Rotations in Yale ED

Student clerkships in Yale EM are designed to be a hands-on experience where students will immerse themselves in the workings of the ED.

Mission

The educational mission of the Department of Emergency Medicine is to educate future leaders and scholars who will advance the practice of emergency medicine at all levels, from local to international.

The outstanding teaching during the Yale EM clerkships is evidenced by the many teaching awards bestowed on our faculty by the students of the Yale School of Medicine.

Dr. Karen Jubanyik received the 2018 Leah Lowenstein Award and Dr. Rachel Liu received the 2018 Blake Award, both for outstanding medical education.  Dr. Christopher Moore (Chief, Section of Emergency Ultrasound) won the Alvan R. Feinstein Award for outstanding teaching of clinical skills in 2016.

To navigate, click one of the following:
> Traditional Sub-I Rotations
> U/S Sub-I Rotations
> MS2/3 Clerkship
> U/S Elective
> FAQ

Traditional Sub-I Rotations

Welcome to the Yale EM Sub-Internship!

Our Sub-I is composed of a combination of clinical shifts, didactic activities as well as a resident-led procedure sim.

  • The schedule consists of 15 x 8 hour clinical shifts at the Yale New Haven ED where you rotate with different attendings to learn from their special skills (ultrasound, critical care, toxicology, EMS, etc).

  • You have protected time for education on Tuesday afternoons and Wednesday mornings.

  • Some Tuesday afternoons you will attend the Ultrasound Image Review with the ultrasound faculty, and others you will attend specialized lectures or simulation.

  • On Wednesday mornings you will attend the EM residency educational conference. You can find the schedule as well as the location for the conference on this website.

Please look under resources to read about some recommended readings to help you improve your knowledge as you rotate with us.

Enjoy your time at Yale!

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U/S Sub-I Rotations

Welcome to the Yale EM Sub-Internship!

Our EM/US Sub-I is composed of a combination of clinical shifts and scanning shifts in the ED as well as didactic activities and resident-led procedure sim.

It is required to have 1 prior EM rotation in order to participate in this elective with the intention of applying to residency in Emergency medicine.

  • The schedule consists of 10 x 8 hour clinical shifts and 4 x scanning shifts at the Yale New Haven ED where you rotate with different attendings with a specific focus on those specialized in ultrasound.

  • You have protected time for education on Tuesday afternoons and Wednesday mornings.

  • Some Tuesday afternoons you will attend the Ultrasound Image Review with the ultrasound faculty, and others you will attend specialized lectures or simulation.

  • On Wednesday mornings you will attend the EM residency educational conference. You can find the schedule as well as the location for the conference on this website.

Please look under resources to read about some recommended readings to help you improve your knowledge as you rotate with us as well as download the bulldog sonobites app to use prior to and on your scanning shifts.

You can find your schedule under the google calendar for the ultrasound department. You will be emailed the username and password.

Enjoy your time at Yale!

If you have any questions please feel free to contact Dr Rachel Liu at rachel.liu@yale.edu.

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MS2/3 Clerkship

All Yale Medical Students participate in a 3 week EM rotation during their 12-week integrated Surgical Approach to the Patient clerkship. Students work closely with Yale EM faculty and residents while providing direct patient care.

Students on the EM clerkship are assigned to a variety of shifts, where they will encounter urgent care level patients as well as resuscitation of the most critically ill emergency department patients. This design allows the student to be exposed to a wide range of EM procedures and presentations. All patient care is directly and closely supervised.

Each student in the clerkship receives individualized teaching from EM faculty members with whom they are paired for one or more shifts in the emergency department. Students also rotate in groups through the Yale Center for Medical Simulation as part of a 12-week integrated EM/Surgery simulation course. Weekly small group case conferences are led by EM faculty and help the student to learn the EM approach to acute presentations of common chief complaints. In addition, there will be a weekly resident-run EM didactic. 

Check out our Medical Student Resources page for some high yield content to help you during your time in the ED. Many of your questions can be answered through our FAQ page.

