The 3-Minute Emergency Medicine MedicalStudent Presentation: A Variation on a ThemeChip Davenport, BA, Benjamin Honigman, MD, Jeff Druck, MD

AbstractOral presentations are a critical element in the communication of medical knowledge between studentsand faculty, but in most locations, the amount of time spent on teaching the oral presentation is minimal.Furthermore, the standard oral presentation does not work well within the emergency medicine (EM)setting, due to time constraints and the different principles that make EM a unique specialty. This articleprovides a suggested approach on how to educate students on optimal oral presentations in EM, as wellas providing a link to an online guide instructing medical students how to give oral presentations.

ACADEMIC EMERGENCY MEDICINE 2008; 15:683–687 ª 2008 by the Society for Academic EmergencyMedicine

Keywords: education, presentation, oral, medical student

A s Dr. William Donnelly stated in his article ‘‘TheLanguage of Medical Case Histories,’’ ‘‘[oralpresentations] are the way in which physicians

at every level of training communicate to each other theirunderstanding of particular patients and their medicalproblems, what has been done about the problems, andwhat is being done about them.’’1 The expectations forthese presentations vary depending on the expertise ofthe medical student and on the clinical service where thestudent is learning. As the field of emergency medicine(EM) evolves, there is a growing interaction betweenmedical students and other members of the EM team,including residents and faculty. Medical students fromall 4 years of training now come into contact with theemergency department (ED). However, their oral presen-tation training is primarily provided by other services.Because of the need in EM to provide a rapid assessmentin addition to telling the patient’s ‘‘story’’ effectively, aspecific style of presentation is required for EM.

In addition, we believe that the majority of the stu-dent and resident educational interactions with attend-ing physicians in EM occur during oral presentations,when the student provides his or her analysis of thepatient’s story to the other medical team members.Other interactions, such as direct patient contact andchart review, occupy a large amount of the student’sinteraction time with patients and are often not

observed by superiors. Thus, the majority of the resi-dent and attending’s impression of a student, and ulti-mately the student’s evaluation, is directly linked tohow well the student presents. As a fourth-year medicalstudent wrote from the University of California, SanFrancisco, ‘‘. . . no matter how much compassion andwarmth I may have with patients, my superiors grademe more on how polished I am, how well crafted mypresentation is.’’2 In this article, we will summarize tra-ditional presentation methods, elucidate how the EMpresentation varies from the standard, and offer ourguidelines for a successful presentation. Although thesesuggestions have not been studied, we have had suc-cess teaching this method to our medical students. Ourgoal is to have a student be able to present all pertinentinformation under 4 minutes, with the ultimate goal ofthe ‘‘3-minute presentation.’’

HISTORY OF THE ORAL PRESENTATION

The evolution of the oral presentation is not welldescribed in the medical literature. The earliest mentionof the patient narrative was in 1846 by Erasmus Fenner(dean of the New Orleans Medical School) whorequired students to read their patient write-ups to pro-fessors on rounds.3 The patient narrative began priorto the creation of the written medical record; however,we theorize that the format of the oral presentationmost likely tracked the evolution of the written medicalrecord. Therefore, the ‘‘standard’’ oral presentation fol-lows the same format as the written medical record,but the oral presentation focuses on information relatedto the chief complaint (CC).

As of 2003, the oral presentation has taken anotherstep in evolution, with the ‘‘SNAPPS’’ format, developed

ª 2008 by the Society for Academic Emergency Medicine ISSN 1069-6563doi: 10.1111/j.1553-2712.2008.00145.x PII ISSN 1069-6563583 683

From the Division of Emergency Medicine, Department of Sur-gery (BH, JD), University of Colorado School of Medicine (CD),Denver, CO.Received December 6, 2007; revisions received March 4 andMarch 28, 2008; accepted April 1, 2008.Address for correspondence and reprints: Jeff Druck, MD;e-mail: Chip.Davenport@UCHSC.edu.

at Case Western Reserve University School of Medi-cine. SNAPPS focuses on students keeping their patientsummaries brief, narrowing the differential to two orthree etiologies, analyzing the information to determinethe most likely cause of the CC, probing the attendingfor knowledge by asking questions, planning thepatient’s management, and finally, selecting an issuerelated to the case for self-directed learning.4 The cre-ators of SNAPPS recognized the limited educationalexperience that many students undergo during oralpresentations. Therefore, SNAPPS was developed to‘‘engage the learner and create a collaborative learningconversation in the context of patient care.’’4 Eventhough the SNAPPS format was designed for outpatientoral presentations, the brevity of the patient’s historyand the limited differential diagnosis are aspects thatcan be applied to EM.

