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Emergency Medicine (Arizona)

Description

The Emergency Department at Mayo Clinic's location in Phoenix, Arizona, hosts four-week rotations for medical students (MS-3/4), PGY-1 residents (transitional and internal medicine), Rochester emergency medicine residents, and PA fellows. Elective rotations and ultrasound specific rotations have also been requested.

About the department

The Emergency Department at Mayo Clinic Hospital at Mayo Clinic's campus in Arizona provided care to over 50,000 patients in 2022. The facility is a 54-bed department within Mayo Clinic Hospital which addresses the needs of both tertiary and community patients seeking emergency and urgent care.

The varied and complex nature of Mayo Clinic patients contributes to an emergency department environment unlike other emergency departments within the greater Phoenix area. The presence of very active cancer, transplant, stroke, specialty surgery, as well as rare and advanced disease focused services creates a special set of circumstances, challenges, and unique considerations in providing emergency care.

The emergency medicine attending physician staff understands the unique needs of Mayo Clinic patients and strives to deliver care in a comprehensive and compassionate manner which focuses on the best interest of each patient seen as directed by our shared Mayo Clinic community values.

Each member of the physician team is board-certified in the specialty of emergency medicine and several possess additional board-recognized fellowship training to include critical care, toxicology, and EMS.

All staff share extensive experience in the teaching and mentorship of medical student, resident and physician extenders who rotate through the emergency department.  

Specific goals

Patient care

Each student or resident will:

  1. Evaluate unselected patients presenting to the emergency department.
  2. Obtain an independent, problem-specific history and physical examination for every patient seen.
  3. Quickly determine the level of acuity, urgency and priority of critical actions applicable to every patient seen.
  4. Develop an appropriate differential diagnosis and management plan for every patient seen.
  5. Direct and coordinate the clinical course, testing and consultations for every patient seen.
  6. Develop and communicate an effective discharge strategy and further outpatient evaluation, as needed, for every patient seen.

Medical knowledge

Each student or resident will:

  1. Demonstrate a basic understanding of historical factors that influence or predispose patients to serious illness.
  2. Demonstrate a basic understanding of the signs and symptoms associated with serious illness.
  3. Demonstrate an understanding of the principles of advanced cardiac life support.
  4. Demonstrate an understanding of the physiologic variability associated with patients of differing ages and sexes.
  5. Demonstrate a progressive understanding of medical problems presenting to the emergency department, including:
    • Airway and respiratory complaints
    • Abdominal and pelvic pain
    • Altered mental status
    • Allergy and anaphylaxis
    • Bleeding
    • Chest pain
    • Cardiac conditions (arrhythmias and congestive heart failure)
    • Diabetes
    • Infection (systemic inflammatory response syndrome and sepsis)
    • Electrolyte imbalances
    • Headache
    • Stroke
    • Trauma (lacerations, fractures and dislocations)
  6. Demonstrate a progressive understanding of, and successful supervised completion of, common emergency department procedures, including:
    • Airway interventions
    • Intravenous (IV) access
    • Foley catheter placement
    • Arterial blood gas collection
    • Pelvic examination
    • Abscess incision and drainage
    • Laceration repair
    • Fracture and dislocation reduction
    • Procedural sedation
    • Lumbar puncture
    • Regional anesthesia
    • Bedside ultrasound

Interpersonal and communication skills

Each student or resident will:

  1. Demonstrate the ability to work effectively with all emergency department team members, including allied health professionals, fellow students and emergency department physicians.
  2. Demonstrate the ability to communicate effectively and compassionately with patients.
  3. Demonstrate the ability to educate and inform patients about their presenting condition.
  4. Demonstrate the ability to convey relevant patient information to each member of the care team.

Professionalism

Each student or resident will: 

  1. Demonstrate behaviors and attitudes consistent with the Mayo Model of Care.
  2. Demonstrate a consistent interest in personal and professional growth during the rotation.
  3. Maintain a professional appearance throughout the rotation.
  4. Demonstrate diligence in completing all tasks related to the care of each patient for whom he or she is responsible.
  5. Maintain patient privacy and confidentiality.

Practice-based learning and improvement

Each student or resident will:

  1. Display a commitment to their education through thoughtful inquiry and active efforts to seek answers to clinical questions relevant to patient care.
  2. Display a commitment to expanding their fund of medical knowledge.
  3. Demonstrate an evidence-based approach to acquiring medical knowledge and answering clinical questions relevant to patient care.
  4. Attend all lectures, laboratories and simulation sessions associated with the emergency department rotation.