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U/S Elective

Welcome to the Ultrasound rotation for medical students, emergency medicine residents and off-service residents!

Your schedule will vary depending on the type of rotation you are signed up for, but it generally consists of a combination of 4-5 hour scanning shifts in the Adult Emergency Department at Yale York Street Campus as well as participation in image review at 464 Congress Street every Tuesday afternoon from 1PM to 5PM.

You can find your schedule under the google calendar for the ultrasound department. You will be emailed the username and password.

The Department of Emergency Medicine owns 5 Phillips Sparq ultrasound machines that you will be training with: 3 machines on A side of the ED, 1 on B side, 1 on C side.

The Emergency Department has a system of cell phones set to work on the wireless network of the hospital called Mobile Heartbeat. The doctors, nurses and other ED staff use it to communicate. The Ultrasound team you will be a part of while scanning must login to a Mobile Heartbeat phone so you can be contacted by the ED staff for scans.

There are generally two types of point of care ultrasounds performed in the ED: diagnostic and educational. This will be explained further but educational studies always need a confirmatory study performed (such as an official radiology study).

After performing a scan, please login into Qpath and complete the worksheet for the study. All the Qpath worksheets should be complete by the end of your shift.

Make sure you clean and stock all the ultrasound machines daily. All machines house a special cleaning spray, a bag of towels, and ultrasound gel packets. You can find supplies in a closet in the corridor directly behind room R1.

Current Rotator Schedule

Enjoy your time rotating in our department!

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U/S resources

In terms of helpful resources for learning ultrasound if this is your first time getting experience with the subject matter, here is a short list:

  • Bulldog app: Created by our own Dr. Cristiana Baloescu!

  • Sonoguide: Created by ACEP section of emergency ultrasound, this is a comprehensive teaching website for point of care ultrasound

  • Ultrasound Podcast: This is for the podcast lovers, series of educational podcasts on general point of care ultrasound topics

  • Emergency Ultrasound Teaching: A great website with clinical cases, tutorials as well as literature repository for some of the more important ultrasound articles, split by topic.

  • Sonospot: Website “where the interesting, funny, cool and geeky meet to share their tips/tricks/knowledge of and adventures with bedside focused EM ultrasound” through patient cases.

  • 1-Minute Ultrasound (for iPhone and also on Google Play, free): This app is a great on the go bedside reference on correct scanning techniques as well as expected normal and abnormal scans. Best of all, each topic is 1 minute!

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FAQ

+ I have a question or concern about the clerkship, whom should I contact?

For any administrative issues regarding the clerkship or subinternship, please always CC: both Dr. Jessica Bod and Becky Sullivan. For sensitive matters, concerns about professionalism or ethics, you may contact Dr. Bod alone.

+ What should I wear to the clerkship?

For the clinical activities of the clerkship, please wear scrubs and comfortable, closed-toe shoes. For the didactic portions of the clerkship, you may wear ‘dress casual’ attire.

+ I don’t want to work on a certain day. Can I make a schedule request?

No, schedule requests cannot be honored due to the difficulty of creating a schedule that works for all students. Shift swaps with other students on the clerkship should not be done without advance permission from Dr. Bod. If you have a scheduling issue please contact Becky Sullivan and Dr. Bod.

+ My clinical shift overlaps with a case conference or sim session, what should I do?

You should attend the case conference or sim session and go to your shift after completing that activity, explaining to your attending where you have been when you arrive. If the didactic activity starts close to, but not exactly at the same time as the start, or ends near the end, you do not need to attend the short portion of the shift at the beginning or end (i.e. 3pm shift start with 4pm case conference), although if you’d like to go and introduce yourself at the start of the shift, particularly if your shift is at York Street campus adjacent to the didactic activity, you are welcome to. Consider e-mailing your preceptor regarding when you will arrive if you have a schedule conflict.

+ What should I do when I arrive for my shift?

You should introduce yourself to the attending and the residents (if at York St) that you will be working with, listen to the sign-out from the prior team, and then look for patients you can take on and see. Since you cannot assign yourself to a patient on the tracking board, be sure to communicate with the team when you are going to see a new patient so that all team members will be aware. You should also introduce yourself and your role to nurses or techs working in your clinical area.

