnesses. (1)
- Discuss the indications for emergent dermatologic consultation. (1)
- Discuss the common pharmacologic agents used to treat dermatologic disorders and their indications. (2)
Goals:
- Learn common organizational structures of emergency medical services.
- Learn the educational requirements and skill levels of various EMS providers.
- Learn principles of EMS system operations.
- Learn basic principles of disaster management.
- Learn principals of prehospital triage and emergency medical care delivery.
- Learn basic principals of EMS research.
- Learn medicolegal principals relating to EMS.
Objectives:
- Actively participate in EMS system. (1)
- Describe local, state and national components of EMS. (3)
- Demonstrate ability to use all elements of the EMS communication system. (2)
- Demonstrate ability to provide initial and continuing education to all levels of EMS personnel (3)
- Demonstrate familiarity with research methodologies relating to EMS and disaster management. (3)
- Discuss medicolegal liability issues relating to EMS. (1)
- Participate in EMS continuous quality improvement. (3)
- Participate as an observer or team member in ground and air medical transport systems. (2)
- Discuss development of EMS prehospital care protocols. (3)
- Discuss basic concepts of mass casualties. (1)
10a. Discuss basic concepts of disaster management. (3)
- Demonstrate understanding of appropriate utilization practices for ground and air medical services. (2)
- Discuss the process of disaster management notification,, response, and medical care on a local, state and national level. (3)
- Discuss the importance of and methods for medical control in EMS systems. (2)
- Discuss the differences in education and skill level of various EMS providers. (2)
- Describe common environmental, toxicologic, and biological hazards encountered in the prehospital care setting as well as injury prevention techniques. (2)
Goals:
- Learn the pathophysiology, patient evaluation and management of thermal and chemical burns.
- Learn the pathophysiology, patient evaluation and management of electrical injury, including lightning injury.
- Learn the pathophysiology, patient evaluation and management of radiation injuries.
- Learn the pathophysiology, patient evaluation and management of hypothermia and frostbite.
- Learn the pathophysiology, patient evaluation and management of heat illness.
- Learn the pathophysiology, patient evaluation and management of drowning and near-drowning.
- Learn the pathophysiology, patient evaluation and management of barotrauma.
- Learn the pathophysiology, patient evaluation and management of high altitude illness.
Objectives:
- Demonstrate the correct care for the burn victim. (1)
- Demonstrate the ability to calculate surface area burned for various age groups using a Lund-Browder chart. (2)
- Demonstrate the method for determining the correct maintenance fluid regimen for the burned patient.(2)
- State the admission criteria for the burned patient, including criteria for burn unit admission. (1)
- State the chemical mechanism of injury for hydrochloric and sulfuric acids, hydrofluoric acid, alkaline burns, and white phosphorous burns. (3)
- List the differences between alkali and acid burns. (2)
- State the treatment for an acid burn, alkali burn, hydrofluoric acid burn, and white phosphorous burn. (1)
- Appropriately manage acute chemical burns in the Emergency Department. (1)
- State the common injuries/conditions which are associated with electrical injuries. (1)
- Demonstrate appropriate clinical and diagnostic evaluation of the electrically-injured patient. (1)
- List the complications resulting from electrical injuries. (2)
- State the common injuries and conditions associated with lightning injuries. (2)
- List the appropriate clinical and diagnostic evaluation of the lightning-injured patient. (1)
- Demonstrate the ability to evaluate and treat lightning injury. (1)
- State the conditions which are associated with radiation injuries. (2)
- State the appropriate clinical and diagnostic evaluation of the radiation-injured patient. (2)
- List the decontamination procedures required for the radiation-injuried patient. (2)
- State the pathophysiologic mechanisms associated with inhalation injury. (3)
