Undergraduate training in Emergency Medicine is aimed at providing a framework for safe decision-making in emergency circumstances, despite a potential lack of comprehensive knowledge of the patient’s problem at the moment of initial contact.
The majority of patients seen are presenting with acute exacerbations of chronic disease processes, often in potentially life-threatening circumstances. As such, initial intervention often precedes definitive diagnosis.
Movement from Base Life Support skills to Advanced life Support, whether trauma, cardiac or medical, is facilitated by involvement in a hands-on fashion in resuscitation, with real-time education and immediate debrief. This includes “Breaking Bad News”, which occurs on a very frequent basis in Emergency Medicine.
The high ratio of patients to staff allows for direct student contact without excessive intrusion into the patient’s time. Indeed, many of the skills taught in the new curriculum are immediately applicable, as students can cannulate and suture in real life situations, which reinforces their previous skills training in a manner rewarding for student, patient and staff alike.
The new undergraduate timetable supports this more advanced role of the student, by placing them in the Emergency Department in their Final Year, rather than at too early a stage of clinical training as it was in the past. In fact, it truly emulates the 19th Century concept of the Clinical Clerk and Surgical Dresser, which were an integral part of the school of bedside teaching started by Robert Graves in the Meath Hospital.
Emergency Medicine straddles the traditional boundaries between Medicine, Surgery and Psychiatry, such that the Consultants in Emergency Medicine examine in Final exams in both Surgery and in Medicine with Psychiatry.
Many of the disease processes seen are those likely to be dealt with in the middle of the night when the student becomes an intern. Congestive cardiac failure, myocardial infarction, respiratory failure, stroke, acute confusional states and uro-sepsis are seen frequently, allowing a reasonable exposure to case numbers within a brief time allowance.
In addition to direct bedside teaching, targeted small group teaching on the main subjects is provided on a daily basis in the Emergency Department.
Students are divided into morning and evening “shifts” to match those of the medical staff, in an attempt to develop a better understanding of the need for extended working hours and team working – both core values of the modern Health Service.
Objectives of undergraduate attachment
Students will demonstrate competence in the diagnostic approach to the following key presentations by case presentation.
- Chest Pain
- Shortness of breath
- Abdominal Pain
- Head and neck injuries
- Limb injuries
- Resuscitation principles
Students will demonstrate competence performing the following practical skills.
- Taking and recording baseline Vital Signs
- IV cannulation/phlebotomy
- Arterial blood gas (ABG) sampling
- Suturing simple wounds
- Urinary Catheterisation
- Plaster cast application/ immobilisation.
- Basic cardiopulmonary resuscitation
Scheduled educational activities in the Emergency Department
- Handover - Daily at 8am and 4 pm. This is the “board round” of all patients in the department, where the management plans for all patients are reviewed, and difficult and interesting cases are discussed.
- Tutorials - Daily, usually at 3 pm to facilitate students arriving for morning or afternoon attachments.
- Case Presentations - each student will present 6 cases, one each from the list below to registrar or consultant in the department over the course of their attachment.
- Clinical Activities - Students will be expected to spend sessions in Resus (zone 1), Majors (zone 2), Minors (zone 3), and in triage shadowing designated clinicians (nurse practitioners or registrars).
Scheduled educational activities outside the Emergency Department
A series of didactic large-group lectures will be provided during the term for the entire class in the Medical School facilities.
Assessment of students during the undergraduate attachment.
The competencies described above will be recorded in the log book. Also their demonstration of professionalism, empathy, enthusiasm, knowledge, and willingness and ability to involve themselves as team members will be evaluated formatively (during) and summatively (at the end) during their attachment.
Currently the only course offered is the Clinical Module for the Masters in Nursing, leading to the Advanced Nurse Practitioner (Emergency).
Funding issues are currently being revaluated
Further information from Ms Val Small (email@example.com)
St James's Hospital
|Clinical Senior Lecturer||Dr. Una Gearyfirstname.lastname@example.org|
|Clinical Senior Lecturer||Dr Una Kennedyemail@example.com|
|Consultant in Emergency Medicine||Dr. C Geraldine McMahonfirstname.lastname@example.org|
|Dr Daragh Shields|
|Clinical Senior Lecturer||Dr Paul Stauntonemail@example.com|
Tallaght University Hospital
Dr Jason Carty
|Clinical Lecturer In Emergency Medicinefirstname.lastname@example.org|
|Dr George Little|