You should also come to each shift with a few self-determined learning goals and share these with your team. These may have to do with clinical assessment, information processing, technical skills, or any other area, but having some explicit objectives in mind will help direct your learning in the unpredictable environment of the ED and give your supervisors specific ways to help you.

+ What if I show up for my shift and the attending differs from my schedule?

Sometimes, attending physicians swap shifts and you may find a different attending working the shift to which you are assigned. Work your assigned shift (date, location, and time) with the attending who picked up the shift. If possible, we try to keep you with the same attendings for continuity and quality of teaching, however, this is not always possible due to a high degree of swapping. Amion (“yedoc” -> “Emergency Medicine”) usually reflects the most up to date attending schedule.

+ What is the weather policy for this clerkship?

If there is inclement weather such that travel seems unsafe, please contact us to try to reschedule your shift.

+ What is the illness policy for this clerkship?

If you are sick with a non-infectious illness and you are not well enough to work, please contact Dr. Bod and Becky Sullivan to let us know. If you are sick with any significant infectious illness (gastroenteritis, the flu, etc) we would prefer that you stay home to prevent spread of the disease. Please contact us to let us know and so that we can help to find a replacement shift for you.

+ How do I get scrubs at SRC campus?

There is a scrub machine at V2137 (Verdi, second floor).

+ Where do I park at SRC?

There is no free student parking at SRC, so most people use the shuttle service and/or safe ride escort for transportation. Be cautious of walking or biking in the SRC neighborhood after dark.

+ What tasks must be completed in order to successfully complete this clerkship?

– On time attendance at all assigned shifts in the emergency department. Lateness is not acceptable on the emergency medicine rotation.
– Attendance at Clinical Reasoning/Problem Solving sessions on Monday afternoons.
– Attendance at simulation sessions on Wednesday and Friday afternoons.
– Completion of patient/procedure log (attached): submit to Rebecca and Dr. Bod.
– Completion of an I-human case online at https://ih2.i-human.com/register/cdem (Marvin Webster case)
– Attendance at EM residency didactics on Wednesday mornings. If you work until 12AM on Tuesday night you are excused for the first hour of conference. If you work until 1AM on Tuesday night you are excused for the first two hours of conference.
– At the end of your rotation please email me and Dr. Bod with the following attachments:

  • Screenshot of I-Human case completion
  • – Completed patient and procedure log

+ How do I assign evaluators?

Shortly after you start your clerkship, you will be able to log in to Medhub and assign evaluators. It is recommended that you assign as many evaluators as possible (both attendings and residents that you work with) in order to increase chances of getting better and more detailed feedback on your performance, and for timely grading. You do not need to assign Medhub evaluations to anyone who has already physically written you an evaluation that you have in hand, but if you were told that the evaluation would be e-mailed, please still assign it in Medhub.

Please make sure you assign at least 4 evaluators in medhub at the end of the rotation to ensure that sufficient feedback is generated to complete your final evaluation.

+ What is the best way to collect evaluations?

You may collect evaluations through using the paper sheet we will provide you, or through Medhub assignments. Some attendings will also e-mail you and Dr. Bod with further details. Collect at least one written evaluation at 7-10 days into the clerkship in order to obtain documented mid-clerkship feedback. With each attending you will work alongside for multiple shifts, it is strongly recommended to ask them for brief oral feedback after the first shift, then follow up for further detail at the end of the last shift. Encourage faculty to complete an evaluation at the end of the shift while giving you face-to-face feedback on your performance. If a faculty member states that they will write an evaluation for you later, it may be a good idea to follow up with them later to remind them (we will also send them a reminder). Faculty evaluations are most valued, though EM resident evaluations (particularly senior residents) are valuable as well. PA or APRN evaluations are also accepted.

If your evaluators are unable to fill out a form while discussing with you face-to-face, it can be helpful to email them a reminder of some cases, topics, and feedback from the shift when you make the electronic request. This will help them to remember specific things to comment on.