- State the indications for intubation in the smoke inhalation patient. (1)
- List the common toxins commonly associated with a house fire. (2)
- Demonstrate appropriate management of inhalation injuries, and recognize those patients who require emergent intubation. (1)
- Demonstrate the correct care for the frostbite victim. (2)
- Discuss the criteria for superficial frostbite and for deep frostbite. (2)
- Demonstrate the correct care for the hypothermic patient. (1)
- State the various techniques for passive and active rewarming. (1)
- Discuss the appropriate interpretation of blood gases in the hypothermic patient. (1)
- State specific considerations regarding intubation, use of external cardiac compression, and use of cardiovascular medications in the hypothermic patient. (1)
- Demonstrate the correct care for the heat cramp, heat exhaustion, and heat stroke patient. (2)
- State the definition for heat stroke and list the patients at risk for heat stroke. (2)
- State the critereon that differentiate the various types of heat illness. (1)
- Demonstrate the correct care for the near-drowning/drowning patient. (3)
- State the pathophysiologic processes associated with immersion. (2)
- List the complications resulting from near-drowning/drowning. (2)
- State the pathophysiology of barotrauma of descent, barotrauma of ascent, air embolism, and decompression sickness. (1)
- Discuss the appropriate therapy for dysbaric injuries. (2)
- List the indications for hyperbaric oxygen therapy. (3)
- Discuss emergency first aid for a diving accident at sea. (2)
- State the symptoms associated with acute mountain sickness, high altitude cerebral edema, high altitude pulmonary edema, and high altitude retinopathy. (2)
- Discuss the appropriate therapy for mountain sickness, high altitude cerebral edema, high altitude pulmonary edema, and high altitude retinopathy. (2)
Goals:
- Learn basic ethical principles relevant to emergency medicine.
- Apply ethical principles to specific patient encounters to assist in decision making.
- Learn basic legal principles relevant to emergency medicine.
- Learn the similarities and differences between legal and ethical principes relating to emergency medicine.
Objectives:
- Discuss the historical, philosophical, and practical implications of beneficiance, autonomy, justice, truth-telling and confidentiality to emergency medical practice and research. (2)
- Demonstrate ability to assess patients' decisional capacity/competency. (1)
- Discuss laws relating to drug dispensing, regulation, and abuse. (1)
- Discuss the importance of proper documentation in medicolegal proceedings. (2)
- Demonstrate ability to apply ethical principles to resuscitation, including advance directives, decision to forgo resuscitation, euthanasia, and organ transplantation. (1)
- Demonstate knowledge of cost containment, resource allocation, quality of care and access to care issues. ( 2)
- Describe basic principles of medical malpractice. (2)
- Demonstrate familiarity with managed care plans. (3)
- Discuss the components of hospital administration and interactions as they relate to emergency medicine. (3)
- Discuss the components and responsibilities of physician-physician relationships. (2)
- Demonstrate knowledge of laws regarding reportable diseases, patient care, and patient transfers. (1)
- Demonstrate knowledge of laws regarding reporting of deaths and appropriate documentation. (2)
Goals:
- Assimilate general concepts of internal medicine, history taking and physical examination skills to develop a systemic evaluation for patients presenting to the emergency department.
- Learn the pathophysiology, presentation, and management of diseases related to the alimentary tract.
- Develop knowledge of the pathophysiology, presentation, and management of common hematologic diseases.
- Master the understanding of the components of the immune system, and the disorders of hyper- and hypofunction of the immune system.
- Know the major systemic infectious disorders, their diagnosis and treatment.
- Learn the pathophysiology, evaluation, and treatment of renal disorders.
- Develop knowledge of the etiologies, manifestations, and treatment of endocrine and metabolic disorders.
- Master an understanding of the diseases of the respiratory system, including pathophysiology, evaluation, and treatment.
