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2010-11 EM Residency Manual

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					LSUHSC Emergency Medicine Residency Handbook 10-11              1




                         Revised June 21, 2010, M. Haydel, MD




   LOUISIANA STATE UNIVERSITY HEALTH SCIENCE
             CENTER – NEW ORLEANS

     EMERGENCY MEDICINE RESIDENCY PROGRAM

 POLICIES TO SUPPLEMENT LSUHSC HOUSE OFFICER
           MANUAL & ROTATION GUIDE




           “Prepared For the Worst ~ Providing the Best”
     LSUHSC Emergency Medicine Residency Handbook 10-11                                                                                     2




                        TABLE OF CONTENTS LSU EM RESIDENCY MANUAL



INTRODUCTION ..................................................................................................................... 6
POLICIES – ACGME................................................................................................................. 7
   ACGME CORE COMPETENCIES........................................................................................................... 7
     Core Competencies Guidelines ................................................................................................ 7
   CORE COMPETENCIES........................................................................................................................ 7
     Core Competencies & LSU EM ................................................................................................. 8
   RESIDENT DUTY HOURS AND THE WORKING ENVIRONMENT ................................................................... 12
        1. Supervision of Residents ............................................................................................... 12
        2. Duty Hours .................................................................................................................... 12
        3. On-Call Activities ........................................................................................................... 12
        4. Moonlighting ................................................................................................................. 13
        5. Oversight ....................................................................................................................... 13
        6. Duty Hours Exception ................................................................................................... 13
   DUTY HOURS - EMERGENCY MEDICINE ............................................................................................. 14
POLICIES - LSUHSC .............................................................................................................. 15
   ETHICS CODE - LSUHSC EMERGENCY MEDICINE RESIDENCY .................................................................. 15
     Code Of Professional Conduct ............................................................................................... 16
     Honor Code ........................................................................................................................... 16
     Grievance Policy - Academic ................................................................................................. 17
     Ombudsman .......................................................................................................................... 21
     MCLNO Quality of care statement ........................................................................................ 22
   JOB DESCRIPTION - EM HOUSE OFFICER ............................................................................................. 23
     House Officer I ....................................................................................................................... 23
     House Officer II ...................................................................................................................... 23
     House Officer III ..................................................................................................................... 24
     House Officer IV .................................................................................................................... 24
   HOUSE OFFICER CONTRACT ...................................................................................................... 25
   COMPENSATION ....................................................................................................................... 26
   INSURANCE ............................................................................................................................... 26
     Health Plans .......................................................................................................................... 27
     Disability Insurance ............................................................................................................... 27
     Medical Practice Liability Coverage ...................................................................................... 27
   LEAVE: ....................................................................................................................................... 27
     Vacation Leave ...................................................................................................................... 27
     Sick Leave .............................................................................................................................. 27
     Maternity/Paternity Leave .................................................................................................... 27
     Educational Leave ................................................................................................................. 27
     Military Leave........................................................................................................................ 27
    LSUHSC Emergency Medicine Residency Handbook 10-11                                                                                    3




      Leave of Absence................................................................................................................... 27
      Family Leave.......................................................................................................................... 28
   PAY SCALES - LSUHSC HOUSE OFFICER ............................................................................................. 32
   EMERGENCY FUND FOR RESIDENTS .................................................................................................... 33
   HOUSE OFFICER SELECTION AND ELIGIBILITY LSUHSC........................................................................... 34
   CAMPUS ASSISTANCE PROGRAM ....................................................................................................... 36
   FITNESS FOR DUTY AND SUBSTANCE ABUSE POLICY .............................................................................. 37
   WORK RELATED INJURY/ILLNESS ....................................................................................................... 39
   DRESS CODE ................................................................................................................................. 40
   LIBRARY - LSUHSC ...................................................................................................................... 49
   WELLNESS CENTER .................................................................................................................... 51
   HOUSE STAFF CLEARANCE FORM .............................................................................................. 52
POLICIES – SECTION OF EM .................................................................................................. 54
   MISSION STATEMENT...................................................................................................................... 54
      GOALS and OBJECTIVES ........................................................................................................ 54
   ROLE OF THE RESIDENCY IN THE EMERGENCY DEPARTMENT .................................................................... 56
   EM RESIDENCY APPLICANTS ............................................................................................................. 57
   RESIDENCY PROMOTIONS ................................................................................................................ 58
   EMERGENCY MEDICINE YEAR END COMPETENCIES ................................................................. 58
      PGY1 YEAR............................................................................................................................. 58
      PGY2 YEAR............................................................................................................................. 60
      PGY3 YEAR............................................................................................................................. 61
      PGY4 YEAR............................................................................................................................. 62
   LIAISON & OVERSIGHT POLICY .......................................................................................................... 63
   DISMISSAL POLICY .......................................................................................................................... 64
   SATISFACTORY ACADEMIC STANDING ................................................................................................. 69
   EVALUATIONS ................................................................................................................................ 70
      Monthly evaluation of Residents by Faculty ......................................................................... 71
      Annual evaluation of Faculty by Residents ........................................................................... 73
      Evaluation of Rotations by Residents.................................................................................... 74
      Evaluation of Program by Residents ..................................................................................... 75
      6 month Evaluation of each Resident by Advisor.................................................................. 76
      Yearly Eval and Final Exit Evaluation of Resident by Program Director ............................... 77
   FACULTY ADVISORS ........................................................................................................................ 84
      Evaluation of Resident Documents Policy ............................................................................. 84
   PROCEDURE AND PATIENT EXPERIENCE DOCUMENTATION...................................................................... 85
      Procedures And Resuscitations ............................................................................................. 85
      Ultrasound ............................................................................................................................ 86
         Airway Techniques ............................................................................................................ 87
         Anesthesia ......................................................................................................................... 87
         Diagnostic Procedures ...................................................................................................... 87
         Genital/Urinary ................................................................................................................. 87
         Head and Neck .................................................................................................................. 87
 LSUHSC Emergency Medicine Residency Handbook 10-11                                                                                       4




      Hemodynamic Techniques................................................................................................ 87
      Obstetrics .......................................................................................................................... 87
      Other Techniques.............................................................................................................. 87
      Resuscitation ..................................................................................................................... 87
      Skeletal Procedures .......................................................................................................... 87
      Thoracic ............................................................................................................................. 87
   Follow-Up Log ....................................................................................................................... 88
RESIDENCY PARTNER....................................................................................................................... 89
EDUCATIONAL STIPEND ................................................................................................................... 90
TRAVEL FORMS .............................................................................................................................. 91
MAILBOXES/ EMAIL ........................................................................................................................ 92
BEEPERS ....................................................................................................................................... 93
VACATION .................................................................................................................................... 94
YEARLY SCHEDULE REQUESTS ........................................................................................................... 94
ED SCHEDULES .............................................................................................................................. 95
DISASTER CALL .............................................................................................................................. 96
   Disaster Call Scheduling ........................................................................................................ 97
   Disaster Call & Duty Hours .................................................................................................... 98
CODE GREY – HURRICANE GUIDELINES ............................................................................................... 99
ADVANCED LIFE SUPPORT PROGRAMS POLICY ................................................................................... 102
MOONLIGHTING POLICY ................................................................................................................ 104
CALL ROOM ................................................................................................................................ 105
SICK LEAVE ................................................................................................................................. 106
CONFERENCE ATTENDANCE POLICY .................................................................................................. 107
MONTHLY CORD EXAM................................................................................................................ 108
   Journal Club Literature Critique Form ................................................................................. 111
M & M PRESENTATIONS ............................................................................................................... 112
MEDICAL RECORDS....................................................................................................................... 114
   Electronic Signature ............................................................................................................ 114
LSU EM READING TOPICS 2009-11 ............................................................................................... 115
RESEARCH REQUIREMENT .............................................................................................................. 117
RESIDENT'S RESEARCH PROPOSAL AND PROGRESS FORM ..................................................................... 118
CHIEF RESIDENT RESPONSIBILITIES ................................................................................................... 119
CHIEF RESIDENT QUESTIONNAIRE .................................................................................................... 119
RESIDENCY CURRICULUM ............................................................................................................... 120
   Model For Emergency Medicine ......................................................................................... 120
REFERENCE BOOK LOAN-OUT POLICY .............................................................................................. 121
MEDICAL LICENSE ........................................................................................................................ 122
   Louisiana License, Training Permit & STEP 3: ..................................................................... 122
   State Licensure .................................................................................................................... 123
   DEA number ........................................................................................................................ 123
   NPI number ......................................................................................................................... 123
   Notary ................................................................................................................................. 124
GUIDELINES TO ROTATIONS/GOALS & OBJECTIVES ............................................................................. 125
LSUHSC Emergency Medicine Residency Handbook 10-11                                                                                   5




 MCLANO Emergency Department ...................................................................................... 126
 ANESTHESIA & ENT ............................................................................................................. 135
 CHABERT Medicine Wards .................................................................................................. 140
 EMS- New Orleans EMS ...................................................................................................... 142
 CHILDREN’S HOSPITAL........................................................................................................ 144
 MICU ................................................................................................................................... 147
 OBSTERICS ........................................................................................................................... 151
 OLOL Pediatric ED ............................................................................................................... 155
 OCHSNER ED ....................................................................................................................... 157
 SLIDELL ED ........................................................................................................................... 163
 TOXICOLOGY ....................................................................................................................... 168
 TRAUMA ICU ....................................................................................................................... 171
 WEST JEFFERSON ED ........................................................................................................... 174
    WEST JEFFERSON ED-Pediatrics & FastTrack .................................................................. 175
 ELECTIVE .............................................................................................................................. 180
   LSUHSC Emergency Medicine Residency Handbook 10-11                                      6




                                       INTRODUCTION

  Welcome to the LSU Emergency Medicine Residency Program. This LSU EM Policies To
Supplement LSUHSC House Officer Manual & Rotation Guide is meant to augment the
LSUHSC School of Medicine, Office of Graduate Medical Education, House Officer Manual.
The House Officer Manual is updated each year and is available on the LSUSHC website at:


http://www.medschool.lsuhsc.edu/medical_education/graduate/HouseOfficerManual.asp




A hard copy of this manual is available in the emergency medicine offices and online at the LSU
EM yahoo website. http://health.groups.yahoo.com/group/LSUEM/
   LSUHSC Emergency Medicine Residency Handbook 10-11                                          7




  POLICIES – ACGME

                                  ACGME Core Competencies

Core Competencies Guidelines (ACGME 2007)

Core Competencies

The following are the 6 Core Competencies for ACGME accreditation purposes.

   1.   Patient Care
   2.   Medical Knowledge
   3.   Practice Based Learning
   4.   Interpersonal & Communication Skills
   5.   Professionalism
   6.   Systems Based Practice


Annual Competency Assessment – The programs must define competencies that are expected
for each year of training taking into account the defined ACGME core competencies. Multiple
tools may be used to evaluate these competencies. Competency evaluation of chief complaints,
procedures, resuscitations and off-service rotations will be used as part of the annual competency
evaluation.


Chief Complaint Competency - The RRC expects that programs will assess the competency of
residents to handle key chief complaints in emergency medicine. At the time of program review,
the program will demonstrate how it assesses resident competency for 3 chief complaints over
the course of the training program. The program can use a variety of tools including direct
observation, check-lists, simulations, etc.

Procedural Competency – The primary responsibility for the determination of procedural
competency rests with the program director and the faculty. The RRC accredits programs, and
does not certify or credential individuals.

The RRC expects programs to assess the competency of residents to perform key index
procedures. At the time of program review, the program will need to demonstrate how it assesses
competency of residents for 3 procedures.

Selected index procedures should consequentially impact patient care, and ideally facilitate
competency assessment initiatives across disciplines.

One of the selected procedures must be ED bedside ultrasound (PR V.B.2.b; appendix 1)


Resuscitation Competency – The RRC expects programs to assess resident competency in the
   LSUHSC Emergency Medicine Residency Handbook 10-11                                        8




resuscitation of critical patients. These include adult and pediatric medical and trauma
resuscitations. At the time of program review, the program will demonstrate how it assesses
competency in one type of resuscitation. The program may use a variety of techniques including
simulations and direct observations.

Off-Service Rotations – The program should define measurable competency objectives for off-
service rotations, how the objectives are assessed and remediated when necessary. At the time of
program review, it is expected that measurable objectives and the tools used for evaluation will
be available for half of the off-service rotations.

Core Competencies & LSU EM
The residency program must require that its residents obtain competence in the six areas listed
below to the level expected of a new practitioner. Programs must cite examples how these
competencies are taught and evaluated within the training program.

   1. Patient Care: Residents must be able to provide patient care that is compassionate,
      appropriate, and effective for the treatment of health problems and the promotion of
      health.

   Among other things, residents are expected to:

       a. Gather accurate, essential information in a timely manner.
       b. Generate an appropriate differential diagnosis.
       c. Implement an effective patient management plan.
       d. Competently perform the diagnostic and therapeutic procedures and emergency
          stabilization.
       e. Prioritize and stabilize multiple patients and perform other responsibilities
          simultaneously.
       f. Provide health care services aimed at preventing health problems or maintaining
          health.
       g. Work with health care professionals to provide patient-focused care.

Residency Experience: each clinical rotation and every off site ED rotation, didactic/lecture
sessions, skill labs, simulation labs, US, Tox, all orientations, teaching ACLS/PALS/ATLS and
freshman anatomy labs.

Residency Assessments: Direct observation and documentation of Daily, Monthly and Yearly
evaluations, simulation cases, oral board cases, Morbidity and Mortality cases 360 evaluations.

2. Medical Knowledge: Residents must demonstrate knowledge about established and evolving
biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the
application of this knowledge to patient care.

Among other things, residents are expected to:
   LSUHSC Emergency Medicine Residency Handbook 10-11                                          9




         a. Identify life threatening conditions, the most likely diagnosis, synthesize acquired
             patient data, and identify how and when to access current medical information.
         b. Properly sequence critical actions for patient care and generate a differential
             diagnosis for an undifferentiated patient.
         c. Complete disposition of patients using available resources.
Residency Experience: each clinical rotation, every off site ED rotation, didactic/lecture sessions,
skill labs, simulation labs, US, Tox, all orientations, teaching ACLS/PALS/ATLS and freshman
anatomy labs.
Residency Assessments: National In-service Exam, Quarterly local in-service exams, Quarterly
question sets, Daily, Monthly and Yearly evaluations, 360 evaluations, oral board cases,
simulation cases and journal club.

3. Practice-Based Learning: Residents must be able to investigate and evaluate their patient
care practices, appraise and assimilate scientific evidence and improve their patient care
practices.

Among other things, residents are expected to:

   a. Analyze and assess their practice experience and perform practice-based improvement.
   b. Locate, appraise and utilize scientific evidence related to their patient’s health problems.
   c. Apply knowledge of study design and statistical methods to critically appraise the
      medical literature.
   d. Utilize information technology to enhance their education and improve patient care.
   e. Facilitate the learning of students and other health care professionals.

Residency Experience: each clinical rotation, every off site ED rotation, didactic/lecture sessions,
skill labs, simulation labs, US, Tox, all orientations, journal club, teaching ACLS/PALS/ATLS
and freshman anatomy labs.

Residency Assessments: Daily, Monthly and Yearly evaluation, 360 evaluations, oral board
cases, simulation cases, journal club, Trauma Conference, Toxicology rotation, RSI forms, End
of Year evaluations and Ultrasound QA.

4. Interpersonal and Communication Skills: Residents must be able to demonstrate
interpersonal and communication skills that result in effective information exchange and teaming
with patients, their families and professional associates.

Among other things, residents are expected to:

   a. Develop an effective therapeutic relationship with patients and their families, with respect
      for diversity and cultural, ethnic, spiritual. Emotional and age-specific differences.
   b. Demonstrate effective participation in and leadership of the health care team.
   c. Develop effective written communication skills.
   d. Demonstrate the ability to handle situations unique to the practice of emergency
      medicine.
   LSUHSC Emergency Medicine Residency Handbook 10-11                                           10




   e. Effectively communicate with out-of-hospital personnel as well as non-medical
      personnel.


Residency Experience: each clinical rotation, every off site ED rotation, didactic/lecture sessions,
skill labs, simulation labs, US, Tox, all orientations, bedside teaching, teaching
ACLS/PALS/ATLS and teaching freshman anatomy labs.

Residency Assessments: Daily, Monthly, Yearly evaluation, 360 evaluations, oral board cases
and simulation cases.

5. Professionalism: Residents must demonstrate a commitment to carrying out professional
responsibilities, adherence to ethical principles and sensitivity to a diverse patient population.

Residents are expected to demonstrate a set of model behaviors that include but are not limited
to:

   a.   Treats patients/family/staff/paraprofessional personnel with respect.
   b.   Protects staff/family/patient’s interests/confidentiality.
   c.   Demonstrates sensitivity to patient’s pain, emotional state and gender/ethnicity issues.
   d.   Able to discuss death honestly, sensitivity, patiently and compassionately.
   e.   Unconditional positive regard for the patient, family, staff and consultants.
   f.   Accepts responsibility/accountability.
   g.   Openness and responsiveness to the comments of other team members, patients, families
        and peers.

Residency Experience: each clinical rotation, every off site ED rotation, didactic/lecture sessions,
skill labs, simulation labs, US, Tox, all orientations, death notification, cultural competency, pain
management, conflict resolution, AMA, teaching ACLS, PALS and ATLS.