More recently, a study from Boston University Schoolof Medicine showed that a multifaceted interventionintroducing specific guidelines for oral presentationsdid improve medical students’ narrative skills.5 Theguidelines were compiled with input from more than 60faculty members of the Department of Medicine. Priorto the guideline intervention, 33 of 111 (30%) studentsreceived a rating of ‘‘excellent’’ during their medicineclerkship. With the integration of the guidelines the fol-lowing year, 42 of 96 (44%) students received an ‘‘excel-lent.’’5 The response from the medical students in thestudy showed appreciation of specific guidelines toexplain why data should be included and in whichorder it should be placed in the oral presentation.

WHY DO STUDENTS STRUGGLE WITH THE ORALPRESENTATION?

Didactic and on-site training are the two general waysmedical students receive education on how to give oralpresentations. Didactic training occurs primarily in thefirst 2 years of medical school, while on-site trainingoccurs during clerkships. Schools may include sessionsduring their Principles of Clinical Medicine courses inYears 1 and 2 or in the Transition to Clerkship at theend of Year 2. Although the Liaison Committee onMedical Education (the accrediting body for physician

programs) states that in a medical school there ‘‘mustbe specific instruction in communication skills as theyrelate to physician responsibilities, including communi-cation with patients, families, colleagues, and otherhealth professionals,’’ there is no requirement for aspecific amount of time to be spent teaching oral pre-sentation skills.6 Another reason students may have dif-ficulty acquiring proper oral presentation skills may bedue to ‘‘no universally accepted or widely used tool tohelp learners improve oral presentation skills.’’5

On-site training also has its challenges. As a teachingtechnique, many students are often asked to duplicatepresentations of more senior members of the team.However, an article summarizing student interviewsabout this issue commented that ‘‘effective presentersalter the structure and organization of their presenta-tions, but could not articulate how, when, or why thesealterations were chosen . . . as a result, students werenot easily able to understand or mimic those successfulpresentations that they witness by more experiencedteam members . . . in fact, experts may not be the idealmodels for novices.’’7 This article provides a frameworkfor students and educators to refine oral presentations,whether in the didactic or clinical environment.

IMPORTANT CHARACTERISTICS IN EM

In addition to the rigors of learning ‘‘general’’ oral pre-sentation skills, the unique characteristics in EM com-pound the difficulty of learning presentation skills.Many EM traits often lead students, who are proficientwith oral presentations on other services, to have diffi-culty with oral presentations in EM. Rosen’s landmarkpaper, ‘‘The Biology of Emergency Medicine,’’8

describes the fundamental differences of EM fromother services. These differences provide a uniqueframework to the oral presentation: 1) assume thatevery patient has a life- or limb-threatening condition,2) juggle multiple patients simultaneously, 3) prioritizepatients according to level of concern, and 4) addresspatient loyalty and follow-up issues and consequencesof incomplete medical records.

These principles mandate presentations to be conciseand to the point without sacrificing essential information

Table 1How the Axioms of Emergency Medicine (EM) Care Translate into an Abbreviated Presentation, with Specific Teaching Points to beElaborated on by the Instructor

Important EM Traits fi Characteristics of Oral Medical Record due to the Important EM Traits

Assume every patient has alife- ⁄ limb-threatening condition

Be concise. The listener expects the presenter to use clinical judgment toedit patient information, with an emphasis on characteristics that apply tothe inclusion or exclusion of life threats

Juggle multiple patients simultaneously Present in less than 5 minutes. State CC first and focus only on CC unlessother concerning problems arise

Prioritize patients Only talk about the most pressing issues; as there are multiple patientswith pressing issues, focusing a presentation allows for rapid assessmentof the critical nature of their complaint and subsequent triage among otherpatients

Address patient loyalty issues and consequencesof incomplete medical records

Obtain a complete history. As patients are not tied to a specific practitioner,‘‘hospital hopping’’ is more common, meaning a complete picture cannotrely on medical records. Therefore, it is critical to get a detailed interview

CC = chief complaint.