Objectives:
- Demonstrate appropriate history taking skills for all patients presenting to the emergency department. (1)
- Demonstrate the ability, based on the history acquired, to do an immediate assessment and initial stabilization, followed by a complete directed examination. (1)
- Combine the knowledge defined in the objectives below with the history and physical examination, to develop an appropriate differential diagnosis for all presentions. (1)
- Demonstrate knowledge of the causes, presentation, and management of esophageal problems. (2)
- Describe the etiologic agents, pathophysiology, and management of infectious diarrhea. (2)
- Demonstrate the ability to evaluate, manage, and appropriately disposition patients with gallbladder and liver disorders. (1)
- Demonstrate knowledge of the presentation, diagnosis, and management of obstructive lesions of the alimentary tract. (1)
- Demonstrate the ability to perform intubation procedures of the alimentary tract, including, but not limited to, NG tube insertion and anoscopy. (2)
- Describe the presentations, work-up, and appropriate treatment of patients with inflammatory processes of the alimentary tract. (1)
- Demonstrate familiarity with the evaluation, treatment, and appropriate disposition of patients with gastrointestinal bleeding. (1)
- Demonstrate knowledge of the proper evaluation and treatment of the patient with sickle cell disease. (1)
- Describe the appropriate steps in the assessment and treatment of the patient with bleeding disorders. (1)
- Demonstrate knowledge in the work-up, treatment, and appropriate disposition of the patient with anemia. (3)
- Demonstrate understanding of the appropriate use of transfusions of blood components, including diagnosis and treatment of transfusion reactions. (1)
- Demonstrate familiarity with the mechanism and manifestations of immune compromise, including that caused by infection with HIV. (2)
- Discuss and be able to differentiate non-AIDS causes of immune hypofunction. (2)
- Discuss the manifestations, initial treatment, and appropriate disposition of patients with rheumatologic and autoimmune diseases. (2)
- Demonstrate understanding of the work-up and treatment of patients with hypersensitivity reactions, including transplant rejection. (1)
- Demonstrate knowledge of the concepts of cellular and humoral immunity and the proper use of immunizations in patients presenting to the emergency department. (3)
- Demonstrate familiarity with the manifestations of, evaluation for, and treatment of bacterial infections, especially including gonorrhea, syphilis, tuberculosis, and tetanus. (1)
- Describe the diagnostic criteria for, and the treatment of, toxic shock syndrome. (1-treatment; 2-criteria)
- Know the characteristics of sepsis in differant age groups. (2)
- Demonstrate knowledge of the appropriate initial treatment of the patient with possible sepsis. (1)
- Demonstrate knowledge of the vector, predisposing factors, clinical course, work-up, and treatment of rickettsial diseases. (3)
- Discuss the manifestations of, treatment of, appropriate disposition for, and immunization (when appropriate) of patients with viral infections. (1)
- Demonstrate knowledge of the time course, vectors, and treatment of the more common protozoal diseases. (2)
- Demonstrate familiarity with the causes, presentation, initial management and disposition of patients with glomerular disorders. (2)
- Describe the common etiologic agents, and appropriate work-up and disposition of patients with infections of the renal system. (1)
- Discuss the common causes, metabolic manifestations, treatment (including dialysis) and disposition of patients with renal failure. (1)
- Describe the common complications of dialysis therapy and how they manifest in patients presenting to the emergency department. (1)
- Define the etiologies, and demonstrate understanding in the evaluation and treatment of patients with acid/base disorders. (1)
- Demonstrate understanding of the etiologies, manifestations, and treatment of fluid and electrolyte abnormalities. (1)
- Discuss the manifestations, work-up, treatment, and disposition of patients with disorders of glucose metabolism. (1)
- Demonstrate understanding of the common endocrine abnormalities, especially regarding presentation, initial evaluation and management, and disposition. (2)
- Discuss acute treatment for patients presenting with disorders of severe malnutrition. (3)
- Demonstrate knowledge in the etiologic agents causing, presentation and evaluation, and disposition of patients with infections of the respiratory system. (1)
- Describe the etiology, manifestation, and treatment of patients with acute and chronic airway disease. (1)
- Discuss the predisposing factors, presentation, and appropriate treatment of patients with pulmonary embolus. (1)
- Demonstrate knowledge of the potential presentation, work-up, treatment and appropriate disposition of patients with chest masses. (3)
- Demonstrate knowledge of the presentation, work-up, treatment, and disposition of patients with chronic granulomatous disease. (3)
- Demonstrate knowledge of the appropriate evaluation of patients with abnormalities of the lymphatic system. (3)
- Demonstrate knowledge of the presentation, treatment, and disposition of patients with malignancies of the hematopoietic system. (2)
- Demonstrate understanding of the etiologies, diagnosis, and treatment of adult respiratory distress syndrome and multisystem organ failure. (1)
Goals:
- Develop familiarity with common general surgical disorders.