Residency Assessments: Daily, Monthly, yearly evaluations, 360 evaluations, oral board cases
and simulation cases.

6. Systems-Based Practice: Residents must demonstrate an awareness of and responsiveness to
the larger context and system of health care and the ability to effectively call on system resources
to provide care that is of optimal value.

Among other things, residents are expected to:

   a. Understand access, appropriately utilize and evaluate the effectiveness of the resources,
      providers and systems necessary to provide optimal emergency care.
   b. Understand different medical practice models and delivery systems and how to best
      utilize them to care of the individual patient.
   c. Practice cost-effective health care and resource allocation that does not compromise
      quality of care.
   d. Advocate for facilitates patients’ advancement through the health care system.
   LSUHSC Emergency Medicine Residency Handbook 10-11                                         11




Residency Experience: each clinical rotation, every off site ED rotation, didactic/lecture sessions,
skill labs, simulation labs, US, Tox, all orientations, Disaster Drills, Hazmat, EMS, chart/EMS
run report reviews, patient follow ups and CQI project (RSI sheets, radiology call backs and M &
M)

Residency Assessments: Daily, Monthly, Yearly evaluations, 360 evaluations, oral board cases,
simulation cases, Toxicology rotation, M & M and interesting case conference
    LSUHSC Emergency Medicine Residency Handbook 10-11                                          12




                        Resident Duty Hours and the Working Environment
                                      (update ACGME 2003)

Providing residents with a sound academic and clinical education must be carefully planned and
balanced with concerns for patient safety and resident well-being. Each program must ensure that
the learning objectives of the program are not compromised by excessive reliance on residents to
fulfill service obligations. Didactic and clinical education must have priority in the allotment of
residents’ time and energies. Duty hour assignments must recognize that faculty and residents
collectively have responsibility for the safety and welfare of patients.
1. Supervision of Residents
        a. All patient care must be supervised by qualified faculty. The program director must
           ensure, direct, and document adequate supervision of residents at all times. Residents
           must be provided with rapid, reliable systems for communicating with supervising
           faculty
        b. Faculty schedules must be structured to provide residents with continuous supervision
           and consultation.
        c. Faculty and residents must be educated to recognize the signs of fatigue and adopt
           and apply policies to prevent and counteract the potential negative effects.
2. Duty Hours
        a. Duty hours are defined as all clinical and academic activities related to the residency
           program, ie, patient care (both inpatient and outpatient), administrative duties related
           to patient care, the provision for transfer of patient care, time spent in-house during
           call activities, and scheduled academic activities such as conferences. Duty hours do
           not include reading and preparation time spent away from the duty site.
        b. Duty hours must be limited to 80 hours per week, averaged over a four-week period,
           inclusive of all in-house call activities.
        c. Residents must be provided with 1 day in 7 free from all educational and clinical
           responsibilities, averaged over a 4-week period, inclusive of call. One day is defined
           as one continuous 24-hour period free from all clinical, educational, and
           administrative activities.
        d. Adequate time for rest and personal activities must be provided. This should consist
           of a 10 hour time period provided between all daily duty periods and after in-house
           call.
3. On-Call Activities
        The objective of on-call activities is to provide residents with continuity of patient care
        experiences throughout a 24-hour period. In-house call is defined as those duty hours
        beyond the normal work day when residents are required to be immediately available in
        the assigned institution.
        a. In-house call must occur no more frequently than every third night, averaged over a
            four-week period.
        b. Continuous on-site duty, including in-house call, must not exceed 24 consecutive
            hours. Residents may remain on duty for up to six additional hours to participate in
            didactic activities, transfer care of patients, conduct outpatient clinics, and maintain
            continuity of medical and surgical care as defined in Specialty and Subspecialty
            Program Requirements.
   LSUHSC Emergency Medicine Residency Handbook 10-11                                        13




       c. No new patients, as defined in Specialty and Subspecialty Program Requirements,
          may be accepted after 24 hours of continuous duty.
       d. At-home call (pager call) is defined as call taken from outside the assigned institution.
          1. The frequency of at-home call is not subject to the every third night limitation.
             However, at-home call must not be so frequent as to preclude rest and reasonable
             personal time for each resident. Residents taking at-home call must be provided
             with 1 day in 7 completely free from all educational and clinical responsibilities,
             averaged over a 4-week period.
          2. When residents are called into the hospital from home, the hours residents spend
             in-house are counted toward the 80-hour limit.
          3. The program director and the faculty must monitor the demands of at-home call in
             their programs and make scheduling adjustments as necessary to mitigate
             excessive service demands and/or fatigue.
4. Moonlighting
       a. Because residency education is a full-time endeavor, the program director must
          ensure that moonlighting does not interfere with the ability of the resident to achieve
          the goals and objectives of the educational program.
       b. The program director must comply with the sponsoring institution’s written policies
          and procedures regarding moonlighting, in compliance with the Institutional
          Requirements III. D.1.k.
       c. Moonlighting that occurs within the residency program and/or the sponsoring
          institution or the non-hospital sponsor’s primary clinical site(s), ie, internal
          moonlighting, must be counted toward the 80-hour weekly limit on duty hours.
5. Oversight
       a. Each program must have written policies and procedures consistent with the
          Institutional and Program Requirements for resident duty hours and the working
          environment. These policies must be distributed to the residents and the faculty.
          Monitoring of duty hours is required with frequency sufficient to ensure an
          appropriate balance between education and service.
       b. Back-up support systems must be provided when patient care responsibilities are
          unusually difficult or prolonged, or if unexpected circumstances create resident
          fatigue sufficient to jeopardize patient care.
6. Duty Hours Exception
       An RRC may grant exceptions for up to 10 % of the 80-hour limit, to individual
       programs based on a sound educational rationale. However, prior permission of the
       institution’s GMEC is required.

h:teamstoll\acgme\dutyhourslanguage.wpd February 24, 2003
    LSUHSC Emergency Medicine Residency Handbook 10-11                                                         14




                                   Duty Hours - Emergency Medicine
                                       Update April, 2004 ACGME

The common duty hour standards include these provisions:
         • An 80-hour weekly limit, averaged over four weeks.
         • An adequate rest period, which should consist of 10 hours of rest between duty
         periods.
         • A 24-hour limit on continuous duty, with up to six added hours for continuity of care
         and education.
         • One day in seven free from patient care and educational obligations, averaged over
         four weeks.
         • In-house call no more than once every three nights, averaged over four weeks.
         • Programs can request an increase of up to 8 hours in the weekly hours, if this benefits
         resident education and is approved by the sponsoring institution and the ACGME
         residency review committee for the particular specialty.


Duty Hours on Emergency Medicine Rotations

―There must at least an equivalent period of continuous time off between scheduled work periods. Residents may
attend educational activities between work periods, but at some point in the 24 hour period must have an equivalent
period of continuous time off between the end of one activity (work or educational) and the start of another activity
(work or educational).‖ ACGME 2007

As a minimum, residents shall be allowed 1 full day in 7 days away from the institution and free of any
clinical or academic responsibilities. While on duty in the emergency department, residents may not work
longer than 12 continuous hours providing direct patient care. There must be at least 10 hours off between
scheduled work periods. The residents should not work more than 60 scheduled hours per week seeing
patients in the emergency department and no more than 72 duty hours per week including residency
related activities.
   LSUHSC Emergency Medicine Residency Handbook 10-11                                           15




  POLICIES - LSUHSC

                    Ethics Code - LSUHSC Emergency Medicine Residency

I agree to abide by the moral standards and ethical behavior deemed suitable for a training
physician in emergency medicine. I will not copy or relay exam materials for other's benefit. I
will present all patient cases and patient exams in a truthful manner, to the best of my knowledge
and capabilities. I will not condone patient, student, or House Officer abuse or degradation.


I have reviewed with the Residency Director, the LSU Emergency Medicine Residency Program
Policy Manual and I understand its contents.




___________________________________________________
NAME
(Print clearly)


___________________________________________________
DATE




___________________________________________________
Signature
    LSUHSC Emergency Medicine Residency Handbook 10-11                                               16




Code Of Professional Conduct


        The residents and faculty of the section of emergency medicine are expected to maintain
the level of professionalism dictated by the School of Medicine's Code of Professional Conduct.

                                              PREAMBLE

        The academic community of the School of Medicine is committed to maintaining an
environment of open and honest intellectual inquiry. Faculty, residents, and students have the
right to enjoy an educational environment characterized by the highest standards of ethical
professional conduct. The individuals who comprise the LSUMC campus come from many
different cultural backgrounds. Discriminatory comments or actions relative to gender, sexual
orientation, racial origin, creed, age, physical or mental status can interfere with an individual's
performance and create an intimidating, hostile, and offensive educational and work
environment. Individuals who manifest such unprofessional behavior in any of these areas are
disruptive and in violation of the School of Medicine's Code of Professional Conduct and of
LSU Medical Center Policy. Report of such conduct will be reviewed by the Council on
Professional Conduct according to the "Rules of Procedure" set forth in the Code.

The students, residents, and faculty share the responsibility, to themselves and to their
colleagues, to protect their individual rights and those of the academic community as a whole. To
this end, and to ensure the rights of due process to members of the academic community, the
students, residents, and faculty of the School of Medicine have adopted this Code of Professional
Conduct. This Code governs questions of professional conduct, including but not limited to,
dishonest, disruptive, discriminatory, and illegal activities. Penalty for such misconduct could
lead to dismissal from the LSU School of Medicine.

Honor Code

On my honor, I will uphold the ideals of the medical profession and protect the name of the LSU School of
 Medicine for the duration of my career. Continuing its tradition of excellence, I vow to leave the school
                      better than it was left to me and expect others to do the same.

Mission Statement
Through an Honor Code, the students of the LSU School of Medicine affirm their adherence to several
basic principles. As students at an institution of professional education and members of the medical
community, we seek to promote a mutual trust and honor between faculty, students, and staff. As future
physicians, we must maintain our educational pursuit at a level consistent with the integrity of our chosen
profession. We believe that ethics, social responsibility, and academic integrity are an essential part of
our experience as medical students in a diverse community that encompasses a wealth of people and
their experiences. Violation of these basic principles will be considered an Honor Offense. An Honor
Offense is not limited to, but includes:

            1. Dishonesty on an examination or assignment through the use of outside materials;
               receiving or giving unauthorized aid on an examination or assignment
            2. Plagiarism
            3. Theft of property, either intellectual or physical
    LSUHSC Emergency Medicine Residency Handbook 10-11                                                            17




              4. Conduct deliberately hindering the education of other students
              5. Illegal, unprofessional, or inappropriate behavior when representing the LSU School of
                 Medicine at outlying facilities or on the campus of LSUHSC

Any offense of the Honor Code can be reported to the Committee on Professional Conduct by faculty,
students, or staff. The Committee on Professional Conduct is composed of students and faculty members
of the School of Medicine. Failure to report a potential offense, while in itself not an Honor Offense,
violates the spirit of the system. Report of such offenses will be reviewed by the Council on Professional
Conduct according to the "Rules on Procedure" set forth in the Code of Professional Conduct.
Recommendations made by the Committee on Professional Conduct range from a formal apology to
dismissal from the School of Medicine. Each student will be required to read and sign a copy of the Honor
Code at the beginning of the academic year prior to the completion of registration.




The Pledge

The pledge, to be signed by students on all examinations and assignments, is as follows:

  I pledge, on my honor, as a member of the medical community, to uphold the Honor Code of the LSU
                                         School of Medicine.

Confidentiality

Every effort will be made to maintain the confidentiality of all parties involved in an investigation and/or trial of an
Honor Code offense. Anyone found to be in violation of confidentiality shall themselves be brought before the
Committee and tried accordingly.

Amendments
This document can be amended by a two-thirds vote of the Student Government Association and
a majority vote of the Student body.



Grievance Policy - Academic

Questions of academic grievances are addressed through procedures established specifically for that purpose.

Resolving allegations of unethical professional conduct: rules of procedure

1. Composition of the Council on Professional Conduct.

Initial review of an allegation of unethical professional conduct is the responsibility of the Council on Professional
Conduct This Council consists of twenty-seven active Representatives. The Student Body is represented by twelve
Council Representatives; each class elects three Representatives from its general membership. The Faculty is
represented by five Representatives from the Basic Science Departments and five Representatives from the Clinical
Science Departments, elected by the Faculty Assembly from the general full-time faculty, Resident representatives
are recommended by the Chairman of each of the Departments of Medicine, OB-GYN, Psychiatry, Pediatrics and
Surgery and appointed by the Dean of the School of Medicine. Chairmanship of the Council is shared by one student
and one faculty Representative, elected by the twenty seven Council Representatives from their own members. In
the event that a Co-Chairman is unable to serve, the vacancy shall be filled by an individual selected from the pool
    LSUHSC Emergency Medicine Residency Handbook 10-11                                                            18




of remaining Committee Representatives by majority vote. The Council maintains its right to nominate additional
members to the Council if the need arises.

Student Representatives are elected during regular class elections in October of their freshman year with expectation
that their tenure is for duration of their enrollment in LSUMC's School of Medicine.

Resident Representatives are appointed for the duration of their residency.

Faculty Representatives are elected for an indeterminate number of years.

2 Filing a Complaint:

a. Initiation of Complaint.

A student (with or without the input of the Student Advocacy Group), resident, or faculty member may initiate a
complaint of unethical professional conduct against a student or resident by submitting an allegation in writing to
any member of the Council on Professional Conduct, including a Co-Chairman. The written statement must include
a description of the circumstances that gave rise to the charges and must be signed by the author(s).

If the written allegation is submitted to a Council member who is not a CoChairman, the Council member shall
deliver the allegation to a Co-Chairman of the Council, who in turn shall arrange for investigation of the facts and
circumstances of the cases.

b. Deadline for Filing a Complaint

A complaint by a student (with or without the input of the Student Advocacy Group), resident, or faculty member
alleging-unethical professional conduct by a student or resident must be submitted in writing to a Council member,
including a Co-Chairman, within fifteen working days of the alleged unethical professional conduct.

c. Confidentiality of Person Initiating Complaint

Because of the gravity of any allegation of unethical professional conduct, the identity of the author of a complaint
shall be held in confidence throughout the investigation; however, a witness's identity may become known during a
final hearing.

d. Interim grade

If a complaint of cheating is filed against a student or resident, that student or resident shall be assigned a grade of
"incomplete" for the work in question during the investigation of the complaint. A student or resident subsequently
found innocent of the complaint will be evaluated for a final grade on the basis of his/her performance.

3. Investigation of Complaint and Determination of Sufficient Cause:

A written allegation of unethical professional conduct is submitted to a Council member, or to one of the Co-
Chairmen. The Co-Chairman shall arrange for a preliminary investigation. One faculty Representative to the
Council is selected by the Co-Chairmen of the Council to assist in the preliminary investigation. In the case of an
allegation against a student, the President of the Student Body will act as primary Fact Finder. In the case of an
allegation against a resident, a Fact Finder will be appointed from among the LSU residents at large.

Investigation of an allegation of unethical professional conduct is conducted in confidence. The purpose of the
investigation is to determine all possible evidence, both tangible and testimonial, that bears on the allegation of
unethical professional conduct. Inquiries by the Student Body President or Resident Representative (i.e. the Fact
Finder) and the faculty Representative are strictly confidential, as is the information amassed during the course of
the investigation, and the identity of the person who submits the complaint.
    LSUHSC Emergency Medicine Residency Handbook 10-11                                                           19




The period of investigation is limited to five working days. During the period allotted for the investigation, the Co-
Chairmen of the Council select three members of the Council to serve as an ad hoc panel for determination of
sufficient cause for convening a formal hearing of the Council. The members of the ad hoc panel are excluded from
further deliberations on that particular case.

The Fact Finder presents the results of the investigation to the ad hoc panel. If the panel determines that there is
sufficient cause for convening the Council, a formal hearing of the Council is scheduled. If the panel determines that
there is insufficient cause for convening the Council, all charges are dismissed and all proceedings cease
immediately. Although the circumstances constituting sufficient cause necessarily will vary from case to case, the
statement of one person, with no other corroborating witness or corroborating tangible evidence, shall not be
considered sufficient cause.

If the ad hoc panel makes a preliminary determination of sufficient cause, the panel shall formulate the formal
charges against the accused in writing, and shall set forth the witnesses to be called and the tangible evidence to be
presented against or for the accused. The identity of any person filing an allegation shall remain confidential,
although such person shall be listed as a witness.

The Fact Finder shall present the case to the Council. Presentation of the case includes introducing tangible evidence
and calling witnesses against or for the accused.

4 Formal Hearing: Council on Professional Conduct

a. Notification to Council and Parties.

The Co-Chairmen of the Council shall give written notification to the Council members, the accused, and the Fact
Finder: 1) the determination of a possible breach of ethical professional conduct, and 2) the designated time and
place for the formal hearing of the case. This notification, together with the formal charge and a list of the witnesses
and evidence in support of the charge, must be distributed to' the above-named persons within two days of the
determination of sufficient cause. The Fact Finder shall notify the named witnesses of the designated time and place
for the formal hearing.

b. Hearing Procedure.