684 Davenport et al. • THE 3-MINUTE EM MEDICAL STUDENT PRESENTATION

for the listener to easily formulate a plan of diagnosisand therapy. The fourth principle, which initiallyfocused on loyalty to specific physicians and frequencyof primary care visits, is now even more applicable asthere are rarely ties to specific hospitals or health caresystems, resulting in fractured and incomplete medicalrecords (see Table 1). By applying these overarchingprinciples of EM to the oral presentation, the studentmaintains focus on the key components of EM practice.

EM ORAL PRESENTATIONS

The following sections are the required elements of a‘‘typical’’ EM oral presentation: chief complaint (CC),history of presenting illness (HPI), medications, aller-gies, physical exam, summary statement, problemassessment, and plan. Detailed instructions to create anEM oral presentation primarily for medical students,EM Oral Presentation Instruction Manual, is availableas an online data supplement at http://www.blackwell-synergy.com/doi/suppl/10.1111/j.1553-2712.2008.00145.x/suppl_file/acem_145_sm_DataSupplementS1.pdf.

One might notice the minimization of past medicalhistory (PMHx), past surgical history (PSHx), social his-tory (SocHx), and family history (FmHx) in the abovelist. Their diminished emphasis is necessary for aspeedy and efficient oral presentation in EM. Bydecreasing the number of sections, the student is com-pelled to include vital information contained in theseareas in other parts of the presentation, or not to men-tion them, as they may not be pertinent to the reasonfor the patient’s visit to the ED. Of note, pertinentPMHx should be included in the first sentence (the oneliner) of the HPI.

The ability to determine pertinent information is diffi-cult for student physicians and is directly limited by thestudent’s level of medical knowledge. We thereforesuggest that students err on the side of safety andinclude questionable pertinent information. However,we do encourage educators to specifically identifyincorrectly ‘‘labeled’’ data and explicitly explain whythe data were ‘‘mislabeled.’’

WHAT IS PERTINENT INFORMATION?

One way for a student to determine ‘‘pertinence’’ is tohave a short differential diagnosis list for the specificCC. Then, by using principles of pathophysiology(mechanism, course of the disease, complications),which a second- or third-year student should know, thestudent can ask clarifying questions about each etiologyon the differential list. For example, if the CC is abdom-inal pain and the potential differential includes gastriculcer, cholecystitis, and pancreatitis, the student shouldask clarifying questions such as ‘‘is the pain worse atnight?,’’ ‘‘worse before or after meals?,’’ ‘‘worse duringfatty meals?,’’ ‘‘any back pain?,’’ or ‘‘any alcohol use?’’The answers to the above questions are pertinent andshould therefore be placed in the HPI. The student willhave the ability to obtain relevant information duringthe extensive interview process, and this informationcan then be narrowed to provide a concise story to thelisteners. An absence of these key pieces of information

should provide a clue to the educator that these possi-bilities were not on the medical student’s differentialand will then provide an opportunity to discuss alterna-tive differential diagnoses that the medical student mayhave missed.