- Develop relevant history and physical exam skills.
- Develop procedural skills relevant to general surgery.
- Develop skill in the overall assessment of the general surgical patient.
- Learn indications for consultation and surgical intervention in patients with acute abdominal pain.
- Learn the principles of care of the perioperative patient.
Objectives:
- Demonstrate ability to perform an appropriate history and physical exam in patients with general surgical disorders, including an appropriate preoperative evaluation. (1)
- Discuss the differential diagnosis of acute abdominal pain and demonstrate ability to evaluate, treat and obtain appropriate consultation. (1)
- Demonstrate ability to diagnose and treat common disorders of the breasts. (2)
- Demonstrate ability to diagnose and treat common disorders of the anus and rectum. (2)
- Demonstrate ability to perform common procedural skills including gastric intubation, tube thoracostomy, placement of central venous lines, wound closure, and abscess incision and drainage. (1)
- Demonstrate ability to assist in the operative and perioperative therapy of surgical patients. (3)
- Discuss the common fluid and electrolyte disturbances in surgical patients and demonstrate ability to manage patients with these disorders. (2)
- Demonstrate appropriate prophylaxis and treatment of surgical infections. (2)
- Demonstrate ability to manage pain in surgical patients. (1)
- Discuss the role of abdominal imaging in the evaluation of abdominal pain and demonstrate ability to appropriately order and interpret imaging modalities in surgical patients. (1)
- Demonstrate ability to rapidly recognize and treat patients with abdominal aortic aneurysm. (1)
- Demonstrate ability to manage patients with acute and chronic peripheral vascular insufficiency. (1)
- Demonstrate ability to manage patients with soft tissue infections. (1)
- Demonstrate ability to diagnose common structural defects of the abdominal wall. (2)
Goals:
- Understand the changes in anatomy, physiology, pharmacology, and psychology that occur with aging.
- Learn the overall principles of managing the geriatric patient in an emergency care environment.
- Understand societal biases regarding aging in the context of the emergency health care system.
- Learn the concept of functional status as the interaction of age, disease, and environment.
- Learn the ethical principles involved in medical decision making with regard to advance directives and life sustaining treatment.
- Learn the pathophysiology and emergency treatment of elderly patients with common medical, neurologic, psychologic, and surgical diseases.
Objectives:
- Demonstrate a sensitivity to the needs of elderly patients and respect for their ability to make decisions. (1)
- Demonstrate the ability to do a formal mental status exam for the elderly patient in the emergency department environment. (1)
- Demonstrate the ability to assess decision making capacity in the elderly; discuss the types and meaning of advance directives. (1)
- Discuss which laboratory tests are physiologically altered with aging and which tests are not changed. (2)
- Discuss which common diseases (appendicitis, myocardial infarction, etc.) present in elderly patients with atypical signs and symptoms that are different than the presentations in younger patients. (1)
- Demonstrate the ability to do functional assessments evaluating activities of daily living (ADL) of elderly patients in an emergency department setting. (3)
- Demonstrate the ability to define and diagnose dementia and delirium in elderly patients. (1)
- Discuss the etiologies and pathophysiology of falls in the elderly; demonstrate the ability to care for the elderly fall victim. (2)
- Discuss the management of elderly patients who present with polypharmacy. (2)
- Demonstrate the ability to detect depression, alcohol and drug abuse, and anxiety disorders in elderly patients. (2)
- Demonstrate the ability to detect and manage elder mistreatment, including physical abuse, sexual assault, physical neglect, and psychological abuse and neglect. (1)
- Demonstrate the ability to diagnose and treat myocardial infarction in elderly patients; discuss the importance of myocardial salvage for elderly patients with acute myocardial infarction. (1)
- Demonstrate the ability to diagnose and treat elderly patients with cerebral vascular accidents. (1)
- Demonstrate the ability to diagnose and manage trauma and acute abdominal emergencies in the elderly patient; discuss the differences in the approach to elderly patients with surgical emergencies compared to the non-elderly. (1)
- Demonstrate the ability to manage elderly patients presenting with syncope, dizziness, bleeding disorders, and acute infections. (1)
- Demonstrate the ability to address the psychosocial needs of the elderly being discharged from the emergency department. (2)
Goals:
- Learn the anatomy, pathophysiology, presentation, and management of common nervous system disorders and injuries.