The hearing by the Council shall be conducted within five working days after the accused receives written notice of
the formal charge against him/her. An extension of up to five working days may be requested by the accused under
special circumstances; granting this request is within the discretion of the Co-Chairmen of the Council. In any event,
the hearing must be convened within ten working days of written notification to the accused. Persons who must be
Present for the formal Council hearing include: eight participating members of the Council (four faculty members
and four additional Council members chosen from students and/or residents, reflecting those involved in the case),
the designated witnesses against the accused, and the Fact Finder. The accused may present additional witnesses or
other evidence in his or her behalf. The accused has the option of being accompanied during the hearing by any one
member of the Medical Center community. This person accompanying the accused may be present as an advisor but
may not address the Council. Each witness will be present only during the time devoted to his or her own testimony.
The evidence and personal testimony supporting the allegations are presented to the Council by or at the request and
direction of the Fact Finder. Thereafter, the accused presents his or her own defense and offers testimony of persons
who support his or her defense.
During the presentation of evidence and personal testimony, members of the Council may ask questions at any time.
Following the presentation of evidence and personal testimony, the Fact Finder followed by the accused may
summarize their positions orally; these final presentations are not interrupted by questioning.

The Co-Chairmen shall control the proceedings and are charged with conducting a hearing that is both thorough and
fair for all parties. The Co-Chairmen may limit duplicative testimony. The hearing is intended to allow informal but
complete presentation of all relevant information.
     LSUHSC Emergency Medicine Residency Handbook 10-11                                                          20




The proceedings of the Council are confidential. An appointed secretary shall take and transcribe written notes of
the proceedings, which are maintained in confidence by the Co-Chairmen. No tape recorders are permitted at any
hearing of the Council.

c.Recommendation of the Council.

Following the presentation of all evidence and testimony, the Council shall deliberate privately and determine,
within two working days, the recommendation to be submitted to the Dean of the School of Medicine. The Co-
Chairmen of the Council shall submit the written recommendation of the Council, the basis for its recommendation,
and a transcript of the notes of the proceedings, to the Dean and the accused within two working days of the
Council's decision as to a recommendation.

Any member of the Council who dissents from the recommendation of the Council may submit the reasons for his or
her dissent in writing at the time that the recommendation of the Council is submitted to the Dean and the accused.

5.Initial decision: Dean. School of Medicine

The Dean must act upon the recommendation of the Council within five working days of receiving the
recommendation. The Dean may accept or reject the recommendation of the Council, in whole or in part, or may
remand the matter to the Council for further fact-finding, including additional testimony if appropriate. If additional
fact-finding is requested by the Dean, such fact-finding, including additional testimony, shall be taken and a
recommendation issued in accordance with procedures and time limits previously set forth.

The decision of the Dean must be communicated promptly to the accused and the Co-Chairmen of the Council.

6.Appeal: Appeals Committee

a. Notification of Appeal

The accused may appeal the decision of the Dean of the School of Medicine as a matter of right. If the accused
wishes to appeal, he or she must notify the Dean of his or her request for appellate review within five working days
of receiving the decision of the
Dean of the School of Medicine. The Dean must convene the Appeals Committee within five working days of
receiving the request for appellate review.

b.       Composition of Appeals Committee

Appellate review of the Dean's initial decision is the responsibility of the Appeals Committee. This Committee
consists of sic members. In the case of an appeal arising from an allegation against a medical student the Student
Body is represented by the presidents of the sophomore, junior, and senior classes. In the case of an appeal arising
from an allegation against a resident, he or she will be represented be three residents chosen at large by the Council.
The Faculty is represented by one Representative chosen by the party asserting the appeal, one Representative
chosen by the Dean of the School of Medicine, and one Representative chosen by the five members designated
above. This sixth member is the Chairman of the Appeals Committee.

c.       Appeal Procedure.

The task of the Appeals Committee is to review the initial decision of the Dean on the proceedings and
recommendations of the Council of Professional Conduct. The Appeals Committee reviews the transcript of the
Council proceedings and may hear further arguments by the parties. However, the Appeals Committee is prohibited
from soliciting or considering any new evidence. Any new evidence would be referred to the Council on
Professional Conduct.
The proceedings of the Appeals Committee are confidential. Written notes of the proceedings are transcribed by an
appointed secretary and are maintained in confidence by the Chairman. No tape recorders are permitted at any
hearing of the Appeals Committee.
    LSUHSC Emergency Medicine Residency Handbook 10-11                                                      21




d. Recommendation of the Appeals Committee.

After reviewing the transcript and hearing arguments, if appropriate, the Appeals Committee deliberates privately
and determines, within two working days, the recommendation to be submitted to the Dean of the School of
Medicine. The Chairman of the Committee shall submit the written recommendation of the Committee, the basis for
its recommendation, and a transcript of the notes of the proceedings, to the Dean within two working days of the
Committee's decision.
A member of the Appeals Committee who dissents from the recommendation of the Committee may submit the
reasons for his or her dissent in writing at the time the recommendation of the Committee is submitted to the Dean.

7. Final Disposition: Dean, School of Medicine

The Dean must render a decision within five working days of receiving the recommendation of the Appeals
Committee. This decision must be communicated promptly to the accused, the Chairman of the Appeals Committee,
and the Co-Chairmen of the Council on Professional Conduct.
The disposition of the case by the Dean of the School of Medicine after appeal is final.
If a student is exonerated of all charges, all written records of the proceedings of the Council on Professional
Conduct and the Appeals Committee, if applicable, are destroyed. If a student is not exonerated of all charges, all
written records of the proceedings of the Council and the Appeals Committee will be maintained in confidence by
the Associate Dean for Student Affairs and Records for five years after final disposition of the case.




Ombudsman

The ombudsman for LSU house officers is Dr. Thomas Alchidiak. He is an unbiased liaison who
will confidentially discuss any issues you have concerning academic grievances. His contact
information is:

Thomas Alchediak, M.D.
Director of Medical Staff Affairs and GME, MCLNO
Cell: 504-669-6822
talche@lsuhsc.edu
   LSUHSC Emergency Medicine Residency Handbook 10-11                                                          22




MCLNO Quality of care statement



                         MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS
                           The Medical Center of Louisiana at New Orleans


        Employees and affiliates of the Medical Center of Louisiana at New Orleans (MCLNO)
make a difference in the lives of thousands of patients on a daily basis. Each MCLNO
employee, physician, student, contract worker, and volunteer is expected to provide quality
patient care services in a safe, courteous, and professional manner.

         If you identify any quality of care or safety issues please report them to management
and/or administrative representatives so that they can be addressed immediately. I ask that you
allow the MCLNO management and administrative staff the opportunity to address/resolve
quality of care or safety issues within the organization, but you may also report your findings to
the following agencies:

                                         Louisiana State University
                                        Health Care Services Division
                                          (888) 652-7699 (toll free)

                                           State of Louisiana
                                    Department of Health and Hospitals
                                            (866) 280-7737

                                                  Joint Commission
                                                   (800) 994-6610
                                                   www.icaho.orq

Disciplinary actions will not be taken against employees, physicians, students, contract
workers, and volunteers who report safety and/or quality of care concerns.


Dwayne Thomas
Chief Executive Officer
2/28/2008
               MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS. 2021 PERDIDO STREET. NEW ORLEANS, LOUISIANA 70112
                                PHONE: 504.903.3000. FAX: 504.903.2837. WWW.LSUHOSPITALS.ORG
    LSUHSC Emergency Medicine Residency Handbook 10-11                                               23




                                   Job Description - EM House Officer


       All house officers enrolled in the LSUHSC Emergency Medicine Residency training program
        function under the direct supervision of Emergency Medicine board certified faculty physicians.
       Emergency Department attendings are ultimately responsible for supervision of the House Staff
        while they are performing clinical activities as part of their Graduate Medical Education.

House Officer I
         The intern will spend approximately 3 months at University/MCLANO ED, 1 month in Ochsner’s
ED and one month in the Ped ED at West Jefferson during the first clinical year. The intern is expected to
evaluate and manage patients presenting to the emergency department under the direct supervision of the
emergency medicine (EM) faculty and senior resident. All patients should be discussed with the
supervising physician and/or senior resident before any treatment or tests are ordered, unless patient care
is in jeopardy. The intern should focus on the fundamentals of emergency care including performing a
focused history and physical, and developing an appropriate differential diagnosis and basic treatment
plan.

       Patient care and management within the Emergency Department include the following procedures
        with indirect faculty supervision or upper level resident supervision: venous and arterial blood
        sampling, venous cannulation, nasogastric tube placement, splinting of extremities, simple
        laceration repair, incision and drainage of subcutaneous abscess, foley catheterization, extremity
        anesthesia, local anesthesia, slit lamp operation, and supervision of medical students.
       Additionally, first year house officers may perform and interpret waived tests which include
        vaginal wet preps, microscopic urinalysis, urine pregnancy tests, interpretation of stool for occult
        blood, and rapid Strep tests.
       The following procedures may only be performed under direct faculty supervision: endotracheal
        intubation, tube thoracostomy, paracentesis, thoracentesis, central line placement, pulmonary
        artery catheterization, arthrocentesis of the knee, arthrocentesis of the shoulder/wrist/ankle,
        transthoracic pacing, transvenous pacing, electronic defibrillation, major trauma resuscitations,
        major medical resuscitations, relocation of joint dislocations, sexual assault exams, conscious
        sedation, vaginal deliveries, on line medical control, and cricothyroidotomy.
       During their first year of training, house officers complete rotations in the emergency department,
        medicine wards, surgical wards, anesthesia, OBGYN, medical intensive care units, and
        community emergency departments.

House Officer II
         The resident will spend approximately 7 months in the emergency department at UH/MCLANO,
1 month at either West Jefferson or Ochsner and 1 month in the Peds ER at OLOL. The second year
resident is expected to evaluate and manage patients presenting to the emergency department under the
direct supervision of the emergency medicine faculty and/or senior resident. The second year resident will
have more responsibility and autonomy in the ED after successful completion of their internship, and is
expected to learn how to function as a charge resident. Second year residents will be able to initiate
management and treatment decisions before their initial discussions with their supervising physicians.
The second year resident is expected to manage multiple patients of varying different acuity levels thus
learning appropriate organizational and patient flow skills. The second year resident is expected to
recognize and stabilize unstable ED patients especially arriving by ambulance. They will also participate
in the management of the airway on trauma, medical and pediatric code patients, and act as the team
    LSUHSC Emergency Medicine Residency Handbook 10-11                                                 24




leader of trauma codes. The second year resident will be expected to provide appropriate on-line medical
command for ground EMS units.

       At the House Officer II level, the resident functions as a junior charge resident. The resident
        continues to have primary patient care responsibilities of the House Officer I, but also assists the
        upper-level charge residents in the management and supervision of interns and medical students
        and leading rounds in the Emergency Department.
       Responsibility for on-line medical control for local EMS services begins during the second year
        of training.
       The following procedures may be performed with faculty supervision: rapid sequence induction
        and endotracheal intubation with sedatives and paralytic agents, conscious sedation, tube
        thoracostomy, cricothyroidotomy.
       During their second year of training, house officers rotate in the ED and with EMS services as
        well as at Children’s Hospital in the pediatric ED.

House Officer III
The resident will spend a approximately 7 months in the ED at UH/MCLANO, one month at
either West Jefferson or Ochsner, and one month in the Pediatric ED at Children’s Hospital.
Third year resident will have more responsibility and autonomy than the second year resident in patient
care decision making. The resident is still responsible for involving the ED attending physician as early as
possible during the patient’s care. The Third year resident is expected to supervise junior level housestaff
and medical students rotating in the emergency department. The third year resident will be expected to
provide appropriate on-line medical command for ground EMS units.

       Graded responsibilities increase in the third year of training. The resident continues to have
        primary patient care responsibilities, but assumes the role of the upper-level charge resident, in
        managing patient through-put in the ED.
       The upper-level charge resident responsibilities include online medical control of ems, working
        knowledge of all patients in the ED, including those awaiting a bed in the Main ER, leading
        rounds, and supervising junior charge residents, interns and medical students in the ED.
       Patient care and management within the Emergency Department to include all of the procedures
        granted to a House Officer Two including the supervision of lower level residents.
       During their third year of training, house officers complete a rotation in MICU.

House Officer IV
The resident will spend approximately 4 months in the ED at UH/MCLANO, one month at either
West Jefferson or Ochsner, and one month in the Pediatric ED at OLOL. Fourth year residents will
have more responsibility and autonomy management and patient flow in the emergency department. The
resident is still responsible for involving the ED attending physician as early as possible during the
patient’s care is expected to supervise junior level housestaff and medical students rotating in the
emergency department. The fourth year resident will be expected to provide appropriate on-line medical
command for ground EMS units.
       Patient care and management within the Emergency Department to include all of the
        procedures granted to a House Officer Three including the supervision of lower level
        residents. During their second year of training, house officers complete rotations on
        toxicology, and the emergency department.
       During the PGY4 year residents are strongly encouraged to commit their elective time to
        a focused area of expertise with a goal of developing a niche in the arena of Emergency
        Medicine.
    LSUHSC Emergency Medicine Residency Handbook 10-11                                                               25




                                       HOUSE OFFICER CONTRACT

                                       2007-2008
                       HOUSE OFFICER AGREEMENT OF APPOINTMENT

                                        BETWEEN (print or type name)

               __________________________________________________________
                                          AND

            BOARD OF SUPERVISORS OF LOUISIANA STATE UNIVERSITY AND
                   AGRICULTURAL AND MECHANICAL COLLEGE
(Hereinafter referred to as ―University‖), herein represented by Charles Hilton, M.D., Associate Dean of Academic Affairs,
Louisiana State University School of Medicine in New Orleans, __________________Head, Department of
_________________, Louisiana State University School of Medicine in New Orleans, and _________________, Program
Director of the ______________ Program in the Department of _______________, Louisiana State University School of
Medicine in New Orleans.

This Agreement of Appointment shall be for one training year effective (date) __________________ and ending (date)
________________________ in the Program of ______________ through the Department of ______________.


DEFINITIONS:
      For purposes of this Agreement of Appointment, the following terms shall have the
meaning ascribed thereto unless otherwise clearly required by the context in which such term is
used:
House Officer – The term ―House Officer‖ shall mean and include interns, residents and fellows.
Program – The term ―Program‖ shall mean a Resident and Fellow Training Program of
University.
Program Director – The term ―Program Director‖ shall mean the University faculty physician
who shall be appointed by University to assume and discharge responsibility for the
administrative and supervisory services related to a Program for a Department at University, as
set forth in this Agreement of Appointment. One or more Program Directors may be appointed
with respect to each Program.
HOUSE OFFICER RESPONSIBILITIES: (Department specific responsibilities may be
appended to this document)
       House Officers are responsible for patient care, teaching, and scholarly activities as
discussed at orientation, detailed in the House Officer Manual, and specified in Departmental
Guidelines, which are available in House Officers’ Department’s Office. Specific daily
responsibilities will be assigned to House Officers on the call schedule and in day-to-day work
team meetings.
    LSUHSC Emergency Medicine Residency Handbook 10-11                                                          26




         The position of House Officer involves a combination of supervised, progressively more
complex and independent patient evaluation and management functions and formal educational
activities. The Department on a regular basis will evaluate the competence of Officers and
confidential records of the evaluations will be maintained as departmental property to which
House Officers have access.

       House Officers shall provide patient care commensurate with their level of advancement;
competence and privileges, under the supervision of appropriately credentialed attending
teaching staff. House Officers’ general obligations include:

   Providing safe, effective and compassionate patient care.
   Documentation of care by appropriate and prompt maintenance of medical records, orders, and notes.
   Developing and understanding of ethical, socioeconomic and medical/legal issues, and cost containment
    measures in the provision of patient care.
   Participation in the educational activities of the training program and assumption of responsibility for teaching
    and supervising other residents and students.
   Participation in institutional orientation and education programs and other activities involving the clinical staff.
   Participation in institutional committees and councils to which House Officers are appointed and invited.
   Performance of these duties in accordance with the established practices, procedures and policies of the
    University, its programs and clinical departments, and those of other hospitals or institutions to which the House
    Officer is assigned.
   Meeting and maintaining Louisiana State Board of Medical Examiners requirements for a permit for physicians
    in training or unrestricted medical licensure.



FACULTY RESPONSIBILITES

       The supervising faculty as appointed by the department of will be responsible for
providing adequate supervision of the house officer during the course of their educational
experience while rotating at all training sites as embodied by both LSU School of Medicine
House Staff Policy and Procedure Manual, and affiliating entity department’s staff policies.
Residents will be expected to be supervised in all their activities commensurate with the
complexity of care being given and the residents own abilities and experience.

COMPENSATION:

        For and in consideration of services rendered under this Agreement of Appointment,
compensation will be provided in accordance with the pay scale determined by the managing
entity of the Louisiana Public Hospital System.

        For a House Officer (level) ____________, the salary will be $_______________ for
fiscal year beginning ________.

       Availability of housing, meals, lab coats, etc. will vary among the hospitals to which
House Officers are assigned. House Officer work hours vary within acceptable ranges
determined by House Officer Program. House Officers are paid every two weeks, calculated
from the above salary expressed as hourly pay for a 7-day workweek of 8 hours per day.
 INSURANCE:
   LSUHSC Emergency Medicine Residency Handbook 10-11                                          27




        Health Plans: House Officers are eligible for the same health insurance/HMO plans as
those for state employees or for Health Science Center students. Other health insurance may be
chosen if desired and paid for by House Officers. As a condition of employment, House Officers
agree to maintain one of these health plans or another plan with equal or better benefits.