As students obtain more clinical and presentationalexperience, they will become more proficient at includ-ing only pertinent data. Early in their medical training,students have limited ability in grouping patient infor-mation as pertinent and nonpertinent.9 Lingard andHaber9 suggest that ‘‘if you give [students] sectionheadings, they’ll always put something under them,even if all the information we need is really containedin the first two sections of the presentation.’’ If deter-mining information relevance is related to clinicalknowledge, then by definition, students will have lim-ited abilities in this area. Therefore, it is vital that theeducator not use vague comments such as ‘‘tell me onlythe stuff I need to know’’ or ‘‘give me information thatis only relevant to the chief complaint’’ for feedback tostudents. Instead, we recommend giving students spe-cific explanations of why certain information in the pre-sentation should be left out to change the learner’smisconceptions about what is really pertinent informa-tion. On the other hand, if critical information is notincluded, the educator should elucidate the knowledgedeficit that results in the absence of the critical informa-tion from the presentation. Keeping these guidelines inmind, we will discuss each individual section of the oralpresentation and how that applies to the EM setting.

HPI

The HPI in EM tends to include more information fromother sections like review of systems (ROS), FmHx, andSocHx due to the need for speed and efficiency in EMpresentations. All of the pertinent information from theROS, FmHx, and SocHx should be included in the HPIto save time. This provides students an abbreviatedtemplate as a guide to limit details of the patient’s medi-cal issues.

PMHX/PSHX/FMHX/SOCHX

As previously mentioned, any pertinent information tothe CC should be mentioned in the HPI. If done cor-rectly, there should be no formal mention of titles likePMHx, PSHx, SocHx, or FmHx in the oral presentation.An example would be: ‘‘This patient is a 40-year-oldman with a past history of coronary artery disease,hyperlipidemia, and hypertension who comes to the EDcomplaining of chest pain.’’ This is also the initialmoment for the educator to realize the knowledge baseof the medical student. With an inappropriate or incom-plete initial statement, the educator will be able to pro-vide teaching points on presentation skills.

ROS

As the student gains more clinical knowledge, the pre-sentation of the ROS should become smaller and smal-ler until ultimately there is little to no mention of ROS.At first, beginning students should mention all patient

ACAD EMERG MED • July 2008, Vol. 15, No. 7 • www.aemj.org 685

complaints. By obtaining as much information in theROS during the interview as possible, the student willbe assured that he or she has not missed anything.Information the student believes is pertinent to the CCis mentioned in the HPI. Information the studentbelieves is not pertinent or is of uncertain relevance tothe CC should be mentioned in the ROS.

There are situations where some nonpertinent com-plaints are serious enough to be relabeled as a secondCC. For example, the patient’s CC is a leg injury, butfurther questioning also reveals the patient to have dys-uria, back pain, fever, and chills, which is concerningfor pyelonephritis. If the patient is allowed only oneCC, then dysuria, back pain, fever, and chills are notpertinent data and by definition should be stated in theROS. However, at times, complaints in the ROS get for-gotten or even ignored. Therefore, dysuria should bemoved from ROS and added to the HPI as a secondCC: ‘‘The patient is a 45-year-old female who came tothe ED complaining of a traumatic leg injury and dys-uria.’’ The student should then divide the patient’s his-tory into two HPIs: one telling the pertinentinformation of the leg injury, and the other telling thepertinent information of the dysuria. Without this‘‘refocusing’’ of a second CC, the educator is at highrisk for missing a key element that the medical studentmay not consider important due to their lack of knowl-edge base. For example, the dual CCs of arthritis andurethritis will trigger in the educator the concern forReiter’s syndrome, but this association may be lost onthe novice learner.

Medications ⁄ AllergiesMedical students should be reminded to mention allmedications and allergies. Medications have numerousside effects, and even though the medication might notbe causing the CC, the concern for future drug reac-tions with therapeutic medications mandates the knowl-edge by the educator of all the patient medications.However, students should only mention the drug; thedosing schedule should only be discussed if applicable

to the case or in the discussion that follows the presen-tation.

Physical ExamThe physical exam portion of the EM presentationshould be similar to the ‘‘review of systems’’ section,focused on the pertinent positives and negatives, withthe remainder left out, under the assumption that theother components are not applicable to this patient’scase. The same caveat for the ROS also applies. Withless medical knowledge, the basic learner may notknow what physical exam findings are important basedon a specific patient’s complaints. As such, it is incum-bent on the educator to ask about unmentioned perti-nent positives and negatives.