- Develop skill in the performance of a screening and detailed neurological evaluation.
- Develop skill in the use and performance of diagnostic procedures in the evaluation of neurological disorders.
- Effectively utilize radiologic studies to diagnose neurological disease or injury.
- Diagnose, stabilize and provide initial treatment of injuries and diseases of the brain, spinal cord, bony spine and peripheral nerves.
- Learn how CSF shunts function and learn to evaluate patients with possible shunt malfunction.
Objectives:
- Demonstrate a brief and a complete neurological history and examination on patients with various levels of consciousness, including trauma patients. (1)
- Demonstrate knowledge of neuroanatomy and application of this knowledge in the neurological examination to localize neurological disorders. (2)
- Demonstrate the ability to recognize and manage cerebrovascular ischemic disorders, seizure disorders, headache, spinal cord compression, shunt malfunction, neurological infections, and neurological inflammatory states. (1)
- Demonstrate the ability to recognize and manage cranial nerve disorders, demyelination disorders, neuromuscular disorders, pseudotumor cerebri, normal pressure hydrocephalus, and peripheral neuropathy. (2)
- Demonstrate skill in the initial evaluation and management of blunt and penetrating traumatic injuries of the CNS. (1)
- Describe initial management of fractures, subluxations, and dislocations of the spine. (1)
- Demonstrate the ability to recognize and manage acute cerebrovascular and spinal cord disorders that are amenable to neurosurgical intervention. (1)
- Describe the main classifications of headaches and state the doses, indications, and contraindications for agents used to manage each of these types of headaches. (2)
- Describe the indications, techniques, and contraindications for neurological imaging procedures including plain radiographs, computerized tomographic scans, magnetic resonance imaging, tomography). (1)
- Demonstrate accurate interpretation of neurological imaging studies including plain radiographs and computerized tomographic scans. (1)
- Demonstrate skill in the performance and interpretation of spinal fluid studies. (1)
- Discuss the indications, contraindications, and dosages of agents used to treat neurological infections in pediatric and adult populations. (1)
- Demonstrate spinal immobilization techniques. (1)
- Demonstrate ability to recognize and manage spinal cord compression due to non-traumatic causes. (1)
- Describe the indications and techniques for control of intracranial pressure. (1)
Goals:
- Learn the principle of contraception.
- Develop expertise in the diagnosis and management of emergent complications of pregnancy.
- Develop expertise in the management of uncomplicated and complicated labor and delivery.
- Develop expertise in the management of sexual assault.
- Learn the principles of management of gynecologic and obstetrical trauma.
- Learn diagnosis and treatment of genital and pelvic infectious diseases.
- Develop expertise in the diagnosis and management of abdominal pain in females.
- Develop expertise in the diagnosis and management of vaginal bleeding.
Objectives:
- Demonstrate ability to correctly perform a complete gynecologic exam. (1)
- Discuss the differential diagnosis and demonstrate ability to evaluate and treat patients with vaginal discharge. (2)
- Discuss the differential diagnosis and demonstrate ability to evaluate and treat patients with pelvic pain. (1)
- Discuss the differential diagnosis and demonstrate ability to evaluate and treat vaginal bleeding in pregnant and non-pregnant women. (1)
- Demonstrate ability to evaluate and treat patients with genitourinary infections including PID, UTI, STD, TOA and vaginitis. (1)
- Describe the symptoms and differential diagnosis of toxic shock syndrome. (1)
- Demonstrate ability to perform perinatal and neonatal resuscitations. (1)
- Describe the relative effectiveness and complications of various contraceptive methods, including post-coital douche, coitus interruptus, condoms, diaphragm, rhythm method, oral contraceptives, injectable hormonal agents and IUD. (2)
- Demonstrate ability to evaluate and manage the care of patients with suspected ectopic pregnancy. (1)
- Discuss the signs, symptoms and treatment of placenta previa. (2)
- Discuss the signs, symptoms and treatment of abruptio placenta. (1)
- Discuss the signs, symptoms and treatment of preeclampsia and eclampsia. (1)
- Discuss the normal stages of labor and the time course for each. (2)
- Demonstrate ability to determine the APGAR score and discuss the significance of different values. (2)
- Define the following according to ACOG guidelines: rape, statutory rape, sexual molestation, and deviant sexual assault. (3)
- Demonstrate ability to evaluate and treat sexual assault victims, including evidence collection, appropriate patient counselling and pregnancy prevention. (1)
- Discuss the differential diagnosis and demonstrate ability to diagnose and treat genital ulcerations. (2)
- Discuss the pathophysiology, differential diagnosis, signs, symptoms and treatment of ovarian torsion.