        Disability Insurance: The Graduate Medical Education Office provides Long-term basic
disability

        Medical Practice Liability Coverage: House Officers providing services pursuant to this
Agreement of Appointment are provided professional liability coverage in accordance with the
provisions of Louisiana Revised Statutes 40:1299.39 et seq. House Officers assigned as part of
their prescribed training under this Agreement of Appointment to facilities outside the state of
Louisiana must provide additional professional liability coverage with indemnity limits set by the
House Officer Program. House Officers while engaged in activities outside the scope of the
House Officer program, are not provided professional liability coverage under LSA-R.S.
40:1299.39, unless said services are performed at Louisiana public health care facilities.

LEAVE:

        Vacation Leave: House Officers are permitted 21 days (three 7 day weeks) of non-
cumulative paid vacation leave in the first year, and 28 days (four 7 day weeks) per year
thereafter, subject to Departmental policy. All vacation must be used in the year earned and may
not be carried forward. All vacation leave not used at the end of the calendar year is forfeited.

        Sick Leave: House Officers are permitted 14 days (two 7 day weeks) of non-cumulative
paid sick leave per year. Extended sick leave without pay is allowable, at the discretion of the
Department and in accordance with applicable law.

       Maternity/Paternity Leave: To receive paid maternity leave, House Officers must utilize
available vacation leave (up to 21 or 28 days depending on the House Officer level) plus
available sick leave (14 days), for a total of up to 42 days. Department Heads and/or Program
Directors may grant extended unpaid maternity leave as appropriate and in accordance with
applicable law. Paternity Leave: To receive paid paternity leave, House Officers must utilize
available vacation leave and may qualify for unpaid leave under applicable law. Under special
circumstances, extended leave may be granted at the discretion of the Department Head and/or
Program Director and in accordance with applicable law.

        Educational Leave: House Officers are permitted 5 (five) total days of educational leave
to attend or present at medical meetings.

        Military Leave: House Officers are entitled to a total of 15 (fifteen) days of paid military
leave for active duty. All military leave, whether paid or unpaid, will be granted in accordance
with applicable law.
        Leave of Absence: Leave of absence may be granted, subject to Program Director
approval and as may be required by applicable law, for illness extending beyond available sick
leave, academic remediation, licensing difficulties, family or personal emergencies. To the
   LSUHSC Emergency Medicine Residency Handbook 10-11                                        28




extent that a leave of absence exceeds available vacation and/or sick leave, it will be leave
without pay. Make up of missed training due to leave of absence is to be arranged with the
Program Director in accordance with the requirements of the Board of the affected specialty.
The Department and University reserve the right to determine what is necessary for each House
Officer for make-up including repeating any part of House Officer Program previously
completed.

        The Office of Graduate Medical Education must be notified of any sick leave extending
beyond two weeks. Weekends are included in all leave days. Each type of leave is monitored
and leave beyond permitted days will be without pay. Makeup of training time after extended
leave is at the discretion of the Department Head and/or Program Director and governed by
applicable law.

       Family Leave All House Officers who have worked for LSUHSC for twelve (12) months
and 1,250 hours in the previous twelve (12) months, may be eligible for up to twelve (12) weeks
of unpaid, job-protected leave in each twelve (12) month period, in accordance with the
requirements of the Family Medical Leave Act of 1993 (FMLA).




LSU HEALTH SCIENCE CENTER DRUG PREVENTION POLICY:
       The unlawful possession, use, manufacture, distribution or dispensation of illicit drugs or
alcohol on University property, in the work place of any employee or student of University, or as
any part of any functions or activities by any employee or student of University is prohibited.

        LSUHSC has adopted a pre-employment drug screening requirement and a drug and
substance abuse policy that includes provisions for employee drug-testing. Acceptance of this
offer constitutes acceptance of LSUHSC drug screening policy as a condition for employment
and adherence to all related institutional policies that may be implemented now or in the future.
This offer is contingent on satisfactory completion of a drug screen.


OUTSIDE ACTIVITIES (Moonlighting)

        Professional activity outside the scope of the House Officer Program, which includes
volunteer work or service in a clinical setting, or employment that is not required by the House
Officer Program (moonlighting) shall not interfere in any way with the responsibilities, duties
and assignments of the House Officer Program. Residents must not be required to moonlight. It
is within the sole discretion of each Department Head and/or Program Director to determine
whether outside activities interfere with the responsibilities, duties and assignments of the House
Officer Program. Before engaging in activity outside the scope of the House Officer Program,
House Officers must receive the approval of the Department Head and/or Program Director of
the nature, duration and location of the outside activity. Foreign Medical Graduates sponsored
for clinical training as a J-1 by ECFMG are not allowed to moonlight or perform activities
outside the clinical training program.
   LSUHSC Emergency Medicine Residency Handbook 10-11                                         29




OUT-OF-STATE SERVICE
        If rotating to an out-of –state institution, House Officers agree to follow the rules,
regulations, and/or by-laws of that institution. Educational objectives and the level of
compensation will be established between the institution and the appropriate Department Head.
Malpractice coverage must be arranged other than that provided by LSA-R.S. 40:1299.39.

SUPPORT SERVICES FOR HOUSE OFFICERS:
       Confidential counseling, medical and psychological support services are available
through the LSU School of Medicine Campus Assistance Program (―CAP‖) for the house officer
voluntarily seeking assistance.

PHYSICIAN IMPAIRMENT POLICY:
        House Officers who work at University are expected to report to work in a fit and safe
condition. A House Officers who is taking prescription medication(s) and/or who has an alcohol,
drug, psychiatric or medical condition(s) that could impair the House Officer’s ability to perform
in a safe manner must contact the Louisiana State Medical Society’s Physicians’ Health
Program, whose mission is to assist and advocate for physicians who are impaired or potentially
impaired as approved by the Louisiana State Board of Medical Examiners. If a House Officer
knows of a physician or colleague who House Officer reasonably believes may be impaired or
potentially impaired, House Officer may report that physician to the Physicians’ Health Program.
        A House Officer who is reasonably believed to be impaired or potentially impaired, but
refuses to avail him/herself of assistance shall be reported to the Campus Assistance Program
and/or the Physicians’ Health Program for evaluation.


CANCELLATION AND RENEWAL OF AGREEMENT OF APPOINTMENT
        House Officer Agreement of Appointments are valid for a specified period of time no
greater than twelve (12) months. During the term of this Agreement of Appointment, the House
Officer’s continued participation in the House Officer Program is expressly conditioned upon
satisfactory performance. This Agreement of Appointment may be terminated at any time for
cause.
Neither this Agreement of Appointment nor House Officer’s appointment hereunder constitute a
benefit, promise or other commitment that House Officer will be appointed for a period beyond
the term of this Agreement of Appointment. Promotion, reappointment and/or renewal of this
Agreement of Appointment is expressly contingent upon several factors, including, but not
limited to the following: (i) satisfactory completion of all training components; (ii) the
availability of a position; (iii) satisfactory performance evaluation; (iv) full compliance with the
terms of this Agreement of Appointment; (v) the continuation of University’s and House Officer
Programs’ accreditation by the Accreditation Council for Graduate Medical Education
(―ACGME‖); (vi) University’s financial ability; and (vii) furtherance of the House Officer’s
Program.
   LSUHSC Emergency Medicine Residency Handbook 10-11                                          30




Termination and non-renewal of this Agreement of Appointment shall be subject to appeal in
accordance with the provisions delineated in the House Officer Manual.


INSTITUTION/HOUSE OFFICER PROGRAM CLOSURE/REDUCTION

         If University itself intends to close or to reduce the size of a House Officer program or to
close a residency program, University shall inform the House Officers as soon as possible of the
reduction or closure. In the event of such reduction or closure, University will make reasonable
efforts to allow the House Officers already in the Program to complete their education or to assist
the House Officers in enrolling in an ACGME accredited program in which they can continue
their education.

SUMMARY SUSPENSIONS
       University, Program Director, or designee, Department Head, or designee, each shall
have the authority to summarily suspend, without prior notice, all or any portion of House
Officer’s appointment and/or privileges, whenever it is in good faith determined that the
continued appointment of House Officer places the safety or health of patients or University
personnel in jeopardy or to prevent imminent disruption of University operations.

GRIEVANCE PROCEDURES:
Policies and procedures for adjudication of House Officer complaints and grievances related to
action which result in dismissal or could significantly threaten a House Officer’s intended career
development are delineated in the House Officer Manual. Complaints of sexual harassment
and/or other forms of discrimination may be addressed in accordance with the policy delineated
in the House Officer Manual.

DUTY HOURS:

        Duty hours must be in accordance with the institutional and ACGME policies. The house
officer agrees to participate in institutional programs monitoring duty hours. Questions about
duty hours should be directed to the LSUHSC Graduate Medical Education Office or
Ombudsman listed in the House Officer Manual, when they can not be resolved at the program
level.


By signing this Agreement of Appointment, House Officer affirms that House Officer has read
and agrees to all the terms and conditions delineated in the House Officer Manual. In addition
House Officer agrees to comply with any and all University policies or procedures as are from
time to time adopted, authorized and approved by University.
This Agreement of Appointment is not valid until it is executed by: (i) the House Officer; (ii) the
Program Director, or designee; (iii) the Department Head or designee; and (iii) the Associate
Dean for Academic Affairs or designee.
   LSUHSC Emergency Medicine Residency Handbook 10-11                                     31




This document, with any appendices represents the entire agreement between the parties.


______________________________              _________________________________
House Officer                               Program Director

Date: __________________________            Date: ____________________________


_______________________________             __________________________________
Department Head                             Associate Dean for Academic Affairs

Date:_________________________              Date: _____________________________
   LSUHSC Emergency Medicine Residency Handbook 10-11   32




Pay Scales - LSUHSC House Officer


2008-2009 Academic Year



              PGY1    $44,168
              PGY2    $45,467
              PGY3    $47,125
              PGY4    $49,029
              PGY5    $50,720
   LSUHSC Emergency Medicine Residency Handbook 10-11                                         33




                                 Emergency Fund for Residents

Guidelines for use of Emergency Fund for Residents/Fellows

The Emergency Fund for Residents/Fellows provides LSUHSC house officers with money in
cases of emergency. In order to ensure that proper procedures are followed when using the
Emergency Fund the following guidelines must be adhered to when requesting use of the
Emergency Fund. Emergency funds are limited. This fund is not to be used for "advance salary"
money. Requests should be for true financial emergencies. The GME Office will keep all
requests confidential.

An Emergency Fund Request for Payment may be in either of two categories--Loan or Grant.
Loans are interest free, if approved by the Assistant Dean for Academic Affairs, and must be
paid back in one lump sum payment as soon as possible within one (1) year. In exceptional
circumstances, grants are given with no expected return payment from the Resident if approved
by the Assistant Dean for Academic Affairs.

Non payment of loan by a resident after the time period of one (1) year will result in notification
of Department Head and Departmental Residency Director by the GME Office staff. A decision
will then be made by the Department Head and/or Residency Director who will determine the
resolution of the loan and any penalty for the Resident.

The Steps for Requesting the Emergency Fund are as follows:

1. Resident notifies his Departmental Residency Coordinator or his Residency Program
   Director about the Emergency situation.

2. Departmental Residency Coordinator or his Residency Program Director gives Resident an
Emergency Fund Request For Payment Form (attached for departmental duplication).

3. Resident completes the Emergency Fund Request For Payment Form and Resident obtains
signatures of his Residency Director or Department Head (or Acting Head in case Department
Head is away.) approving of Resident request.

4. Resident presents approved Request For Payment Form to the Office of Graduate Medical
Education, Room 237, Medical School Building, 1542 Tulane Avenue, for final approval or
denial by the Assistant Dean for Academic Affairs.

5. If Request for Payment Form is approved by the Assistant Dean for Academic Affairs, the
GME Office staff will contact the Resident to notify him when the check will be ready for pick
up. Loan Repayment: When loans are paid back, the Resident must complete a Loan Repayment
Form (attached for departmental duplication). The completed Form and Payment should be
delivered to the Office of Graduate Medical Education. Checks should be made payable to the
LSU Medical Center Foundation.
   LSUHSC Emergency Medicine Residency Handbook 10-11                                       34




                       House Officer Selection and Eligibility LSUHSC

        House Officer selection criteria must conform to the guidelines of the Accreditation
Council for Graduate Medical Education (ACGME) General Requirements. House Officers are
selected by program directors from an applicant pool in the National Residency Matching
Program (NRMP) or from NRMP Specialty Matching Services programs.

        First year House Officers must participate through the NRMP programs. Only in the
absence of an NRMP matching program in a particular discipline or at an advanced level of
appointment, may candidates compete and be appointed individually. Such candidates must meet
all the ACGME General Requirements for selection of House Officers.

        House Officers must be (1) graduates of medical schools in the United States and Canada
accredited by the Liaison Committee on Medical Education (LCME); (2) graduates of colleges
of osteopathic medicine in the United States accredited by the American Osteopathic Association
(AOA); (3) graduates of medical schools outside the United States who have received a currently
valid certificate from the Education Commission for Foreign Medical Graduates or have a full
and unrestricted license to practice medicine in a United States licensing jurisdiction; or (4)
graduates of medical schools outside the United States who have completed a Fifth Pathway
Program by an LCME-accredited medical school. [A Fifth Pathway program is an academic year
of supervised clinical education provided by an LCME-accredited medical school to students
who a.) have completed, in an accredited college or university in the United States,
undergraduate premedical education of the quality acceptable for matriculation in an accredited
United States medical school; b.) have studied at a medical school outside the United States and
Canada but listed in the World Health Directory of Medical schools; c.) have completed all of
the formal requirements of the foreign medical school except internship and/or social service; d.)
have attained a score satisfactory to the sponsoring medical school on a screening examination;
and e.) have passed either the foreign Medical Graduate Examination in the Medical Sciences,
Parts I and II of the examination of the National Board of Medical Examiners, or Steps 1 and 2
of the United States Medical Licensing Examination (USMLE).] .

        All House Officer trainees must have a valid license or permit to practice medicine in the
State of Louisiana. Requirements for medical licensure change from time to time. Beginning
with medical graduates of 1992, all Louisiana licensure examination is through the United States
Medical Licensing Examination (USMLE) three-step pathway. The Louisiana State Board of
Medical Examiners will confer unlimited licensure only after the candidate successfully
completes the post - graduate year I level and passes the USMLE Step examinations 1 through 3.
The examination of the National Board of Osteopathic Examiners and the LMCC Canada
examination are not currently accepted by the Louisiana licensing Board.

        The Louisiana State Board of Medical Examiners issues temporary training permits to
qualified post-graduate year I level trainees. Temporary permits (Visiting Resident Permits) also
may be issued for certain foreign medical graduates entering the U.S. on J-1 visas. Foreign
citizen trainees must have standard Educational Commission for Foreign Medical Graduates
(ECFMG) certification. They must pass the Foreign Medical Graduate Examination in the
Medical Sciences (FEMGEMS) and the ECFMG English test. Rules and regulations regarding
   LSUHSC Emergency Medicine Residency Handbook 10-11                                           35




trainees with visas frequently change. Examples include which types of visa holders may do
clinical training and issues regarding funding sources. When questions arise the GME Office will
refer all questions to Ms. Rose Chatelain or her designee for final determination to be sure we are
in compliance with all institutional, state and Federal rules and regulations.

         Eligible House Officer candidates will be selected on the basis of their preparedness,
ability, aptitude, academic credentials, communication skills and personal qualities such as
motivation and integrity. The number and apportionment of House Officers will depend on
educational opportunities, the patient population, levels of illnesses, types of procedures, number
of staff available for supervision, financial resources of in-patient and out-patient care facilities,
and recommendations of the Residency Review Committees (RRC). The Institutional Graduate
Medical Education Committee and the Academic Dean, supervise the overall number of
positions offered and the apportionment of House Officers among services and departments.
House Officers are appointed for one year. Contract renewal is subject to mutual written consent
of the Department Head and the House Officer. This renewal must be made in a timely manner
in accordance with ACGME requirements as outlined in our Policy and Procedure Manual and
with dates set by the GME office.
    LSUHSC Emergency Medicine Residency Handbook 10-11                                                  36




                                         Campus Assistance Program

o   The Campus Assistance Program is a free service provided by LSU Health Sciences Center in New
    Orleans to assist employees, faculty, staff, residents, and students in resolving personal or work
    related problems.
o   LSUHSC-NO recognizes that everyone, at sometime, needs a “helping hand” or assistance.
    Whether you have a simple or a complex problem, the Campus Assistance Program can help.
o   A counselor is on call 24 hours a day to assist in time of crisis. If you feel you have an emergency
    or need immediate assistance at any time, contact the counselor on call.