+ How can I get the most constructive evaluation of my performance while on the emergency medicine clerkship?

There are several things that you can do to help obtain more detailed and useful evaluation information. Remember that in order to accurately assess your performance, you have to demonstrate your abilities to the people who will be evaluating you, and you have to get their impressions of what you’ve done recorded. Ways to do this include: – Get as much face time as you can (without getting in the way of their provision of patient care) with the senior members of the team.
– Tell them about your career plan and your personal learning objectives while on the EM clerkship. Our preceptors like to know, for example, if you are an MD/PhD, what your research field has been. They like to know if you plan to become a plastic surgeon so they can help seek you out opportunities for wound care or wound repairs while you are with us. If you start your shift by saying “I’m trying to work on my physical exam skills today. Can you help me specifically assess how I’m doing in that area and let me know what I need to do to improve?” Then your preceptor can try to take time to observe you conducting physical exams (or just describing your findings) and will be mindful of that throughout the shift to give you pointed feedback at the end of the shift. If you can give the people you’re working with an understanding of your personal background and future goals, this can help them remember you and provide more personalized feedback.
– Get some or most of your feedback done on the spot. Definitely ask for verbal assessment of your performance, but even better if you can ask your preceptor to take the extra minute to scribble those impressions on the paper evaluation form that you’ve been provided. There is nothing to say that you cannot get multiple, sequential evaluations on that form from the same person (if you do, we will be sure to emphasize the progression of your skills in your evaluation – and you can print as many extra forms as you need). Not all the numeric values need to be filled out – that is much less important than the free text. Optimal from our perspective would be if you’re sitting at a computer and have already assigned your preceptor as an evaluator in Medhub, to have them complete your evaluation on the spot if you are having your final feedback session with them; however, we understand that this is not always easy to do.
– Ensuring timely evaluation: If you do not physically witness your evaluation being filled out, a single e-mail note to ask about/remind your preceptor could be a good idea. Dr. Bod and Becky will send a reminder at the end of the clerkship to preceptors who have not yet completed evaluations, but these are form letters and a message from you personally may be more effective. The more time that passes in between your face-to-face experience with a preceptor and when they fill out your evaluation, the less specific and useful it is likely to be. Although you cannot ultimately control the timing of your evaluation completion, these are some things you can do to help expedite the process. Dr. Bod receives the summary of the evaluations that have been completed at the end of the full clerkship block, so many weeks may have passed by the time she is aware of a lack of information from your preceptors, which makes follow up for obtaining delayed feedback a challenge.

+ How can I perform well and make the most of the EM clerkship?

In emergency medicine, timely arrivals for commitments and enthusiasm are valued, as well as the ability to work well with all members of a care team. We also appreciate willingness to assist with tasks at any level and students who take initiative and are self-motivated learners. Students who stand quietly by and do not pick up patients, who do not communicate effectively with the team, or spend long periods of time reading on computers while on shift are less likely to get great evaluations. Students who have received excellent written evaluations have been cited for their impressive initiative in getting involved with patient care and following their own patients closely through their ED stay, superior communication skills at dealing with difficult patients or families, staying late to help out where needed, or actively seeking procedures and greater exposure to clinical experiences. See these resources (including video and handout on how to present in emergency medicine, and handout on how to be an excellent medical student in EM) for more details. Remember that it is up to you to ensure that your evaluators have the chance to observe your skills and your hard work and to help clerkship staff to obtain information on your performance that truly reflects what you accomplished.

+ What are some factors that can result in delayed grade submission?

The reason for delayed grade submission is nearly always a lack of adequate evaluation information, requiring the clerkship directors to hunt out potential evaluators via e-mail, phone, and in person conversation. By the time that the clerkship director is able to see which evaluations have been submitted in order to assign grades, many weeks may have passed since your clerkship experience, making it difficult for faculty or residents to remember you and your performance.

+ I’m interested in EM. What should I do?

Dr. Jessica Bod will be happy to meet with any students interested in EM to discuss career questions. Please see the Student Mentorship in Emergency Medicine Program page for other options.

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