Summary StatementThe summary statement should be one to two sen-tences that encapsulate the entire clinical picture of thepatient’s visit to the ED. The first sentence should beapproximately the same as the first sentence in the HPI.‘‘The patient is a {age}-year-old {gender} with a historyof {pertinent PMHx} who presents with {CC}.’’ The sec-ond sentence should include only the most importantcomplaints, physical exam findings, studies, or labs val-ues. We believe that beginning students should not givea diagnosis in the summary statement, which differenti-ates the summary statement from an impression state-ment. This is not an area where the student shouldpresent the final diagnosis, as it is unlikely for a defini-tive diagnosis to be possible at this stage in thepatient’s workup. Instead, this is the summation of thehistory and physical elements that will assist in formu-lating the differential diagnosis.

Problem Assessment and PlanThe problem assessment is the first section in the oralpresentation where the medical student should givehis or her opinion. The patient’s problems should bementioned from the most life-threatening to least life-threatening. There is no ‘‘right’’ order, since everyone

Table 2How to Correct Common Mistakes of the Oral Presentation

Pitfalls in Oral Presentations Example Method on How to Change Pitfall

Failure to include relevantPMHx

An elder patient has an acute episode chestpain but student does not mention patienthad a CABG 2 years prior

Tell the student that any conditions that cancause the CC should be labeled pertinentand included in the oral presentation

Including nonrelevant ROSin the HPI

Patient has chest pain but the student alsomentions in the HPI that the patient hasalso had a knee replacement in the distantpast

Ask the student why this piece ofinformation was included, and thenspecifically explain why the kneereplacement is not relevant to thechest pain

Including PE findings in theHPI or ROS

The patient complains of a swollen kneeafter a skiing accident, painful to walk butthe knee had full range of motion and wasnot tender

Remind the student that anything theysee or do to the patient should only bementioned in the physical exam section

Poor body language The student has distracting gestures duringpresentation

Explain why body movements aredistracting and encourage verbaldescriptions

CABG = coronary artery bypass graft; CC = chief complaint; HPI = history of presenting illness; PE = physical exam; PMHx = pastmedical history; ROS = review of systems.

686 Davenport et al. • THE 3-MINUTE EM MEDICAL STUDENT PRESENTATION

will have different opinions. However, this order is crit-ical for the educator to elucidate; it allows insight intothe student’s thought processes as to possible lifethreats. The first mentioned problem does not have tobe the patient’s CC. For example, a patient complainsof abdominal pain, but since arriving to the ED hasstarted vomiting large quantities of blood. The firstproblem mentioned should be hematemesis, notabdominal pain, even though it was the abdominal painthat brought the patient to the ED. Next, the speakershould quickly list life-threatening etiologies of theproblem, any labs or studies needed, and recommenda-tions for current treatment.

Additional Training TechniquesIt is expected that medical students will not achieveexcellence with initial presentations. It is also commonfor students to substitute additional errors in presenta-tions as initial errors are corrected. We have discussedthe most common errors that we have found and cor-rection methods in Table 2. If time permits, studentsshould be allowed to present each case two times. Thefirst time is the way the student believes the case shouldbe presented. After specific feedback from the listener,the student’s second presentation of the same case willinclude corrections to reinforce proper technique.

SUMMARY

With medical students spending increasing time in theED, there is a greater need for student education onhow to deliver patient narratives since ‘‘high-qualityoral presentations have the potential to promote coor-dinated patient care, enhance the efficiency of rounds,and encourage teaching and learning.’’5 The four axi-oms of EM require a rapid and efficient student presen-tation. However, a direct result of students’ limitedclinical knowledge is the inability to determine nonrele-vant from pertinent details and can lead students toinclude extraneous facts causing lengthy presentations.As EM educators, we believe that it is important for allstudents who rotate through the ED to be able to tellthe patients story in a ‘‘3-minute’’ format.

The authors thank Dr. Alison Mann for assistance with manuscriptpreparation.