    You may reach a counselor by calling (504) 568-8888
    CAP is located in the Lions Clinic Building on the 6th Floor
    2020 Gravier St, New Orleans, LA 70112

    Types of Problems
    CAP is a resource that offers individuals assistance with solving life, school and work problems. Any
    problems, regardless of severity, that are interfering with one’s peace of mind or personal
    effectiveness are appropriate to bring to this service. The counselors will work with you to either
    resolve the problem, or find the resources in the community to help you. The program also offers
    assistance to supervisors who are working with troubled individuals. Examples of problem areas
    include:

       Crisis Management
                                               Job Productivity
       Mental Health
                                               Career Satisfaction
       Interpersonal / Family
                                               Alcohol and Other Drug Use
        Relationships
       Child / Adolescent Development
                                               Loss / Bereavement

       Workplace Conflict Resolution
                                               Financial




Privacy
Use of program services is voluntary. All information conveyed during use of the services, including use
of the service itself, is confidential.

Services
24-Hour Crisis Line  A counselor is on call 24 hours a day to assist in times of crisis.

Community Information  The Campus Assistance Program maintains up-to-date lists of community
resources, treatment programs and agencies. If you are looking for a community resource, Campus
Assistance Program will work with you to find the best resource in the community that can help you.

Problem Assessment  A counselor will help you clarify the nature of your problem and develop a plan
to resolve your problem.

Short-Term Counseling  Short-term counseling for problem clarification is available through the
Campus Assistance Program. If after talking with the counselor, a referral to a specialist within the
community is needed, one will be made for the best cost-effective treatment of your problem.

Cost
Services are provided at no cost to the client. If a referral is made to a resource outside of the Program,
the cost of that service is the responsibility of the client. Such costs may be covered by heath insurance.
    LSUHSC Emergency Medicine Residency Handbook 10-11                                                          37




                             Fitness For Duty And Substance Abuse Policy

Louisiana State University Health Sciences Center (LSUHSC) is governed by and complies with
the provisions of the Drug Free Workplace Act of 1988. The applicable provisions are as
follows:

The unlawful manufacture, distribution, dispensing, possession and/or use of unlawful drugs at
any facility of the Louisiana State University Health Sciences Center is prohibited.

Penalties for violation of this policy could result in written disciplinary action, suspension,
demotion, and/or immediate dismissal depending on the severity of the circumstances; or
criminal prosecution.

Further, all employees are required to notify the Director of Human Resource Management of any drug related
criminal conviction which occurs in the workplace within five (5) days following conviction. The Director will
notify the Grants Office so that they may comply with the provision for notice to the federal funding agency within
ten (10) days. Notice to the federal contractor should include the sanctions imposed on the employee convicted of a
drug work-related crime.

Campus/Employee Assistance Program (C/EAP) is available to all House Officers of LSUHSC.
Abiding by this policy and any other drug policy established by LSUHSC or other House Officer
training facility, regardless of when promulgated, is a condition of the House Officer’s
employment with LSUHSC. (Revised May 2000 by the Campus Assistance Program Office)
FITNESS FOR DUTY POLICY
The Louisiana State University Health Sciences Center (LSUHSC) promotes and protects the
well being of faculty, staff, residents, students, and patients.
Any individual who works or is enrolled at Louisiana State University Health Sciences Center (LSUHSC) is
expected to report to work/school in a fit and safe condition. An individual who has an alcohol, drug, psychiatric, or
medical condition (s) that could be expected to impair their ability to perform in a safe manner must self report their
medical status to their supervisor and provide a signed medical release indicating their fitness for work/school to the
Campus/Employee Assistance Program (C/EAP).

LSUHSC requires all faculty, staff, residents, students or other LSUHSC workers who observe
an individual who is believed to be impaired or is displaying behavior deemed unsafe at
work/school to report the observation (s) to their supervisor for appropriate action. Supervisors
are then required to make an administrative referral to the Drug Testing Program and C/EAP.
An individual who is referred to C/EAP and found to be impaired must provide C/EAP, prior to
returning to work, with a signed medical release indicating they are fit to resume their work or
school responsibilities at LSUHSC. LSUHSC will, as a condition of continued
employment/enrollment, require an ―at risk‖ individual to maintain a continued care plan either
recommended or approved by C/EAP and sign a Continuation of Employment/Enrollment
Contract.

This policy applies to all faculty, staff, residents, students, contract and subcontract workers,
medical staff, volunteers, laborers, or independent agents who are conducting business on behalf
   LSUHSC Emergency Medicine Residency Handbook 10-11                                    38




of, providing services for (paid or gratis), or being trained at LSUHSC. (Revised May 2000 by
the Campus Assistance Program Office)
    LSUHSC Emergency Medicine Residency Handbook 10-11                                                          39




                                         Work Related Injury/Illness
Department: Employee Health Services Policy Title: Work-related Injury/Illness (Excepting Needle Sticks and
Exposures Which are Covered by Specific Policies and Procedures)
Effective Date: Prior 11/96

Purpose: To outline Employee Health Services policy and procedure for handling the employee who is injured on
the job. This policy is set forth to ensure maximum protection of the employee and the Medical Center of Louisiana
(MCL) in the event that an accident or exposure, causing illness or injury, occurs while the employee is on duty at
MCL.

Policy: The Medical Center of Louisiana offers screening, evaluation and treatment and referral, as indicated, for
work-related accidents or illnesses. In the event of a work-related accident or illness, an employee must notify the
supervisor if at all possible. An Employee Accident Report Form must be completed and handled as per hospital
policy. Employees who are injured after hours or are seriously injured or need prompt medical attention due to such
things as loss of blood, loss of consciousness or loss of mobility are immediately sent to the Emergency Room by
their supervisor or other appropriate personnel. The Employee Accident Report Form is given to the Emergency
Room as soon as possible after any potentially life-threatening needs are attended to. In the event of minor injury, if
the employee requests medical attention, the supervisor is to send the employee to Employee Health Services with
the Employee Accident Report Form. If the injury is of a more serious or severe nature, the Employee should be sent
to the Emergency Room for treatment first.

In cases where medical attention is needed and Employee Health Services is closed or the Employee Health Services
physician is not available, the supervisor sends the employee to the Emergency Room with the Employee Accident
form. The Emergency Room should notify Employee Health Services of those MCL employees who have been
injured on the job.
The supervisor and Emergency Room should instruct the employee to report to Employee Health Services at the first
available opportunity following treatment for work-related injury in the Emergency Room. Employee Health
Services provides follow-up assessment for employees treated in the Emergency Room and will initiate follow-up
treatment or referral, as indicated. Emergency Room Patient Discharge Instructions should be brought to Employee
Health Services during regular office hours and return follow-up visit.

Employee Health Services provides instructions to injured employee regarding treatment, referral and appointments
and return-to-work. Employee Health Services schedules appointments or facilitates the scheduling process for
appointments to return to Employee Health or to see other medical care providers.
Employee Health Services instructs employee to return with instructions and/or clearances from other medical care
providers regarding return-to-work recommendations and to return to Employee Health Services for
case-management.
Employee Health maintains contact with employees on Workers' Compensation and the Workers' Compensation
representative concerning duration of disability for employees.

Employee Health Services gives documentation slip to employee returning with return to work clearance from own
physician. Said work clearance paperwork is maintained in confidential Employee Health Services employee file. At
the discretion of Employee Health Services, Employee Health Services physician may see employee at return to
work.
LSUHSC Emergency Medicine Residency Handbook 10-11                                          40




                                       Dress Code

1. Residents must abide by the dress code of each hospital to which they rotate.
2. The general principles of the programs dress code are listed below.

   a.   One way a physician indicates his professionalism and his respect for the patient and
        his family is by his appearance.

   b.   Residents should present a neat, clean, and professional appearance at all times.

   c.   Scrubs are acceptable attire in the ED and when on call as are neat pants, skirts and
        shirts. No sandals or open shoes are allowed for safety reasons.

   d.   No attire bearing unprofessional messages or pictures is to be worn.

3. Emergency medicine residents spend about 50% of their residency on non-emergency
   department rotations interacting with residents, faculty, and administrators. The
   appearance of our residents influences how our entire department is viewed. Residents
   are encouraged to keep this, in mind when dressing. Events such as conferences are also
   professional activities and residents should dress appropriately. Shorts, tee shirts, and
   sandals are not to be worn to conference.

4. Please refer to the MCLNO personal appearance policy below:
LSUHSC Emergency Medicine Residency Handbook 10-11   41
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   LSUHSC Emergency Medicine Residency Handbook 10-11                                         49




                                     LIBRARY - LSUHSC

433 Bolivar St., Box B3-1
New Orleans, LA 70112-2223
Help Desk: (504) 568-6102
http://www.lsumc.edu/campus/library/no-lib.htm

 Much of the library can be accessed from your LSU Desktop. Go to www.lsuhsc.edu, go to
quicklink dropdown menu and click on desktop/psdesktop . Use your assigned username and
password that you use to get on the LSU system. The next frame go to ―Install web client‖ and
click on Internet explore 4.0 and above (desktop) and follow the instructions in the dialog box.

The Library is excited to announce that access to a whole new set of databases will be provided
by software from Ovid Technologies, Inc. Access to the OVID databases is via a Web browser
and is available through the library's Web page at
http:/www.Isumc.edu/campus/library/no-lib.htm or directly to http://ovid.Isumc.edu. The
following databases will be available:

MEDLINE: 1966 present Produced by the U.S. National Library of Medicine, the MEDLINE
database is widely recognized as the premier source for bibliographic coverage of biomedical
literature. MEDLINE encompasses information from Index Medicus, Index to Dental Literature,
and International Nursing, as well as other sources of coverage in the areas of communication
disorders, population biology, and reproductive biology. More than 8.5 million records from
more than 3,600 journals are indexed.

PsycINFO: 1988-present. Produced by the American Psychological Association, PsycINFO
covers the professional and academic literature in psychology and related disciplines, including
medicine, psychiatry, nursing, sociology, education, pharmacology, physiology, linguistics, and
other areas. PsycINFO's coverage is worldwide, and includes references and abstracts to over
1,300 journals in more than 20 languages, and to book chapters and books in the English
language. The database includes information from empirical studies, case studies, surveys,
bibliographies, literature reviews, discussion articles, conference reports and dissertations.

HealthSTAR: 1975-present. HealthSTAR contains citations to the published literature on health
services, technology, administration, and research. It focuses on both the clinical and non-clinical
aspects of health care delivery. The following topics are included: evaluation of patient
outcomes; effectiveness of procedures, programs, products, services and processes;
administration and planning of health facilities, services and manpower; health insurance; health
policy; health services research; health economics and financial management; laws and
regulation; personnel administration; quality assurance; licensure; and accreditation.

HealthSTAR is produced cooperatively by the U.S. National Library of Medicine and the
American Hospital Association. The database contains citations and abstracts (when available) to
journal articles, monographs, technical reports, meeting abstracts and papers, book chapters,
government documents, and newspaper articles from 1975 to the present.
   LSUHSC Emergency Medicine Residency Handbook 10-11                                        50




Bioethicsline: 1973-present. Produced jointly by the Kennedy Institute of Ethics and the U.S.
National Library of Medicine, the BioethicsLine database includes more than 47,000 records of
English-language materials on bioethics. Documents are selected from the disciplines of
medicine, nursing, biology, philosophy, religion, law, and the behavioral sciences. Selections
from popular literature are also included. Covered document types include journal and
newspaper articles, monographs, court decisions, bills, laws, and audiovisual materials.

ERIC: 1966-present. Produced by the U. S. Department of Education, ERIC is a national
bibliographic database which indexes over 775 periodicals dealing with the subject of education.
It is the premier resource for references to these materials. Targeted to teachers, administrators
and other education professionals, ERIC combines information from two printed sources:
Resources in Education (RIE) and the Current Index to Journals in Education (CUE).

CINAHL: 1982-present. Produced by CINAHL Information Systems, The Nursing & Allied
Health (CINAHL) database provides comprehensive coverage of the English language journal
literature for nursing and allied health disciplines. Material from over 650 journals are included
in CINAHL, covering fields such as cardiopulmonary technology, emergency services, health
education, med/lab technology, medical assistance, medical records, occupational therapy,
physical therapy, radiologic technology, respiratory therapy, social sciences, surgical technology,
and the physician's assistant. Also included are healthcare books, nursing dissertations, selected
conference proceedings, standards of professional practice, and educational software. There is
selective coverage of journals in biomedicine, the behavioral sciences, management, and
education.

CANCERLIT: 1983-present. Produced by the U.S. National Cancer Institute, CancerLit is an
important source of bibliographic information pertaining to all aspects of cancer therapy,
including experimental and clinical cancer therapy; chemical, viral and other cancer causing
agents; mechanisms of carcinogenesis; biochemistry, immunology, and physiology of cancer,
and mutagen and growth factor studies. Some of the information in CancerLit is derived from the
MEDLINE database. Approximately 200 core journals contribute a large percentage of the
750,000+ records in this database. In addition, other information is drawn from proceedings of
meetings, government reports, symposia reports, theses, and selected monographs.

OVID CORE BIOMEDICAL COLLECTION

MD CONSULT- Can be accessed from your LSU Desktop, click on Medical package or go to
www.lsuhsc.edu, click INTRANET, click MD Consult. Use your assigned username and
password that you use to get on the LSU system. If you are accessing the system out of campus
for the first time, after clicking on INTRANET on the next frame click ―Desktop ECA client
Download‖ and follow the instructions in the dialog box.
         LSUHSC Emergency Medicine Residency Handbook 10-11                                                  51




                                               WELLNESS CENTER


           The Wellness Center is dedicated to promoting the health and well being of all
        members of the LSU Health Sciences Center community in a safe and educational
                                                     environment.



       Hours of Operation
Mon.-Fri.  6:30 am - 8:00 pm                            Contact Information
Sat.       9:00 am - 1:00 pm                          450 S. Claiborne Avenue
Sun.       Closed                                     New Orleans, LA 70112
                                                       Phone: (504) 568-3700
                                                         Fax: (504) 568-3720
           Amenities                                Email: wellness

      18,000 square feet
      Cardiovascular
       equipment: treadmills,       Entry granted with a valid LSUHSC or MCLNO I.D.
       bikes (upright and
       recumbent), ellipticals,     Membership Requirements
       rowers, and stair
       climbers                     All individuals must show a valid LSUHSC I.D. on the 3rd floor of Stanislaus Hall
      Selectorized weight          for entrance into the Wellness Center. In addition, initially, each individual member
       equipment: Nautilus          must complete an Express Assumption of Risk Release of Liability Form and a
       Nitro                        PAR-Q.
      Plate loaded/free
       weights                      Forms
      A multipurpose room for      Express Assumption of Risk Release of Liability Form PAR Q
       group exercise activities,
       such as group cycling,       Free Admission is granted to:
       mind body (yoga/pilates
       mat), step, resistance              LSUHSC Students, Residents, Faculty, and Staff
       training, etc.                      Spouses and Children 16 years or older of LSUHSC Students, Residents,
      Lounge area / Wireless               Faculty, and Staff
       Internet                            *MCLNO Staff ONLY
      Spacious locker rooms               *HCSD Staff ONLY
       with shower facilities
   LSUHSC Emergency Medicine Residency Handbook 10-11                                      52




                            HOUSE STAFF CLEARANCE FORM

  Each resident completing final rotations (prior to graduation) must have this form processed
   before a final certificate will be issued. Signatures indicate that your medical records are
        complete; you have returned lab coats; and you have returned Autovalet Cards.



 NAME OF RESIDENT




 SCHOOL/DEPARTMENT                                               DATE OF DEPARTURE




                                                           Signature                       Date

 MEDICAL RECORD SERVICES
 Doctor’s Dictation area
 All records dictated and signed up to
 including departure date and reassignment
 form completed.


 COAT EXCHANGE


 AUTOVALET CARDS


 RESIDENCY PROGRAM DIRECTOR




Completed form should be submitted to the Medical Staff Office
   LSUHSC Emergency Medicine Residency Handbook 10-11                                   53




                  MEDICAL CENTER OF LOUISIANA AT NEW ORLEANS
                           MEDICAL RECORD SERVICES
                                    CERTIFICATE REQUEST
Certificates are awarded only when you have completed entire program –internship, residency
and fellowship, if applicable. This form must be approved by your Residency Program Director.

Please complete, as you want your certificate to read.
Name:________________________________________________________________________
       First                              Middle       Last          Degree
Status:        (circle one)   Intern                 Resident                 Fellow

School:        (circle one)   LSU      or     TULANE

Department:____________________________________________

Dates:_______________________to_________________________

If any year was in a different program, please provide that information.

Status:        (circle one)   Intern          Resident               Fellow

School:        (circle one)   LSU      or     TULANE

Department:____________________________________________
Dates:________________________to________________________

Permanent forwarding address for mailing certificate:

       ________________________________________________________________
       ________________________________________________________________
       _______________________________________________________________
       ________________________________________________________________

APPROVAL:
I have reviewed applicant’s request for MCL certificate and verify that information
provided above is accurate.

       _____________________________________________________________________
                   Residency Program Director                      Date
CERTIFICATE REQUESTS THAT HAVE NOT BEEN APPROVED BY RESIDENCY
PROGRAM DIRECTOR WILL NOT BE PROCESSED.
   LSUHSC Emergency Medicine Residency Handbook 10-11                                                      54




  POLICIES – Section of EM

                                            Mission Statement


       The mission of LSUHSC-New Orleans Emergency Medicine Residency Program is to
deliver superior patient care, foster medical education, promote research, and provide service to
our community, the LSUHSC system and the specialty of emergency medicine.