- Discuss the management of trauma during pregnancy. (1)
- Discuss the indications for perimortem caesarian section and describe the technique. (1)
- Demonstrate ability to perform uncomplicated full-term deliveries. (1)
- Demonstrate ability to manage patients with hyperemesis gravidarum. (2)
- Discuss the diagnosis and treatment of complicated labor including premature rupture of membranes, premature labor, failure to progress, fetal distress, and ruptured uterus. (2)
- Describe the management of complicated deliveries, including prolapsed cord, uncommon presentations, dystocia, uterine inversion, multiple births and stillbirth. (1 for prolapsed cord; 2 for others)
- Demonstrate abiliity to diagnose and manage postpartum complications including retained products, endometritis and mastitis. (2)
- Discuss RH incompatibility. (1)
- Describe the presentation a patient with hydatidiform mole. (2)
- Describe the classification scheme for abortion. (3)
Goals:
- Develop relevant history and physical exam skills
- Learn to recognize and treat emergent causes of visual loss
- Learn the principles of ocular trauma management
- Learn the evaluation and management of common ophthalmologic complaints.
Objectives:
- Demonstrate an understanding of normal ocular anatomy. (2)
- Demonstrate ability to perform an ocular exam. (1)
- Recognize and discuss the differential of abnormal funduscopic findings. (1)
- Demonstrate the technique of slit lamp examination. (1)
- Demonstrate ability to measure intraocular pressures. (1)
- Demonstrate knowledge of the dosages, indications and contraindications of topical and systemic ophthalmologic medications. (1)
- Discuss the differential diagnosis of acute loss of vision. (1)
- Discuss the differential diagnosis and demonstrate correct evaluation of patients presenting with a painful eye. (1)
- Discuss the differential diagnosis and demonstrate correct evaluation of patients presenting with a red eye. (1)
- Demonstrate ability to evaluate and manage chemical injuries of the eye. (1)
- Demonstrate ability to evaluate and manage blunt and penetrating trauma to the eye and surrounding tissues. (1)
- Demonstrate ability to evaluate and manage ocular foreign bodies. (1)
- Discuss the presenting signs, symptoms and management of acute angle closure glaucoma. (1)
- Discuss the presenting signs, symptoms and management of orbital and periorbital cellulitis. (1)
- Describe and identify the various patterns seen on flourescein staining of the eye. (1)
- Discuss the ocular manifestations of systemic disease. (2)
- Discuss the indications for emergent ophthalmologic consultation. (1)
Goals:
- Develop relevant history and physical exam skills.
- Learn use of the diagnostic imaging modalities available for the evaluation of orthopedic disorders.
- Develop skill in the evaluation and management of musculoskeletal trauma.
- Develop skill in the diagnosis and treatment of inflammatory and infectious disorders of the musculoskeletal system.
- Learn principles of acute and chronic pain management in patients with musculoskeletal disorders.
