• Students should develop an understanding of the initial assessment and treatment of the acutely ill or injured patient.
• Students should be able to formulate basic differential diagnoses that include serious or life-threatening conditions for common chief complaints and presentations in the Emergency Department.
• Students should participate in the care of critically ill or unstable patients, including patients with traumatic injuries.
• Students should be able to formulate a basic treatment plan and provide for an acceptable disposition for ED patients.
• Students should be proactive in their learning, with independent reading of material pertinent not only to their patients seen in the ED, but also for common ED chief complaints (i.e. chest pain, dyspnea, abdominal pain, fever, headache, etc.).

• Professional dress is expected during all clinical shifts in the Emergency Department. For both men and women, professional office attire is required, and this includes shirt and tie for men.
• Proper school ID/name badge is required.
• Introduce yourself to the patient, and to the nursing staff caring for the patient.
• All interactions between medical students and the ED staff, nursing staff, patients, patient families, and consulting services should be courteous, compassionate, and on a professional level.
• Punctuality for shifts, lectures, and other scheduled meetings is expected.

• Medical students will see a wide variety of patients that present to the Emergency Department.
• Once a medical student picks up a chart, they should check with a staff physician first before seeing the patient. This pre-screen will allow the staff to direct medical students away from overly complicated patients or cases that do not offer a significant educational benefit.
• Once approved by the staff, the medical student may proceed to see the patient and obtain an appropriate history and perform a physical exam.
• Rectal exams must always be chaperoned.
• Pelvic exams must also always be chaperoned, and should not be initiated before discussing the case with the supervising physician.
• Medical students are not permitted to enter orders directly without a resident or staff physician co-signature.
• Medical students are not permitted to perform procedures, diagnostic or therapeutic, or give medications to any patient without supervision of a resident or staff physician.
• When seeing patients in the ED, medical students may initiate an EM note in the EPIC electronic patient care record. Additional details may be found in the separate “Guidelines for Medical Student EPIC Charting” document, which is distributed at the beginning of the rotation.
• During the initial encounter between the patient and medical student, if the medical student feels that the patient is critically ill, or if there is a sense that “something isn’t right”, the medical student should not proceed any further and instead must find a staff or resident physician immediately for assistance. The staff will pre-screen cases as noted above to avoid these situations as much as possible.
• Medical students are not expected to carry a large patient volume, and in no case should they ever have more than three active patients at any given time. The decision to see more than one patient at any given time should be made after checking with the supervising resident or staff physician.

Supervision and Patient Presentation:

• Medical students will generally be assigned to an upper level or senior Emergency Medicine resident. Cases will be presented to this resident, and the resident will be responsible for seeing the patient, directing patient care, formulating a plan, and completing the documentation.
• Once the case has been presented to the upper level resident, the resident and medical student will then discuss the case with the attending staff. The attending staff will make every effort to provide further educational insight (“teaching points”) for the case, and provide further guidance and case management as needed.
• There may be certain times of the day, depending on staff coverage, patient volume, patient acuity, and other factors when the medical student may bypass the resident and present directly to attending staff. Whenever possible, staff will attempt to be available for direct patient care with medical students.
• The resident and medical student will continue to work together on each case until an appropriate disposition is reached. If the decision is to admit the patient to the hospital, the medical student should be the person to contact the admitting service and present the case.
• Medical students will observe and/or participate in other patient care under the supervision of senior residents or attending staff as much as possible, including trauma patients and acutely ill medical patients.
• Daily patient logs will be required, and are supplied at the beginning of the rotation. These need to be completed daily and turned in at the end of the rotation.