GOALS and OBJECTIVES

   The overall goal of LSU EM training program is to prepare physicians for the independent
practice of emergency medicine. This goal is achieved via teaching the fundamental skills,
knowledge, and humanistic qualities that constitute the foundations of emergency medicine
practice. Residents, under the guidance and supervision of a qualified faculty, develop a
satisfactory level of clinical maturity, judgment, and technical skills, by being exposed to
progressive levels of responsibility in clinical experiences that enable effective management of
acute care problems. Upon completion of the program, residents will be capable of
independently practicing emergency medicine, able to incorporate new skills and knowledge
during their careers, and able to monitor their own physical and mental well being.
   Specific objectives include:

       1. Manage life-threatening conditions competently and efficiently
       2. Support and stabilize the acutely ill patient and arrange appropriate management and
          referral
       3. Recognize, evaluate and initiate management of non-acute illness and injury.
       4. Manage multiple patients concurrently, and establish appropriate treatment priorities.
       5. Demonstrate full integration of the ACGME core competencies:
               a.   PATIENT CARE: Residents must be able to provide patient care that is compassionate,
                    appropriate, and effective for the treatment of health problems and the promotion of health.
               b.   MEDICAL KNOWLEDGE: Residents must demonstrate knowledge about established and
                    evolving biomedical, clinical, and cognate (e.g. epidemiological and social-behavioral)
                    sciences and the application of this knowledge to patient care.
               c.   PRACTICE BASED LEARNING & IMPROVEMENT: Residents must be able to
                    investigate and evaluate their patient care practices, appraise and assimilate scientific
                    evidence and improve their patient care practices.
LSUHSC Emergency Medicine Residency Handbook 10-11                                                         55




           d.   INTERPERSONAL AND COMMUNICATION SKILLS: Residents must be able to
                demonstrate interpersonal and communication skills that result in effective information
                exchange and teaming with patients, their families and professional associates.
           e.   PROFESSIONALISM: Residents must demonstrate a commitment to carrying out
                professional responsibilities, adherence to ethical principles and sensitivity to a diverse patient
                population.
           f.   SYSTEMS BASED PRACTICE: Residents must demonstrate an awareness of and
                responsiveness to the larger context and system of health care and the ability to effectively
                call on system resources to provide care that is of optimal value.
    LSUHSC Emergency Medicine Residency Handbook 10-11                                            56




                      Role of the Residency in the Emergency Department


       All patient care in the Emergency Department of MCLNO is provided and supervised by
the residents and faculty of the LSUHSC EM Residency Program. Emergency medicine teaching
faculty from the LSUHSC EM Residency Program are on duty in the department at all times and
review the care of every patient treated before that patient is discharged. The faculty provides
supervision and teaching of residents, interns and students, and are ultimately responsible for all
patient care in the ED. All faculty are ABEM eligible or certified.
       Emergency medicine residents at the PGY 1,2,3, and 4 levels are assigned to the
department each month. Emergency medicine residents perform several functions in the
department under the supervision of the Emergency Medicine faculty including primary triage of
all patients presenting for care, supervision of all patient care activities and teaching of interns
from all services assigned to the emergency department and of medical students taking
emergency medicine rotations, direction of resuscitation of critically ill or injured patients,
arrangement for appropriate consultation, and direction of pre-hospital care via radio
communication. Procedures in the emergency department are supervised either directly or
indirectly by the ED attending physicians depending on the level of training of the resident
performing the procedure. The faculty are ultimately responsible for all procedures performed in
the ED.
       The emergency medicine faculty of the residency program fills the medical
administrative positions in the department such as Director of the Emergency Department and
the Director of EMS, Director of Disaster Planning, etc. The faculty also participates in the
Quality Assurance and Peer Review functions of the Department.

.
   LSUHSC Emergency Medicine Residency Handbook 10-11                                        57




                                   EM Residency Applicants

         Selection of residents for LSUHSC Emergency Medicine residency involves all members
of the Section of Emergency Medicine. The program directors and chief residents perform the
initial screening of applications received via ERAS. Candidates are then invited for an interview
and are then interviewed by the program director, associate program director, at least one general
faculty member and one chief resident. The applicants go to lunch with EM residents on the day
of their interview and attend an informal gathering with the residents the night before their
interview. The applicant’s interaction with our residents is the most important aspect of the
interview process and is instrumental part in the recruitment of future residents.

         Qualified applicants should at least be in their final year of medical school training and
have successfully passed USMLE Step 1. USMLE Step 2 is encouraged but not required before
interviewing but must be successfully completed to be ranked. A dean’s letter and at least 3
letters of recommendations are required. We participate in ERAS for all applicants. Applicants
must be citizens of the United States or possess a green card or J-1 visa. We do not sponsor H-1b
visas. Our resident’s appraisal of the applicant, along with our faculty’s impressions and
assessments, combined with the applicant’s letters of recommendation, medical school dean’s
letter, and personal statement makes up the file for each applicant. All files are then carefully
reviewed by the program directors and chief residents, and a match list is compiled for the
computerized national match of R-1's. Our residency program participates in the National
Residency Matching Program (NRMP) and as such, is obligated to follow all rules and
regulations set forth by the NRMP.
   LSUHSC Emergency Medicine Residency Handbook 10-11                                         58




                                     Residency Promotions


       LSUHSC Emergency Medicine residents are evaluated each year in a formative and
summative fashion. These evaluations, in-service exam scores and resident self reflections offer
the basis for successful promotion from one year to the next. Residents that do not show
appropriate improvement and progress based on a combination of formative and summative
evaluations, in-service exam scores and maintenance of residency requirements are required to
remediate for 3 month periods with subsequent re-evaluations by the Program Director at those
times. The Program Director in conjunction with the resident’s advisor, offer residents focused
feedback on their areas of weakness and residents are asked to seek daily feedback on their
clinical performance in the Emergency Department. Once residents meet their residency
requirements and address their weakness they are promoted to their appropriate class level.
Residents who fail to reach the standards after 12 months of remediation are dismissed.


EMERGENCY MEDICINE YEAR END COMPETENCIES
PGY1 YEAR
        These objectives are the criteria that are used to determine a resident’s ability to
           advance to the next year of residency.
        By the end of the PGY-1 year, EM residents are expected to:
                                                                     Core                Assessment
  Competency Objective
                                                                     Competency          Method
  Complete all clinical rotations with satisfactory evaluations      PC, MK, ICS         Rotation evals
  Attend at least 70% of all mandatory EM conferences.               PF, MK, PBL         Attendance sheets
                                                      th
  Demonstrate EM knowledge by scoring at least 70 percentile
                                                                     MK, PC              ABEM exam
  on the ABEM In-service examination.
  Demonstrate progression towards competency in the chief                                SDOT, oral
                                                                     MK, PC
  complaints of chest pain, syncope and pediatric fever.                                 boards, simulations
  Obtain documents required for medical licensure.                   PC, SBP             Resident File
  Properly assist in trauma or medical resuscitations with                               Simulations, global
                                                                     MK, PC
  guidance.                                                                              evals, oral boards
  Demonstrate the ability to execute admission and discharge,                            SDOT, global
                                                                     MK, PC, SBP
  once the disposition is determined.                                                    evaluations
  Residents are expected to maintain timely documentation of                             Procedure logs,
                                                                     ICS, PC, SBP
  charts in the ED, medical records and hospital paperwork.                              med. recs dept.
  Begin procedure related readings, achieve 80% on post-tests,                           Procedure logs,
                                                                     PC
  obtain faculty evaluations and document procedures in RP.                              simulations, SDOT
  Demonstrate adequate documentation of procedures with at           PC                  Procedure logs
LSUHSC Emergency Medicine Residency Handbook 10-11                                59




least 1/5 of ACGME targeted procedures in the RP.
Demonstrate adequate documentation of follow-up diagnoses                     Follow up logs,
                                                                   PC, MK
of patients seen in the ED and complete 10 follow-up/year                     resident portfolios
Demonstrate adequate progress with all specified academic                     Portfolio, lecture
                                                                   PBL, ICS
requirements as judged by the program director.                               evaluations
Identify a potential area of need for the residency required
                                                                   SBP        Semi-Annual eval.
administrative project.(pending)
Identify and choose a potential topic for the residency required
                                                                   PBL        Semi-Annual eval.
academic project.
Residents must demonstrate a commitment to carrying out
                                                                              Global evaluations,
professional responsibilities, adherence to ethical principles     PF
                                                                              360 evaluations
and sensitivity to a diverse patient population.
Demonstrate the ability to interact effectively with nurses,                  Global evaluations,
                                                                   ICS
ancillary staff, patients and families.                                       360 evaluations
   LSUHSC Emergency Medicine Residency Handbook 10-11                                       60




PGY2 YEAR
        These objectives are the criteria that are used to determine a resident’s ability to
           advance to the next year of residency.
        By the end of the PGY-2 year, EM residents are expected to:
                                                                     Core                Assessment
  Competency Objective
                                                                     Competency          Method
  Complete all clinical rotations with satisfactory evaluations      PC, MK, ICS         Rotation evals
  Attend at least 70% of all mandatory EM conferences.               PF, MK, PL          Attendance sheets
  Demonstrate improvement in EM knowledge by scoring at
                                                                     MK, PC              ABEM exam
  least 75th percentile on the ABEM In-service examination.
  Demonstrate progression towards competency in the chief                                SDOT, oral
                                                                     MK, PC
  complaints of chest pain, syncope and pediatric fever.                                 boards, simulations
  Pass USMLE Step 3. Louisiana License, Training Permit &
                                                                     MK, PC, SBP         Resident File
  STEP 3:
  Properly perform a trauma or medical code resuscitation with                           Simulations, global
                                                                     MK, PC
  minimal guidance.                                                                      evals, oral boards
  Demonstrate the ability to execute admission, discharge, and                           SDOT, global
                                                                     MK, PC, SBP
  transfers once the disposition is determined.                                          evaluations
  Residents are expected to maintain timely documentation of                             Procedure logs,
                                                                     ICS, PC, SBP
  charts in the ED, medical records and hospital paperwork.                              med. recs dept.
  Completes all procedure-related readings, achieve 80% on all                           Procedure logs,
                                                                     PC
  post-tests, obtain faculty evals and documentation in RP.                              simulations, SDOT
  Demonstrate adequate documentation of procedures with at
                                                                     PC                  Procedure logs
  least ½ ACGME targeted procedures in RP.
  Demonstrate adequate documentation of 10 follow-up                                     Follow up logs,
                                                                     PC, MK
  diagnoses of patients seen in the ED.                                                  resident portfolios
  Demonstrate adequate progress with all specified academic                              Portfolio, lecture
                                                                     PL, ICS
  requirements as judged by the program director.                                        evaluations
  Complete significant progress on the residency required
                                                                     SBP                 Semi-Annual eval.
  administrative project. pending
  Complete significant progress on the residency required
                                                                     PL                  Semi-Annual eval.
  academic project.
  Residents must demonstrate a commitment to carrying out
                                                                                         Global evaluations,
  professional responsibilities, adherence to ethical principles     PF
                                                                                         360 evaluations
  and sensitivity to a diverse patient population.
  Demonstrate the ability to interact effectively with nurses,                           Global evaluations,
                                                                     ICS
  ancillary staff, patients and families.                                                360 evaluations
   LSUHSC Emergency Medicine Residency Handbook 10-11                                       61




PGY3 YEAR
        These objectives are the criteria that are used to determine a resident’s ability to
           advance to the next year of residency.
        By the end of the PGY-3 year, EM residents are expected to:
                                                                     Core                Assessment
  Competency Objective
                                                                     Competency          Method
  Complete all clinical rotations with satisfactory evaluations                          Rotation
                                                                     PC, MK, ICS
  (meets expectations or above).                                                         evaluations
  Attend at least 70% of all mandatory EM conferences.               PF, MK, PL          Attendance sheets
  Demonstrate improvement in EM knowledge by scoring at
                                                                     MK, PC              ABEM exam
  least 78th percentile on the ABEM In-service examination.
  Demonstrate [progression towards] competency in the chief                              SDOT, oral
                                                                     MK, PC
  complaints of chest pain, syncope and pediatric fever.                                 boards, simulations
  Maintain licensure.                                                PC, SBP             Resident File
  Properly perform a trauma or medical code resuscitation with
  minimal supervision. Appropriately sequences critical actions                          Simulations, global
                                                                     MK, PC
  and identifies interventions required to immediately stabilize a                       evals, oral boards
  patient.
  Manages multiple patients at various, progressive stages of
                                                                                         SDOT, global
  work-up throughout the shift, making appropriate, timely           MK, PC, SBP
                                                                                         evaluations
  decisions
  Residents are expected to maintain timely documentation of                             Procedure logs,
                                                                     ICS, PC, SBP
  charts in the ED, medical records and hospital paperwork.                              med. recs dept.
  Demonstrate adequate documentation of procedures with at
                                                                     PC                  Procedure logs
  least ¾ of ACGME targeted procedures listed in RP.
  Demonstrate adequate documentation of 10 follow-up                                     Follow up logs,
                                                                     PC, MK
  diagnoses of patients seen in the ED.                                                  resident portfolios
  Demonstrate adequate progress with all specified academic                              Portfolio, lecture
                                                                     PL, ICS
  requirements as judged by the program director.                                        evaluations
  Complete [significant progress on] the residency required
                                                                     SBP                 Semi-Annual eval.
  administrative project. pending
  Complete [significant progress on] the residency required
                                                                     PL                  Semi-Annual eval.
  academic project.
  Residents must demonstrate a commitment to carrying out
                                                                                         Global evaluations,
  professional responsibilities, adherence to ethical principles     PF
                                                                                         360 evaluations
  and sensitivity to a diverse patient population.
  Demonstrate the ability to interact effectively with nurses,                           Global evaluations,
                                                                     ICS
  ancillary staff, patients and families.                                                360 evaluations
   LSUHSC Emergency Medicine Residency Handbook 10-11                                       62




PGY4 YEAR
    These objectives are the criteria that are used to determine a resident’s ability to advance
       to the next year of residency.
    By the end of the PGY-4 year, EM residents are expected to:
                                                                     Core                Assessment
  Competency Objective
                                                                     Competency          Method
  Complete all clinical rotations with satisfactory evaluations                          Rotation
                                                                     PC, MK, ICS
  (meets expectations or above).                                                         evaluations
  Attend at least 70% of all mandatory EM conferences.               PF, MK, PL          Attendance sheets
  Demonstrate improvement in EM knowledge by scoring at
                                                                     MK, PC              ABEM exam
  least 80th percentile on the ABEM In-service examination.
  Demonstrate competency in the chief complaints of chest pain,                          SDOT, oral
                                                                     MK, PC
  syncope and pediatric fever.                                                           boards, simulations
  Maintain licensure.                                                PC, SBP             Resident File
  Properly perform a trauma or medical code resuscitation.                               Simulations, global
  Appropriately sequences critical actions and identifies            MK, PC              evaluations, oral
  interventions required to immediately stabilize a patient.                             boards
  Manages multiple patients at various, progressive stages of
                                                                                         SDOT, global
  work-up throughout the shift, making appropriate, timely           MK, PC, SBP
                                                                                         evaluations
  decisions. Supervises and facilitates patient flow in ED.
  Residents are expected to maintain timely documentation of                             Procedure logs,
                                                                     ICS, PC, SBP
  charts in the ED, medical records and hospital paperwork.                              med. recs dept.
  Demonstrate adequate documentation of procedures with at
                                                                     PC                  Procedure logs
  least 100% of ACGME targeted procedures listed in RP.
  Demonstrate adequate documentation of 10 follow-up                                     Follow up logs,
                                                                     PC, MK
  diagnoses of patients seen in the ED.                                                  resident portfolios
  Demonstrate adequate progress with all specified academic                              Portfolio, lecture
                                                                     PL, ICS
  requirements as judged by the program director.                                        evaluations
  Complete the residency required administrative project. pending SBP                    Semi-Annual eval.
  Complete the residency required academic project.                  PL                  Semi-Annual eval.
  Residents must demonstrate a commitment to carrying out
                                                                                         Global evaluations,
  professional responsibilities, adherence to ethical principles     PF
                                                                                         360 evaluations
  and sensitivity to a diverse patient population..
  Demonstrate the ability to interact effectively with nurses,                           Global evaluations,
                                                                     ICS
  ancillary staff, patients and families.                                                360 evaluations
   LSUHSC Emergency Medicine Residency Handbook 10-11                                        63




                                   Liaison & Oversight Policy

         Records of EM resident evaluations are maintained by the EM Program Director. These
files are generally available to the individual trainees, training faculty, Program Director.
Residents are formally evaluated by the program director and/or faculty advisor twice a year.
Both strengths and weaknesses are documented and discussed in the evaluation process as well
as plans to remediate any deficiencies. Evaluation of Residents routinely includes comments by
multiple evaluators such as the Program Director, clinic faculty, chief resident, and others.
Additionally, each House Officer is expected to participate in departmental self-assessment.

