Department of Medicine - Knoxville

Residency Program

Curricula Area - Emergency Medicine

1. Curricular Area:    Emergency Medicine

2. Location:

UTMCK Emergency Department-Main

Phone: 305-9402

Contact: Dr. Debra Durst

3. Faculty:

Kip Wenger, DO, Chair

Debra Durst, MD   

Pat O'Brien, MD

Chris Brooks, MD

Brad Smith, MD

Corey Voss, MD

Robb McLean , MD

John Watson, MD

Hussein Kammona, MD

Christie Lietzke, MD

Anand Patel , MD

Travis Gullett, MD

Doug Jentilet, MD

4. Orientation:

   An orientation session will be held the first weekday of the rotation at 8am. A brief overview of the rotation will be given and expectations discussed. Documents specific to the ED setting will be reviewed. Instruction on ED documentation will be given, which includes coding basics. Following the orientation session, the resident will need to contact Mark Cecil (phone 305-5819) to obtain a temporary password for First Net which will be used during the ED rotation. It is the resident's responsibility to acquire a temporary password for First Net use during the rotation.

5. Schedule:

   The resident must complete fourteen 12 hour shifts during the rotation. Four of the shifts must be night shifts and 4 must be weekend shifts. The night and weekend requirements may be combined. The options of day shifts are 7:00 AM – 7:00 PM, 10 AM – 10 PM or 12:00 Noon – 12:00 AM. The night shifts are 7PM-7AM. The resident is expected to attend Noon Conference during the day shifts, resident clinic one afternoon per week and Grand Rounds and Morbidity and Mortality Conference. The resident clinic days are left available when the schedule is made by the scheduler. Conference attendance is permitted during the rotation. We do ask that residents review and sign out with Emergency attendings before leaving the ED for conference. The schedule is prepared by Dr. Durst or an assigned Fellow. Residents will receive the schedule in the month prior to the rotation. Any simple requests need to be made by the 1 st of the month prior to the rotation. Every attempt to accommodate requests is made but there are no guarantees. Once the schedule is complete, any changes to the schedule must be approved by Dr. Durst or the ED Fellow in charge of scheduling. Dr. Durst or the Fellow will then change it on the master schedule in the ED.

6. Related Conferences/Venues:

    The resident is required to attend an intraspeciality conference each Tuesday from 9 AM until 12:00 PM. The lectures are given by the Emergency Department Attendings, Fellows and guest lecturers. A proposed schedule is completed at the beginning of the year but may vary as the year progresses. A list of planned topics is available upon request. The resident may be asked to prepare a case presentation for this conference. The resident may be asked to spend time in the Simulation unit reviewing skills commonly used in the Emergency setting.

7. Primary Goals:

   Emergency medicine involves the evaluation and care of acute illness and injuries that require intervention within a limited time span. It is defined by a time interval rather than by a particular organ. The Internist may encounter these conditions in an office practice or in an acute care setting. Regardless of the setting, the general internist should be able to manage common emergency conditions and provide consultation and management for a variety of acute serious illnesses. General Internists will learn when it is appropriate to refer their patients to the ED for emergent evaluation.

8. Primary Objectives:   See Competency Table below.

9. Supplemental References, Suggested Readings :

Emergency Medicine: An approach to Clinical Problem Solving/Glenn C. Hamilton et al. Second Edition, 2003 W.B. Saunders Company.

Accessmedicine.com - This internet resource allows online access to many sources. It is the only internet access to Tintinali's Textbook of Emergency Medicine which is used as a primary reference source in the ED. Sign on codes will be provided during the rotation. Assigned reading from this source will be made for the intraspeciality conferences.

Rose, BD (Ed); Up-To-Date, Wellesley , MA , 2008. Available through Preston Medical Library.

The following Up-To-Date topics should be read:

Evaluation of chest pain in the emergency department

Diagnostic approach to abdominal pain in adults

General approach to drug intoxication in adults

Initial evaluation and management of transient ischemic attacks and minor stroke

Approach to the adult patient with syncope in the emergency department

Approach to the adult patient with upper gastrointestinal bleeding

Approach to the adult patient with lower gastrointestinal bleeding

Community-acquired pneumonia in adults: Risk stratification and the decision to admit

Approach to the diagnosis and evaluation of low back pain in adults

Overview of the management of acute ST elevation myocardial infarction

Management of severe sepsis and septic shock in adults

Rapid sequence intubation in adults

Approach to vaginal bleeding in the emergency department

Evaluation of the patient with neck pain and cervical spine disorders

Incidence, risk factors and pathology of ectopic pregnancy

10. Procedures:

    Residents will learn the indications, contraindications and complications of various procedures. Some of the more common procedures include lumbar puncture, arthrocentesis, laceration repair, pelvic exam, central line placement and occasionally endotracheal intubation. All procedures will be supervised by an Attending Physician. Peripheral IV placement is routinely done by the ED nursing staff. Residents are required to place at least 3 peripheral IVs during the rotation. It is the Resident's responsibility to provide documentation to the Department of Medicine.

11. Other Resources:

    Residents will have the opportunity to work with a variety of individuals and teams who are essential to the function of the Emergency Department. This includes members of the Rural Metro team, Lifestar employees, Chaplains, Mobile Crisis counselors, case managers, psychologists and other outside agencies. They will learn how to work effectively with others in an emergency health care setting. The resident will learn to coordinate care within our health system and with outside agencies. They will learn to work as a team member to deliver patient care that is safe and cost effective.

12. Research Opportunities:

    Residents may encounter patients who are suitable for case reports or poster presentation. Select faculty members from the Department of Medicine have agreed to assist with these efforts.

13. Method of Resident Evaluation:

    Residents will be evaluated in an informal manner by direct clinical observation and case discussion. Any problems or issues identified by an Attending or Fellow concerning the performance of a resident will be discussed with the resident early in the rotation. Likewise, any problems the resident encounters during the rotation should be discussed with Dr. Durst in a timely manner. Early discussions allow issues to be resolved during the rotation. At the completion of the rotation, the resident will be evaluated in a summative manner using New Innovations electronic forms. The evaluation will be discussed with the resident by Dr. Durst.

14. Method of Specialty Evaluation:

Residents are asked to provide feedback regarding concerns at any time to the attending. They will complete an evaluation form using New Innovations at the end of the rotation. Cumulative feedback to the attending faculty member will be given by the Departmental Chair.

Competency Table:

Emergency Medicine Learning Objectives -