References

1. Donnelly WJ. The language of medical case histories.Ann Intern Med. 1997; 127:1045–8.

2. Sobel RK. MSL–Medicine as a Second Language. NEngl J Med. 2005; 352:1945.

3. Hunter KM. Doctors’ Stories: The Narrative Struc-ture of Medical Knowledge. Princeton, NJ: PrincetonUniversity Press, 1991.

4. Wolpaw T, Wolpaw D, Papp K. SNAPPS: A learner-centered model for outpatient education. Acad Med.2003; 78:893–8.

5. Green EH, Hershman W, DeCherrie L, Greenwald J,Torres-Finnerty N, Wahi-Gururaj S. Developing andimplementing universal guidelines for oral patientpresentation skills. Teach Learn Med. 2005; 17:263–7.

6. Liason Committee on Medical Education. Functionsand Structure of a Medical School - Standards forAccreditation of Medical Education Programs Lead-ing to the MD Degree, June 2007. Available at:http://www.lcme.org/standard.htm. Accessed Apr 1,2008.

7. Haber RJ, Lingard LA. Learning oral presentationskills: a rhetorical analysis with pedagogical and pro-fessional implications. J Gen Intern Med. 2001;16:308–14.

8. Rosen P. The biology of emergency medicine. J AmColl Emerg Phys. 1979; 8:280–3.

9. Lingard LA, Haber RJ. What do we mean by ‘‘rele-vance?’’ A clinical and rhetorical definition withimplications for teaching and learning the case-presentation format. Acad Med. 1999; 10(Sup-pl):S124–7.

Supplementary Material

The following supplementary material is available forthis article:

Data Supplement S1. Oral presentations in emer-gency medicine (PDF file)

This material is available as part of the online arti-cle from: http://www.blackwell-synergy.com/doi/suppl/10.1111/j.1553-2712.2008.00145.x/suppl_file/acem_145_sm_DataSupplementS1.pdf

Please note: Blackwell Publishing is not responsiblefor the content or functionality of any supplementarymaterials supplied by the authors. Any queries (otherthan missing material) should be directed to the corre-sponding author for the article.

(This link will take you to the supplementary mate-rial).

ACAD EMERG MED • July 2008, Vol. 15, No. 7 • www.aemj.org 687

Medical Student Ride-Along Information Charlottesville-Albemarle Rescue Squad 828 McIntire Road Charlottesville, VA 22902 434-296-4825

Welcome! The Charlottesville-Albemarle Rescue Squad (CARS) is pleased to have you participate in our ride-along program. CARS is the busiest volunteer rescue squad in the nation (average 40 calls per day) and you will certainly see action during your shift. Keep in mind our personnel are very knowledgeable and experienced and that you are here to observe and learn. In order to prepare yourself for this experience, we ask that you read the following, which explains how we operate. 1) Understand the hierarchy of types of care delivered in the pre-hospital setting. Providers function in Virginia at 4 levels:

EMT Basic: This is a 121 hour course that prepares the provider to do basic life support skills such as splinting, uncomplicated childbirth, CPR. They are the backbone of the local EMS system. EMT Enhanced: This is an additional 128 hours of instruction. Often called “traumas”, these providers are allowed to practice advanced life support skills such as starting IVs, needle chest decompressions, intraosseous access, and giving more advanced medications such as Narcan, D50, Epinephrine. They typically run calls for allergic reactions, altered level of consciousness, major motor vehicle accidents. EMT Intermediate: Typically referred to as “medics,” these providers do more advanced skills such as interpreting 12-lead ECGs, intubations and RSI. Their medication set includes cardiac drugs such as Metoprolol and Lasix. They function as the team leader in pre-hospital codes, and run calls for chest pain and shortness of breath. EMT Paramedic: These are the upper echelon of pre-hospital providers, with most providers having gone to a community college for up to 2 years to obtain this level of certification. They do more advanced and invasive skills such as rapid sequence intubations.