Systems-based learning and improvement

Each student or resident will:

  1. Gain an understanding of the role of risk stratification in determining the time and resources required to evaluate patients presenting to the emergency department.
  2. Gain an understanding of the unique risks and considerations associated with the care of specific patient populations, including age, socioeconomic factors, decision-making capacity and substance use.
  3. Gain an understanding of the risks associated with inadequate discharge planning and communication.
  4. Gain an understanding of the factors that commonly contribute to patient dissatisfaction.
  5. Gain an understanding of behaviors that contribute to poor patient outcomes and medicolegal risk in emergency care.

Activity outline

During this clerkship, bedside teaching is prioritized. The emergency department, by nature, is a clinical environment which operates continuously regardless of the time of day or day of the week. As such, the opportunities for rotating learners to see and learn in this environment are abundant.

Each rotating learner will see unselected emergency patients, obtain a problem focused assessment and learn to assign a level of urgency to their visit. Because every emergency patient is assigned to an attending physician during the triage process, each learner will present each of their patients to the attending physician to which the patient has been pre-assigned.

The attending physician will critique and guide the learner in their rapid patient assessment, information gathering process, and the development of a diagnostic and management plan.

Any required patient procedures will be supervised by attending physicians with graduated levels of participation as competency develops. 

During a one month rotation, each learner should encounter a variety of clinical scenarios, varied levels of clinical complexity and urgency, and a variety of common emergency or urgent procedures. 

Common clinical scenarios should include: 

  • Airway and/or respiratory difficulties
  • Altered mental status or level of consciousness
  • Abdominal or pelvic emergencies (bleeding, infection, obstruction, vascular, surgical)
  • Advanced cardiac issues (chest pain, dysrhythmias, congestive heart failure, cardiomyopathies)
  • Endocrine problems (diabetes)
  • Trauma (lacerations, wounds, fractures, dislocations)
  • Neurologic emergencies (headache, stroke, seizure, intracranial hemorrhage, neoplasm)
  • Infection (SIRS/sepsis, common community infection types [urine, lung, skin])
  • Musculoskeletal injuries/pain
  • Transplant issues (primary transplant issues or additive to the presenting problem)
  • Oncologic issue (primary oncology or additive to the presenting problem)
  • Pediatric (fever, injury)
  • Bleeding

Common emergency department procedures should include:

  • Foley catheter
  • I.V. starts
  • Pelvic examination
  • Laceration repair
  • Abscess incision and drainage
  • Airway assessment and management
  • Bedside ultrasound (Focused trauma exam, IVC assessment of volume status, cardiac evaluation for contractility/pericardial effusion, eye evaluation for retinal detachment, skin evaluation for foreign body or abscess)
  • Fracture/Dislocation reduction
  • Procedural sedation
  • Lumbar puncture
  • Regional anesthesia

Simulation Center experience

Emergency department rotations will include a half day simulation center experience.  This experience will involve management of a simulated patient encounter utilizing a common but challenging emergency scenario.

The primary focus of the scenario will be to identify and manage airway issues, cardiac arrhythmia, and hypotension.

In addition, each learner will participate in a procedural skills lab designed to introduce and/or reinforce skills in airway management (identifying the difficult airway, using the bag/valve mask, and intubation techniques), lumbar puncture, interosseous vascular access, ultrasound assisted vascular access, and laceration repair.

Didactics

Rotating learners will be expected to supplement their educational experience by attending weekly didactic sessions run by Dr. Rappaport, Dr. Kelley, and Dr. Martini. These will include high yield EM focused topics. The last didactic session of the rotation each intern is expected to present a case presentation on an interesting case encountered during the month. The presentation should be approximately 15-20 minutes in length. 

Method of evaluation

Each rotating learner shares an individual responsibility to seek knowledge and advancement in their progression toward becoming a competent and skilled practitioner. It is assumed that each learner rotating through the emergency department desires to gain and grow through their experience with us. We are committed to their advancement and our role in guiding and teaching each learner who rotates with us. To this end we must be objective and consistent in our expectations and in the standards we apply to each learner in providing an evaluation of their abilities and performance.

Our evaluation methods will focus on the learner’s attitude, knowledge, ability to communicate, procedural ability, self- awareness, attention to detail, diligence, participation in their own education, resourcefulness, professionalism, and progress during the rotation. We will apply these criteria to each learner in completing their specific departmental evaluation form(s).  

Per Mayo Clinic institutional policy, faculty and residents/fellows will not complete any outside evaluations. You will be provided with an electronic performance evaluation via Mayo Clinic’s MedHub portal. A final summative evaluation will be sent to you and your school official upon completion of your clerkship.

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