Emergency Medicine Clerkship
Department of Emergency Medicine
Mark Levine, M.D.
8th Floor Barnard Hospital
Division of Emergency Medicine
Washington University School of Medicine
Phone: 314-747-4156, Fax: 314-362-0478
All third year medical students have a mandatory four-week rotation in ambulatory care of which Emergency Medicine is one of three options. About one-third of the third year students may be randomly clustered to the emergency department. This is one of the most popular ambulatory care electives for third year students because they work in the Emergency Department and Urgent Care Area, where urgent and acutely injured patients are treated. For many students, it is their first experience in evaluating patients without a known diagnosis. Even as third year students, they are encouraged to act as "interns" by evaluating, diagnosing, and treating patients. Over the course of four weeks, they become more proficient with H&P's and begin to understand patient management. There is also an opportunity to learn several basic procedures, such as ABG's, LP's, suturing, simple reductions, and splinting.
Medical students interested in completing a rotation in the Emergency Room may use the followiing links to make arrangements.
Visiting Student Links
Web Page: Curriculum Office
Application Service (VSAS): Visiting Student Application
Interest Groups The Emergency Medicine Interest Group (EMIG) is an organization for medical students interested in emergency medicine. EMIG comprises first- to fourth-year medical students who meet on a monthly or every other monthly basis to go over ED procedures, discuss cases, learn EKG skills, and generally get to know other medical students with similar interests. Meetings are casual and food is generally provided. Two medical student representatives (from the third- and fourth-year class) act as liaisons between the ED department and the medical school.
Student Research Many opportunities are offered to students to conduct research. Many of the ED faculty and residents are involved with varied research interests and welcome the chance to coach and mentor medical students. Grants are available through the medical school to pursue a research project over the summer between the first and second year. A research elective in emergency medicine is also available during the fourth year. Our students from Washington University School of Medicine have been very successful obtaining grants by ACEP and producing publishable papers.
Workload When you report for your first shift, you should find the senior EM resident for further orientation. During your shift, you should plan on picking up one new patient every two hours on average. This does not mean you should only pick up a new patient on the hour. Instead, you should concentrate on seeing a new patient, writing orders, checking on lab and x-ray results pending from earlier patients, making a disposition for earlier patients, then moving on to the next new patient. You will find that you need to pick up more patients early in your shift, as your rate will slow down later once test results have come back and patients need to be dispositioned. If the ED is busy, you may be assigned patients by the senior EM resident, who is responsible for maintaining flow of the entire ED in addition to seeing patients, giving medical orders to ambulance crews, accepting transfers, and helping junior residents and students.
Shifts Clinical shifts have been scheduled to rotate with the attendings and the resident schedules. The shifts run from 7am-3pm, 3pm-11pm, and 11pm-7am. Urgent care shifts will be 8am-4pm and 4pm-12am if you are scheduled there. You will be scheduled an equal number of shifts (e.g., a total of 13-15 shifts) and as close as possible to having an equal number of weekend shifts as your fellow students. This is to give you a varied experience and allow you to see the ebb and flow of the ED throughout the day and week.
There will also be a tech day from 12noon-5pm (usually after a conference) where you will work one on one with a nurse or tech to start IVs, draw labs, do NG tubes, do EKGs, and the such. It is not meant to be scut, but to give you more clinical experience at minor procedures. On Tuesday mornings, you are excused from your clinical duties. The conferences last from 8am-10am. (You do not need to show up from 7am-8am.) If you would like, you may stay for the additional optional conferences from 10am-12pm and grab lunch in the residents lounge afterwards. Wednesday mornings your day will again start at either 830 am or 9am for conferences until 12pm.
The first hour(s) will be spent going over cases in small group session format with a resident and the next two hours will be lectures by one of the EM attending physicians. These are just for the medical students. There will be no night shift scheduled on Tuesday from 11pm-7am to make sure that everyone shows up and is awake. We generally try to give each student a 20-30 minute break during their shift to eat when time is allowed. You must speak with the senior resident or attending in your area to be excused.
DO NOT leave the ED without being excused. Check over all your patients before leaving to make sure you haven’t overlooked anything and try to anticipate any test results that may return or interventions that may be needed during your absence. For more information and Admission Requirements, visit the Curriculum Office website.