In addition to patient care training, most of our members have additional training in such rescue disciplines as vehicle, technical (rope, trench, confined space, building collapse) and water rescue. 2) Skim through the EMS protocols under which local agencies function prior to the shift. They are available here: www.tjems.org/Guidelines.pdf. This will help you become a bit familiar with the protocols that provide a guideline for the delivery of pre-hospital care. Here is an example of the chest pain protocol:

EMT-Basic 1. Administer oxygen. 2. Aspirin 162 mg (2 baby aspirin) chewed. 3. Assist patient with prescribed Nitroglycerin (NTG), 1 tablet SL every 5 minutes as long as SBP > 100 mmHg, to a maximum of 3 doses. 4. EMT-J should apply 1” of Nitro Paste. If patient has taken NTG in past, may administer 1 NTG SL every 5 minutes as long as SBP > 100 mmHg. EMT-Enhanced 1. Establish IV access. 2. Nitroglycerin 0.4 mg SL every 5 minutes with a SBP >100 mmHg. 3. Apply 1 inch of 2% Nitropaste (15 mg) topically keeping SBP > 100 mmHg. EMT-Intermediate / Paramedic 1. Initiate cardiac and pulse oximery monitoring. 2. Obtain 12 lead ECG if available. 3. For patients with persistent chest pain after above measures, and/or a 12 lead ECG indicating an acute myocardial infarction, pulse rate greater than 80 and systolic blood pressure greater than 120 mmHg, metoprolol (Lopressor) 5 mg IV, may be repeated every 10 minutes up to a total of 15 mg. 4. If pain persists, consider morphine sulfate 2 mg slow IV, maintaining a SBP > 100 mmHg. May be repeated every 5-10 minutes to a total of 6 mg. 5. For patients with repeated vomiting, consider promethazine (Phenergan) 12.5 mg IV, reduce dose to 6.25 mg IV for age 70 or older.

3) Understand the basic structure and function of the local emergency response system.

All 911 calls in Charlottesville, UVa, and Albemarle are directed to the Emergency Communications Center located on the grounds of the University. When a call is a deemed to be a medical emergency, the 911 operator asks a series of questions to determine the subject’s dispatch complaint and severity. Based on these questions, the dispatcher will send an ambulance with a recommended level of training (ie does the call require an EMT Basic or an EMT Paramedic?). Also, if the call is life threatening, the dispatcher will also send for the fire department as a first responder agency. Upon arrival the scene of the incident, the pre-hospital providers assess and treat the patient according to the Thomas Jefferson EMS Council Protocols noted above. The patients are then transported to the hospital of their choice (either

Martha Jefferson or UVa), unless the call is a major trauma, in which patients are sent to UVa. En route to the hospital, the providers contact either UVa’s Medical Communications Center or Martha Jefferson’s charge nurse to provide a brief description of the patient and his/her complaint. This allows the hospital to prepare to have resources available immediately for sick patients upon their arrival. For example, a patient with major trauma will have a trauma alert issued, giving the trauma team and the emergency department enough time to prepare.

4) When arriving for your shift at CARS, introduce yourself to the crew captain, who will be wearing a white shirt. They will assign you to an ambulance crew, please be sure to stay close to them since they will not wait for you when a call comes in. The crew captains for each crew are: Mondays: Captain Rose Tuesdays: Captain Judkins Wednesdays: Captain Inofuentes Thursdays: Captain Hamrick Fridays: Captain Garrett 5) Please help the crew to which you are assigned with checking the ambulance. This will help you understand the types of equipment CARS carries, and where they are located. In the event of a cardiac arrest, for example, if the medic asks for the suctioning, you will know where to find it. 6) When a call comes in, go to the patient compartment and wear a seatbelt. When operating on the street where traffic is an issue, please don a traffic safety vest. The vast majority of pre-hospital provider deaths and injuries occur because of accidents. Please protect yourself. 7) Observe how EMS providers assess and treat patients in the field, turn over care to the receiving facility, and document the call on the run sheet. 8) Help the crew place the ambulance back in service by restocking supplies and cleaning the patient compartment after each call. This really helps the crews out a great deal. 9) Help the crew make breakfast and lunch. 10) Ask a member to give you a tour of the other types of apparatus that CARS runs, such as the Water Rescue Truck, the Heavy Rescue, and the Mass Casualty Incident truck (which can accommodate over 200 patients!).