Objectives:
- Develop ability to correctly perform a history and physical in patients with musculoskeletal disorders. (1)
- Demonstrate ability to correctly order and interpret radiographs in patients with orthopedic injuries. (1)
- Demonstrate knowledge of standard orthopedic nomenclature. (1)
- Demonstrate knowledge of appropriate aftercare and rehabilitation of orthopedic injuries. (2)
- Demonstrate knowledge of the differences in pediatric and adult skeletal anatomy and indicate how those difference are manifest in clinical and radiographic presentations. (1)
- Demonstrate ability to apply orthopedic devices, including compressive dressings, splints and immobilizers. (1)
- Demonstrate skill in performance of the following procedures: fracture/dislocation immobilization and reduction, arthrocentesis, extensor tendon repair. (1)
- Demonstrate ability to prioritize and manage the treatment of orthopedic injuries in multiple trauma patients. (1)
- Describe the presentation of patients with inflammatory and infectious disorders and demonstrate ability to diagnose and treat them. (1)
- Demonstrate ability to diagnose and treat soft tissue foreign bodies. (1)
- Describe the presentations, complications, diagnosis, management and prognosis of patients with human and animal bites. (1)
- Describe the presentations, complications, diagnosis and management of compartment syndromes. (1)
- Demonstrate ability to provide regional anesthesia, including hematoma blocks, Bier blocks and radial, ulnar, median, axillary, posterior tibial and sural nerve blocks. (2)
- Discuss the dosages, indications, contraindications and side effects of standard analgesic and sedative agents used to treat patients with acute orthopedic trauma and demonstrate skills in their use. (1)
- Discuss the dosages, indications, contraindications, side effects and relative potency of standard oral analgesics used in treatment of patients with musculoskeletal disorders. (1)
- Discuss the differential diagnosis, historical features, physical and examination findings of patients with low back pain. (1)
- Demonstrate ability to recognize and treat soft tissue infections involving muscle, fascia, and tendons. (1)
- Describe diagnosis and treatment of overuse syndrome. (2)
- Describe how to evaluate and preserve amputated limb parts. (1)
- Demonstrate knowledge of joint injuries, evaluation and grading of joint injuries, treatment of joint injuries and prognosis. (2)
- Discuss evaluation and treatment of soft tissue injries such as strains, penetrating soft tissue injuries, crush injuries, and high pressure injection injuries. (1)
Goals:
- Develop relevant history and physical exam skills.
- Learn the evaluation and management of common problems of the head and neck.
- Learn the evaluation and management of facial trauma.
- Develop skill in the evaluation and management of upper airway disorders.
- Learn use of the diagnostic imaging modalities avalible for evaluation of head and neck disorders.
Objectives:
- Demonstrate ability to correctly perform a history and physical in patients with disorders of the head, ears, nose, pharynx, neck and larynx. (1)
- Demonstate ability to diagnose and treat infections of the head and neck including rhinitis, otitis, labyrinthitis, sinusitis, mastoiditis, laryngitis, pharyngitis, epiglotitis., stomatitis, and gingivitis. (1)
- Demonstrate ability to control anterior and posterior epistaxis including placement of nasal packing. (1)
- Demonstrate ability to diagnose and treat disorders of the tympanic membrane and middle ear perforation. (1)
- Demonstrate ability to perform incision and drainage of oropharyngeal abscesses. (2)
- Demonstrate knowledge of common dental emergencies and indications for emergent referral. (1)
- Demonstrate ability to evaluate and manage disorders of the mandible, including fractures, dislocations, and infections. (1)
- Demonstrate ability to evaluate and manage trauma to the head, neck, face, teeth. (1)
- Demonstrate ability to diagnose and treat disorders of the salivary glands. (2)
- Demonstrate ability to remove foreign bodies from the ears, nose and throat. (1)
- Demonstrate ability to perform direct, indirect and fiberoptic laryngoscopy. (2)
- Demonstrate knowledge of the indications, contraindications and complications of surgical airway techniques and demonstrate ability to perform a cricothyroidotomy. (1)
- Demonstrate ability to obtain airway control in patients with major facial trauma. (1)
- Demonstrate ability to perform facial nerve blocks including supraorbital, infraorbital, mental, auricular and dental blocks. (2)
- Demonstrate knowledge of uncommon but life threatening infections of the head and neck including cavernous sinus thrombosis, Ludwig's angina, and malignant otitis. (1)
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