3/29/13 EM Resources for Medical Students — School of Medicine at the University of Virginia

www.medicine.virginia.edu/clinical/departments/emergency-medicine/formedicalstudents/em-education.html 1/3

EM Resources for Medical Students

Welcome to the resource page for medical students going into Emergency Medicine! Here you will find

everything you need to prepare you for the field of Emergency Medicine.

Away Rotations

It is highly encouraged that you do an away rotation. Away rotations are important because they provide the

opportunity for you learn in a different hospital setting which expands your view of emergency medicine.

When should I do an away rotation? Preferably, this should be done after you have done an EM rotation here

at UVA. Ensure that after you do your rotation, you meet with Dr. Huff or another faculty member who can

provide valuable feedback that you can use and apply to when going to your next rotation. UVA opens up it's

away rotation slots in May. You can contact the program before then the express interest and find out the

details of applying.

What program should you rotate at? Primarily, you should rotate at a program you are interested in

matching at. An away rotation will allow you to check out the program first hand. Also, you will have the

opportunity to make a good impression on the program. Therefore it is important that you work very hard on

the away rotation. In addition to representing yourself, you are representing UVA's School of Medicine.

Recommended Books This is a list of books that are used on several of the electives and that EM residents

use.

Recommended for the Elective:

MS4 EM Elective - Markovchick - Emergency Medicine Secrets

PEDS EM Elective - Fleisher - Textbook of Pediatric Emergency Medicine

Dr. Brady gives everyone who is taking the ECG Elective a free book.

EM books that the Residents Are Reading

3/29/13 EM Resources for Medical Students — School of Medicine at the University of Virginia

www.medicine.virginia.edu/clinical/departments/emergency-medicine/formedicalstudents/em-education.html 2/3

Here is a list of free E-Books. All of the e-books are free to UVA SOM students.

From the list, the recommended books are:

Knopp - Atlas of Emergency Medicine

Roberts and Hedges - Clinical Procedures

Marx - Rosen's Emergency Medicine

Tintinalli - Tintinalli's Emergency Medicine

Goldfrank's Toxicological Emergencies

Simon - Emergency Orthopedics

UVA EM on iTunes U

The Department of Emergency Medicine has our own iTunes U site where we store

recorded lectures from our weekly conferences as well as guest lectures. We

currently have 40 videos available to the public, with more on our private site. For

login information for the private site, please email Travis Harris at

tth7d@hscmail.mcc.virginia.edu

DailyEM Blog DailyEM is the hotspot for University of Virginia and University of Maryland EM

education. Come check out hot topics in Emergency Medicine and stay up to date

with the latest in both research and clinical skills.

Reading List Keep up with what our residents are currently studying and find articles related to

current topics in Emergency Medicine.

Visiting Student

Application

Applying from outside of UVA? Find the application here!

Residency For more information about UVA's Emergency Medicine Residency Program! Tons

of information about our curriculum, objectives, benefits, facilities, current

residents, and life in Charlottesville!

EMRA Student

Resources

The Emergency Medicine Residents' Association contains a ton of helpful

information for medical students who are interested in pursuing a career in

emergency medicine. Their page includes medical student pearls and podcasts, skills

demonstration videos, and recommended reading lists.

CDEM Student Portal The Clerkship Directors of Emergency Medicine is associated with the Society for

3/29/13 EM Resources for Medical Students — School of Medicine at the University of Virginia

www.medicine.virginia.edu/clinical/departments/emergency-medicine/formedicalstudents/em-education.html 3/3

Academic Emergency Medicine (SAEM) and dedicated to the education of medical

students in the field of Emergency Medicine. Their student portal contains a variety

of online self-study modules and approaches to situations or diseases commonly seen

in the Emergency Department.

Medscape Reference A collection of articles related to diagnoses, lab studies, imaging, procedures, and

other topics relevant to emergency medical care.

Emergency Medicine

Societies

ACEP

SAEM

AAEM

American College of Emergency Physicians

Society for Academic Emergency Medicine

American Academy of Emergency Medicine

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