       The EM residency program maintains a standard of Satisfactory Academic Standing
which is maintained on all the off-site and off-service rotations. The program director meets
with the director of each rotation on an annual basis and, then electronically on a monthly basis.
The director of each rotation completes a standardized evaluation of each rotating EM resident
which is promptly reviewed by the program director. The EM residents are also required to
complete rotation reviews after completing each rotation. If a unacceptable evaluation score is
given by either the director of a rotation or the rotating resident, the EM program director
immediately solicits full information and addresses the issue.
    LSUHSC Emergency Medicine Residency Handbook 10-11                                              64




                                            Dismissal Policy


PRELIMINARY INTERVENTION
Substandard disciplinary and/or academic performance is determined by each Department.
Corrective action for minor academic deficiencies or disciplinary offenses which do not warrant
remediation as defined below, shall be determined and administered by each Department. Corrective
action may include oral or written counseling or any other action deemed appropriate by the
Department under the circumstances. Corrective action for such minor deficiencies and/or offenses
are not subject to appeal.

PROBATION
House Officers may be placed on probation for, among other things, issuance of a warning or
reprimand; or imposition of a remedial program. Remediation refers to an attempt to correct
deficiencies which if left uncorrected may lead to a non-reappointment or disciplinary action. In the
event a House Officer’s performance, at any time, is determined by the House Officer Program
Director to require remediation, the House Officer Program Director shall notify the House Officer in
writing of the need for remediation. A remediation plan will be developed that outlines the terms of
remediation and the length of the remediation process. Failure of the House Officer to comply with
the remediation plan may result in termination or non-renewal of the House Officer’s appointment.

A House Officer who is dissatisfied with a departmental decision to issue a warning or reprimand,
impose a remedial program or impose probation may appeal that decision to the Department Head
informally by meeting with the Department Head and discussing the basis of the House Officer’s
dissatisfaction within ten (10) working days of receiving notice of the departmental action. The
decision of the Department Head shall be final.

CONDITIONS FOR REAPPOINTMENT
Programs will provide notice in writing of the intent to non-renew or non-promote residents 4 months
prior to the end of the current contract except in the case when the cause for non-promotion/non-
reappointment occurred within the final 4 months. In such cases house officers will be notified in
writing with as much notice as possible (revised 6/21/2007)

TERMINATION, NON-REAPPOINTMENT, AND OTHER ADVERSE ACTION
A House Officer may be dismissed or other adverse action may be taken for cause, including but not
limited to: i) unsatisfactory academic or clinical performance; ii) failure to comply with the policies,
rules, and regulations of the House Officer Program or University or other facilities where the House
Officer is trained; iii) revocation or suspension of license; iv) violation of federal and/or state laws, 8
regulations, or ordinances; v) acts of moral turpitude; vi) insubordination; vii) conduct that is
detrimental to patient care; and viii) unprofessional conduct.

The House Officer Program may take any of the following adverse actions: i) issue a warning or
reprimand; ii) impose terms of remediation or a requirement for additional training, consultation or
treatment; iii) institute, continue, or modify an existing summary suspension of a House Officer’s
appointment; iv) terminate, limit or suspend a House Officer’s appointment or privileges; v) non-
renewal of a House Officer’s appointment; vi) dismiss a House Officer from the House Officer
Program; vii) or any other action that the House Officer Program deems is appropriate under the
circumstances.
   LSUHSC Emergency Medicine Residency Handbook 10-11                                           65




DUE PROCESS
Dismissals, non-reappointments, non-promotion (revised 6/21/2007) or other adverse actions which could
significantly jeopardize a House Officer’s intended career development are subject to appeal and the
process shall proceed as follows:

Recommendation for dismissal, non-reappointment, or other adverse action which could significantly
threaten a House Officer’s intended career development shall be made by the Program Director in the
form of a Request for Adverse Action. The Request for Adverse Action shall be in writing and shall
include a written statement of deficiencies and/or charges registered against the House Officer, a list
of all known documentary evidence, a list of all known witnesses and a brief statement of the nature
of testimony expected to be given by each witness. The Request for Adverse Action shall be
delivered in person to the Department Head. If the Department Head finds that the charges registered
against the House Officer appear to be supportable on their face, the Department Head shall give
Notice to the House Officer in writing of the intent to initiate proceedings which might result in
dismissal, non-reappointment, summary suspension, or other adverse action. The Notice shall include
the Request for Adverse Action and shall be sent by certified mail to the address appearing in the
records of the Human Resource Management or may be hand delivered to the House Officer.

Upon receipt of Notice, the House Officer shall have five (5) working days to meet with the
Department Head and present evidence in support of the House Officer’s challenge to the Request for
Adverse Action. Following the meeting, the Department Head shall determine whether the proposed
adverse action is warranted. The Department Head shall render a decision within five (5) working
days of the conclusion of the meeting. The decision shall be sent by certified mail to the address
appearing in the records of the Human Resource Management or hand delivered to the House Officer
and copied to the Program Director and Academic Dean.

If the House Officer is dissatisfied with the decision reached by the Department Head, the House
Officer shall have an opportunity to prepare and present a defense to the deficiencies and/or charges
set forth in the Request for Adverse Action at a hearing before an impartial Ad Hoc Committee,
which shall be advisory to the Academic Dean. The House Officer shall have five

(5) working days after receipt of the Department Head’s decision to notify the Academic Dean in
writing whether the House Officer would challenge the Request for Adverse Action and desires an
Ad Hoc Committee be formed. If the House Officer contends that the proposed adverse action is
based, in whole or in part on race, sex (including sexual harassment), religion, national origin, age,
Veteran status, and/or disability discrimination, the House Officer shall inform the Academic Dean
of that contention. The Academic Dean shall then invoke the proceedings set out in the Section
entitled ―Sexual Harassment 9 Policy‖ of this Manual. The hearing for adverse action shall not
proceed until an investigation has been conducted pursuant to the Section entitled ―Sexual
Harassment Policy.‖

The Ad Hoc Committee shall consist of three (3) full-time clinical faculty members who shall be
selected in the following manner:

The House Officer shall notify the Academic Dean of the House Officer’s recommended appointee
to the Ad Hoc Committee within five (5) working days after the receipt of the decision reached by
the Department Head. The Academic Dean shall then notify the Department Head of the House
Officer’s choice of Committee member. The Department Head shall then have five
    LSUHSC Emergency Medicine Residency Handbook 10-11                                             66




(5) working days after notification by the Academic Dean to notify the Academic Dean of his
recommended appointee to the Committee. The two (2) Committee members selected by the House
Officer and the Department Head shall be notified by the Academic Dean to select the third
Committee member within five (5) working days of receipt of such notice; thereby the Committee is
formed. Normally, members of the committee should not be from the same program or department,
In the case of potential conflicts of interest or in the case of a challenge by either party, the Academic
Dean shall make the final decision regarding appropriateness of membership to the ad hoc
committee.(rev. 7-1-2005) Once the Committee is formed, the Academic Dean shall forward to the
Committee the Notice and shall notify the Committee members that they must select a Committee
Chairman and set a hearing date to be held within ten (10) working days of formation of the
Committee. A member of the Ad Hoc Committee shall not discuss the pending adverse action with
the House Officer or Department Head prior to the hearing. The Academic Dean shall advise each
Committee member that he/she does not represent any party to the hearing and that each Committee
member shall perform the duties of a Committee member without impartiality or favoritism.

The Chairman of the Committee shall establish a hearing date. The House Officer and Department
Head shall be given at least five (5) working days notice of the date, time, and place of the hearing.
The Notice may be sent by certified mail to the address appearing in the records of the Human
Resource Management or may be hand delivered to the House Officer, Department Head, and
Academic Dean. Each party shall provide the Committee Chairman and the other party a witness list,
a brief summary of the testimony expected to be given by each witness, and a copy of all documents
to be introduced at the hearing at least three (3) working days prior to the hearing.

The hearing shall be conducted as follows:

The Chairman of the Committee shall conduct the hearing. Each party shall have the right to appear,
to present a reasonable number of witnesses, to present documentary evidence, and to cross-examine
witnesses. The parties may be excluded when the Committee meets in executive session. The House
Officer may be accompanied by an attorney as a nonparticipating advisor. Should the House Officer
elect to have an attorney present, the Department Head may also be accompanied by an attorney. The
attorneys for the parties may confer and advise their clients upon adjournment of the proceedings at
reasonable intervals to be determined by the Chairman, but may not question witnesses, introduce
evidence, make objections, or present argument during the hearing. However, the right to have an
attorney present can be denied, discontinued, altered, or modified if the Committee finds that such is
necessary to insure its ability to properly conduct the hearing. Rules of evidence and procedure are
not applied strictly, but the Chairman shall exclude irrelevant or unduly repetitious testimony. The
Chairman shall rule on all matters related to the conduct of the hearing and may be assisted by
University counsel. 10 The hearing shall be recorded. At the request of the Dean, Academic Dean, or
Committee Chairman, the recording of the hearing shall be transcribed in which case the House
Officer may receive, upon a written request at his/her cost, a copy of the transcript.

Following the hearing, the Committee shall meet in executive session. During its executive session,
the Committee shall determine whether or not the House Officer shall be terminated, or otherwise
have adverse actions imposed, along with reasons for its findings; summary of the testimony
presented; and any dissenting opinions. In any hearing in which the House Officer has alleged
discrimination, the report shall include a description of the evidence presented with regard to this
allegation and the conclusions of the Committee regarding the allegations of discrimination. The
Academic Dean shall review the Committee’s report and may accept, reject, or modify the
Committee’s finding. The Academic Dean shall render a decision within five (5) working days from
   LSUHSC Emergency Medicine Residency Handbook 10-11                                          67




receipt of the Committee’s report. The decision shall be in writing and sent by certified mail to the
House Officer, and a copy shall be sent to the Department Head and Dean.

If the Academic Dean’s final decision is to terminate or impose adverse measures and the House
Officer is dissatisfied with the decision reached by the Academic Dean, the House Officer may
appeal to the Dean, with such appeal limited to alleged violations of procedural due process only.
The House Officer shall deliver Notice of Appeal to the Dean within five (5) working days after
receipt of the Academic Dean’s decision. The Notice of Appeal shall specify the alleged procedural
defects on which the appeal is based. The Dean’s review shall be limited to whether the House
Officer received procedural due process. The Dean shall then accept, reject, or modify the Academic
Dean’s decision. The decision of the Dean shall be final.

A House Officer who at any stage of the process fails to file a request for action by the deadline
indicates acceptance of the determination at the previous stage.

Any time limit set forth in this procedure may be extended by mutual written agreement of the parties
and, when applicable the consent of the Chairperson of the Ad Hoc Committee.

SUMMARY SUSPENSIONS
The House Officer Program Director, or designee, or the Department Head or designee shall have the
authority to summarily suspend, without prior notice, all or any portion of the House Officer’s
appointment and/or privileges granted by University or any other House Officer training facility,
whenever it is in good faith determined that the continued appointment of the House Officer places
the safety of University or other training facility patients or personnel in jeopardy or to prevent
imminent or further disruption of University or other House Officer training facility operations.

Within two (2) working days of the imposition of the summary suspension, written reason(s) for the
House Officer’s summary suspension shall be delivered to the House Officer and the Academic
Dean. The House Officer will have five (5) working days upon receipt of the written reasons to
present written evidence to the Academic Dean in support of the House Officer’s challenge to the
summary suspension. A House Officer, who fails to submit a written response to the Academic Dean
within the five (5) day deadline, waives his/her right to appeal the suspension. The Academic Dean
shall accept or reject the summary suspension or impose other adverse action. Should the Academic
Dean impose adverse action that could significantly threaten a House Officer’s intended career, the
House Officer may utilize the due process delineated above. 11 The Department may retain the
services of the House Officer or suspend the House Officer with pay during the appeal process.
Suspension with or without pay cannot exceed 90 days, except under unusual circumstances.

OTHER GRIEVANCE PROCEDURES
Grievances other than those departmental actions described above or discrimination should be
directed to the Program Director for review, investigation, and/or possible resolution. Complaints
alleging violations of the LSUHSC EEO policy or sexual harassment policy should be directed to the
appropriate supervisor, Program Director, Director of Human Resource Management and EEO/ AA
Programs, or Ms. Flora McCoy, Labor Relations Manager (568-742).

Resident complaints and grievances related to the work environment or issues related to the
program or faculty that are not addressed satisfactorily at the program or departmental level
should be directed to the Associate Dean for Academic Affairs. For those cases that the resident
   LSUHSC Emergency Medicine Residency Handbook 10-11                                         68




feels can’t be addressed directly to the program or institution s/he should contact the LSU
Ombudsman. (GMEC October 2007)

OMBUDSMAN
Dr. Joseph Delcarpio, Associate Dean for Student Affairs is available to serve as an impartial,
third party for House Officers who feel their concerns cannot be addressed directly to their
program or institution. Dr. Delcarpio will work to resolve issues while protecting resident
confidentiality. He can be reached at 504-568-4874. (3/2010)
REVIEW OF TRAINING PROGRAMS
Each House Officer Program at the LSU School of Medicine-New Orleans will be reviewed
regularly between accreditation site visits and in accordance with the ACGME guidelines. The
Graduate Medical Education Committee (GMEC) is a standing school committee charged with
the oversight of Graduate Medical Education. Program evaluation is accomplished by a detailed
internal site visit process quite similar to the regular ACGME site visit.
At the conclusion of the GMEC review, the committee should make recommendations, formulate
a suggested action plan if necessary, and summarize its findings for each program reviewed.
Minutes and summary reports should be filed in the GME Office. Serious programmatic
problems should be brought to the attention of the Department Head and the Dean.

OMBUDSMAN
Dr. Joseph Delcarpio, Associate Dean for Student Affairs is available to serve as an impartial,
third party for House Officers who feel their concerns cannot be addressed directly to their
program or institution. Dr. Delcarpio will work to resolve issues while protecting resident
confidentiality. He can be reached at 504-568-4874. (3/2010)
.
   LSUHSC Emergency Medicine Residency Handbook 10-11                                       69




                               Satisfactory Academic Standing

         The EM residency program maintains a standard of satisfactory academic standing. The
program director will assess your standing at minimum twice a year and will notify you if you
are not meeting these minimum standards and assist you in formulating a remediation plan. The
definition of satisfactory academic standing in our residency includes, but is not limited to the
following:

       a. Pass assigned monthly open-book CORD exams with a grade of 75 or above-- prior
          to scheduled deadline.
       b. Conference (didactic and non-didactic home study) and Journal Club attendance
          overall 70 percent or more (excluding vacation time)
       c. Carry out assigned lectures and journal clubs.
       d. Take and teach BLS, ACLS, PALS or any residency associated course when
          assigned.
       e. Meet all scheduling requirements of each monthly rotation.
       f. Complete all medical records in a timely fashion.
       g. Meet all ACGME and residency requirements for duty hours.
       h. Score at or above the national average for your level of training on the National In-
          Service examination.
       i. Complete and submit monthly evaluation forms prior to the 15th of next month.
       j. Maintain a procedure log which is updated at least quarterly.
       k. Abide by moonlighting policy in the Moonlighting Policy.
       l. Maintain a minimum performance level of ―acceptable‖ based on monthly rotation
          evaluations.
    LSUHSC Emergency Medicine Residency Handbook 10-11                 70




                                                  Evaluations

Resident Evaluation

   Resident Monthly Rotation Evaluation
   Resident 6 Month Faculty Advisor Evaluation
   Resident End of the Year Evaluation
   Resident 360 Evaluation: filled out by peers, faculty and nurses
   Resident Post Graduate Survey and Evaluation



Program Evaluations

   Rotation and Special Topic Evaluations
   EM Lecture Evaluation
   EM Resident Anonymous Annual Faculty Evaluations
   End of the Year Program Evaluation
   GME End of the Year Questionnaire
   EM Faculty Peer Review
     LSUHSC Emergency Medicine Residency Handbook 10-11                                                                                     71




Monthly evaluation of Residents by Faculty

FROM: LSUHSC-New Orleans Emergency Medicine Residency Program (or may be complete online in ResidencyPartner)
              (504) 903-3594 Fax: 903-0321
TRAINEE ______________________________             SERVICE:______________________________
DATE OF ROTATION______________________________ LOCATION: ______________________________

Scale: (na) Not Applicable, not observed, Unacceptable, Acceptable, Outstanding If Unacceptable or Outstanding, please provide example.
 MEDICAL KNOWLEDGE :
 □    □ Inadequate: Does not display understanding       □ Acceptable. Has appropriate knowledge            □ Outstanding. Superior knowledge & mature
 n    of basic science or clinical information, or       base for level of training and is able to relate   application of knowledge to clinical setting.
 a    unable to relate knowledge to cases. Does not      it to clinical setting. Recognizes life-           Consistently able to sequence critical actions for
      recognize life-threatening conditions. Unable      threatening conditions; may require                patient care and generate a differential diagnosis
      to sequence critical actions.                      assistance in sequencing critical actions.         for an undifferentiated patient.
      Example:                                                                                              Example:

 PATIENT CARE: H&P, Differential Diagnosis
 □    □ Inadequate: Incomplete or inaccurate,            □ Acceptable. Usually complete and                 □ Outstanding. Comprehensive information,
 n    misses major problems.                             accurate, identifying major & minor                thorough, precise. Mature analysis & synthesis of
 a    Unable to make appropriate differential            problems with an appropriate differential          data by priority, extensive differential diagnosis.
      diagnosis or problem list.                         diagnosis list.                                    Example:
      Example:

 PATIENT CARE: Procedural Skills
 □    □ Inadequate: Doesn’t use proper technique,        □ Adequate: Uses proper technique,                 □ Outstanding. Precise, efficient performance
 n    awkward, bypasses steps, avoids procedures         organizes equipment; Occasional difficulty         with ease & dexterity, puts patient at ease
 a    or disorganized.                                   with complicated procedures.                       Example:
      Example:

 PATIENT CARE: Diagnostic Tests & Consultations
 □    □ Inadequate: Overlooks basic tests, unable to     □ Adequate: Orders & interprets diagnostic         □ Outstanding. Has planned alternative
 n    interpret results, consults are inappropriate or   tests, consults appropriately.                     strategies based on pending diagnostic test
 a    untimely.                                                                                             results. Consultations are timely and well-
      Example:                                                                                              coordinated with plan of care.
                                                                                                            Example:

 PATIENT CARE: Decision-making
 □    □ Inadequate: Decisions are risky, unsafe or       □ Adequate: Decisions typically accurate           □ Outstanding. Mature, safe, decisions based on
 n    inappropriate.                                     and safe, uses common sense. Able to triage        sound integration of data & reason. Prioritizing
 a    Example:                                           patients and problems by level of acuity.          and critical actions are consistently appropriate.
                                                                                                            Example:

 PRACTICE-BASED LEARNING: Evidence Based Medicine And Self-Education
 □    □ Inadequate: Doesn’t know patients, no            □ Adequate: Supplements patient care with          □ Outstanding. Extensive supplemental reading,
 n    reading or online learning evident.                current literature, textbooks or online            knows disease process of own and other patients.
 a    Example:                                           readings.                                          Example:

 PRACTICE-BASED LEARNING: Teaching
 □    □ Inadequate: Does not participate in teaching     □ Adequate: Participates in teaching               □ Outstanding. Develops teaching opportunities,
 n    students or other residents.                       opportunities. Actively teaches students &         motivates, and teaches with enthusiasm and
 a    Example:                                           junior residents, motivates learning.              dedication.
                                                                                                            Example:
 SYSTEMS-BASED PRACTICE: Resource Utilization
 □    □ Inadequate: Unable to formulate an               □ Adequate: Management and discharge               □ Outstanding. Management plan is typically
 n    appropriate, resource- or cost-effective           plan is appropriate for patient, with              comprehensive, precise, and resource- & cost-
 a    management plan.                                   consideration given to patient and hospital        effective.
      Example:                                           resources.                                         Example:

 PROFESSIONALISM: Work Habits
 □    □ Inadequate: Poor attendance, shirks              □ Adequate: Attends required activities,           □ Outstanding. Consistently attends extra
 n    responsibility, frequently late, prolonged         accepts responsibility, usually punctual and       functions, displays leadership role, highly
 a    absence on shifts. Prevaricates.                   organized. Occasionally performs extra             efficient. Stays late to help.
      Example:                                           functions, showing some independent                Example:
                                                         initiative.
     LSUHSC Emergency Medicine Residency Handbook 10-11                                                                            72




 PROFESSIONALISM: Insight And Self-Assessment
 □   □ Inadequate: Doesn’t accept criticism,         □ Adequate: Accepts constructive criticism,    □ Outstanding. Assesses own limitations &
 n   displays little insight.                        appropriately asks for assistance and          responds constructively to feedback.
 a   Example:                                        feedback.                                      Example:

 PROFESSIONALISM: Ethical and cultural sensitivity

 □   □ Inadequate: Not responsive to patient’s       □ Adequate: Responsive to patient’s age,       □ Outstanding. Consistently acts as an
 n   age, culture, disability or gender issues.      culture or gender issues. Demonstrates         outstanding role model, demonstrating
 a   Unaware of patient as a person.                 respect, compassion and integrity.             compassion and integrity in response to cultural,
     Example:                                                                                       gender, age or disability issues.
                                                                                                    Example:

 INTERPERSONAL & COMMUNICATION SKILLS: Team Member
 □   □ Inadequate: Doesn’t work well with others.    □ Adequate: Maintains good working             □ Outstanding. Highly regarded by team.
 n   Alienating, disrespectful to nurses, peers,     relationship with team. Respected by nurses,   Consensus-builder. Role model.
 a   consultants.                                    peers, consultants.                            Example:
     Example:


 INTERPERSONAL & COMMUNICATION SKILLS: Verbal, nonverbal and documentation skills
 □   □ Inadequate: Unable to create or sustain a     □ Adequate: Creates and sustains               □ Outstanding. Excellent verbal, nonverbal and
 n   therapeutic or ethical relationship with        therapeutic and ethical relationships with     writing skills. A role model
 a   patients. Ineffective listener. Unacceptable    patients and families. Effective listening,    Example:
     documentation.                                  verbal, nonverbal and writing skills.
     Example:

 SUMMARY RATING:


 □   □ Inadequate                                    □ Adequate                                     □ Outstanding
 n
 a

EVALUATOR:                     ______ SIGNATURE____________________________________ DATE:

ADDITIONAL
COMMENTS:____________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________
    LSUHSC Emergency Medicine Residency Handbook 10-11                                          73




Annual evaluation of Faculty by Residents

              RESIDENT EVALUATION OF EMERGENCY MEDICINE FACULTY
    SECTION OF EMERGENCY MEDICINE, LSU HEALTH SCIENCES CENTER, NEW ORLEANS

ATTENDING:

RATING SCALE: Please use the following 1-5 numbered rating scale. You may use decimal points.
1) Unsatisfactory   2) Marginal              3) Satisfactory          4) Good 5) Outstanding

CLINICAL PERFORMANCE:
1.    Overall knowledge                                                _______________
2.    Clinical judgment                                                _______________
3.    Communicates effectively with patients, staff, etc               _______________
4.    Availability during shifts                                       _______________
5.    Organization/administration of department                        _______________
6.    Is generally available during clinical shifts                    _______________
7.    Teaches while working clinical shifts                            _______________
8.    Sees patients while working clinical shifts                      _______________

CLINICAL TEACHING:
9.    Quality of teaching skills                                       _______________
10.   Encourages questions and discussion                              ______________
11.   Provides appropriate supervision for resident=s level            _______________
12.   Promotes practical application of knowledge                      ______________
13.   Conducts regular patient rounds                                  _______________

DIDACTIC TEACHING:
14.  Provides regular lectures                                         _______________
15.  Attends conference/journal club                                   _______________
16.  Quality of lectures                                               _______________
17.  Didactic knowledge of Emergency Medicine                          ______________
18.  Provides/offers assistance with research                          _______________

ROLE MODEL:
19.   Approaches responsibilities with enthusiasm                      ______________
20.   Demonstrates a genuine interest in residents                     ______________
21.   Displays professional and ethical behavior                       _______________
22.   Maintains good relations with house staff                        _______________



OVERALL CONTRIBUTION TO RESIDENCY PROGRAM:



ADDITIONAL COMMENTS:



LIST AT LEAST ONE AREA WHERE THIS ATTENDING COULD IMPROVE:
   LSUHSC Emergency Medicine Residency Handbook 10-11                                     74




Evaluation of Rotations by Residents

Rotation:_____________________________________________



                                          Unacceptable   Acceptable   Outstanding   n/a
Patient Pathophysioloy
Charting, documentation, administration
Faculty Supervision
Faculty Teaching Efforts
Nursing/ancillary Support
Duty hours
Balance between service & education
Clear goals & objectives


Please comment on any rating of unacceptable:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
___________________________________________

Anything that you think should be improved?
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_________________________________________________________
             LSUHSC Emergency Medicine Residency Handbook 10-11                            75




         Evaluation of Program by Residents   (part of year-end self eva)

 The residency

   What do you like best about our residency?
   What would you like to see changed about our
   residency?
Yearly residency requirements

 Have you met with your advisor this year?

 Are all ACGME required procedures logged into
 Residency Partner?
 Have all your monthly evaluations been
 completed?
 Have you submitted all scholarly activities and lectures to be
 filed in your portfolio?
 Does your conference attendance (including home study modules and
 journal club) exceed 70%?
 Have you completed the Core Competencies?

 Have you submitted your 20 patient follow-ups?
 Are you in compliance with the ACGME mandated duty-hour maximum of an average of
 60 hours per week (in ED), and 1 day off in 7, and minimum 10 hours off between shifts?
   LSUHSC Emergency Medicine Residency Handbook 10-11                                   76




6 month Evaluation of each Resident by Advisor

Resident:     _____________________________________
Date:         __________ HO-I    HO-II    HO-III   HO-IV

Monthly Evaluations
          July Aug        Sept    Oct    Nov       Dec   Jan Feb    Mar    Apr    May    June
Rotation
Eval

Current National In-Service Examination score: _______ Goal for next year_________

Residency Partner Data (Obtain from EM Coordinator prior to meeting)
               Conference attendance above 70%                    Yes No
               Procedure Log up to date                           Yes No
               Compliance with duty hours                         Yes No
              If answer “no” to any of above, please refer to Dr. Haydel immediately
Scholarly Activity:          Topic: ___________________________________
                             Faculty: __________________________________
       Progress:

       Completed: Y      N


Short-term goals:


Long-term goals:



Plans for PGY4 subspecialty track:



Resident comments, suggestions, requests, input:



Recommendations to resident:


Signatures:   ____________________          ____________________
              Faculty                       Resident
    LSUHSC Emergency Medicine Residency Handbook 10-11                                          77




Yearly Eval and Final Exit Evaluation of Resident by Program Director

PGY1 Meeting Date______________

     Medical Knowledge:
In-service score: _________ Goal for next year:________________ Plan:________________________
Mean monthly CORD test score:_____________
70% conference attendance:        yes     no
Medical Knowledge Monthly evals:       inadequate _____ adequate _______ outstanding ______
Medical Knowledge 360 degree:          inadequate _____ adequate _______ outstanding ______
Medical Knowledge Self evaluation:     inadequate _____ adequate _______ outstanding ______
Medical Knowledge action plan initiated: no     yes_________________________________________

     Patient Care:
Patient Care monthly Evals:            inadequate _____ adequate _______ outstanding ______
Procedure log vs ACGME targets         inadequate _____ adequate _______ outstanding ______
Patient care Self evaluation:          inadequate _____ adequate _______ outstanding ______
Patient care 360 degree:               inadequate _____ adequate _______ outstanding ______
Patient Care action plan initiated:   no     yes_____________________________________________

    Practice-Based Learning & Improvement:
Journal Club attendance 70 %:              yes      no
20 patient follow-ups completed:           yes      no
PB learning monthly evals:          inadequate _____ adequate _______ outstanding ______
PB learning Self eval:              inadequate _____ adequate _______ outstanding ______
PB learning 360 eval:               inadequate _____ adequate _______ outstanding ______
PB learning action plan initiated: no    yes ______________________________________________
____________________________________________________________________________________

    Systems Based Practice:
SBP Monthly Evaluation:            inadequate _____ adequate _______ outstanding ______
SBP 360 degree                     inadequate _____ adequate _______ outstanding ______
SBP Self evaluation:               inadequate _____ adequate _______ outstanding ______
Systems Based Practice action plan initiated: no   yes ____________________________________
____________________________________________________________________________________

    Professionalism:
Professionalism monthly evals:     inadequate _____ adequate _______ outstanding ______
Prof 360 degree                    inadequate _____ adequate _______ outstanding ______
Prof Self evaluation:              inadequate _____ adequate _______ outstanding ______
Conference attendance >70 % yes            no
Professionalism action plan completed: no       yes ________________________________________
____________________________________________________________________________________

    Interpersonal Communication Skills:
ICS monthly evals:            inadequate _____ adequate _______ outstanding ______
ICS 360 degree:               inadequate _____ adequate _______ outstanding ______
ICS Self evaluation:          inadequate _____ adequate _______ outstanding ______
ICS action plan completed:    no      yes ______________________________________________
____________________________________________________________________________________

Resident signature__________________________________________
Program Director___________________________________________
   LSUHSC Emergency Medicine Residency Handbook 10-11                                           78




PGY 2 Meeting Date______________

     Medical Knowledge:
In-service score: _________ Goal for next year:________________ Plan:________________________
Mean monthly CORD test score:_____________
70% conference attendance:        yes     no
Medical Knowledge Monthly evals:       inadequate _____ adequate _______ outstanding ______
Medical Knowledge 360 degree:          inadequate _____ adequate _______ outstanding ______
Medical Knowledge Self evaluation:     inadequate _____ adequate _______ outstanding ______
Medical Knowledge action plan initiated: no     yes_________________________________________
____________________________________________________________________________________

     Patient Care:
Patient Care monthly Evals:          inadequate _____ adequate _______ outstanding ______
Procedure log vs ACGME targets       inadequate _____ adequate _______ outstanding ______
Patient care Self evaluation:        inadequate _____ adequate _______ outstanding ______
Patient care 360 degree:             inadequate _____ adequate _______ outstanding ______
Patient Care action plan initiated: no     yes_____________________________________________
____________________________________________________________________________________

    Practice-Based Learning & Improvement:
Journal Club attendance 70 %:              yes      no
20 patient follow-ups completed:           yes      no
PB learning monthly evals:          inadequate _____ adequate _______ outstanding ______
PB learning Self eval:              inadequate _____ adequate _______ outstanding ______
PB learning 360 eval:               inadequate _____ adequate _______ outstanding ______
PB learning action plan initiated: no    yes ______________________________________________
____________________________________________________________________________________

    Systems Based Practice:
SBP Monthly Evaluation:            inadequate _____ adequate _______ outstanding ______
SBP 360 degree                     inadequate _____ adequate _______ outstanding ______
SBP Self evaluation:               inadequate _____ adequate _______ outstanding ______
Systems Based Practice action plan initiated: no   yes ____________________________________
____________________________________________________________________________________

    Professionalism:
Professionalism monthly evals:     inadequate _____ adequate _______ outstanding ______
Prof 360 degree                    inadequate _____ adequate _______ outstanding ______
Prof Self evaluation:              inadequate _____ adequate _______ outstanding ______
Conference attendance >70 % yes            no
Professionalism action plan completed: no       yes ________________________________________
____________________________________________________________________________________

    Interpersonal Communication Skills:
ICS monthly evals:            inadequate _____ adequate _______ outstanding ______
ICS 360 degree:               inadequate _____ adequate _______ outstanding ______
ICS Self evaluation:          inadequate _____ adequate _______ outstanding ______
ICS action plan completed:    no      yes ______________________________________________
____________________________________________________________________________________
____________________________________________________________________________________


Resident signature__________________________________________
Program Director___________________________________________
   LSUHSC Emergency Medicine Residency Handbook 10-11                                           79




PGY 3 Meeting Date______________

     Medical Knowledge:
In-service score: _________ Goal for next year:________________ Plan:________________________
Mean monthly CORD test score:_____________
70% conference attendance:        yes     no
Medical Knowledge Monthly evals:       inadequate _____ adequate _______ outstanding ______
Medical Knowledge 360 degree:          inadequate _____ adequate _______ outstanding ______
Medical Knowledge Self evaluation:     inadequate _____ adequate _______ outstanding ______
Medical Knowledge action plan initiated: no     yes_________________________________________
____________________________________________________________________________________

     Patient Care:
Patient Care monthly Evals:          inadequate _____ adequate _______ outstanding ______
Procedure log vs ACGME targets       inadequate _____ adequate _______ outstanding ______
Patient care Self evaluation:        inadequate _____ adequate _______ outstanding ______
Patient care 360 degree:             inadequate _____ adequate _______ outstanding ______
Patient Care action plan initiated: no     yes_____________________________________________
____________________________________________________________________________________

    Practice-Based Learning & Improvement:
Journal Club attendance 70 %:              yes      no
20 patient follow-ups completed:           yes      no
PB learning monthly evals:          inadequate _____ adequate _______ outstanding ______
PB learning Self eval:              inadequate _____ adequate _______ outstanding ______
PB learning 360 eval:               inadequate _____ adequate _______ outstanding ______
PB learning action plan initiated: no    yes ______________________________________________
____________________________________________________________________________________

    Systems Based Practice:
SBP Monthly Evaluation:            inadequate _____ adequate _______ outstanding ______
SBP 360 degree                     inadequate _____ adequate _______ outstanding ______
SBP Self evaluation:               inadequate _____ adequate _______ outstanding ______
Systems Based Practice action plan initiated: no   yes ____________________________________
____________________________________________________________________________________

    Professionalism:
Professionalism monthly evals:     inadequate _____ adequate _______ outstanding ______
Prof 360 degree                    inadequate _____ adequate _______ outstanding ______
Prof Self evaluation:              inadequate _____ adequate _______ outstanding ______
Conference attendance >70 % yes            no
Professionalism action plan completed: no       yes ________________________________________
____________________________________________________________________________________

    Interpersonal Communication Skills:
ICS monthly evals:            inadequate _____ adequate _______ outstanding ______
ICS 360 degree:               inadequate _____ adequate _______ outstanding ______
ICS Self evaluation:          inadequate _____ adequate _______ outstanding ______
ICS action plan completed:    no      yes ______________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Resident signature__________________________________________
Program Director___________________________________________
   LSUHSC Emergency Medicine Residency Handbook 10-11                                           80




PGY 4 Meeting Date______________

     Medical Knowledge:
In-service score: _________ Goal for next year:________________ Plan:________________________
Mean monthly CORD test score:_____________
70% conference attendance:        yes     no
Medical Knowledge Monthly evals:       inadequate _____ adequate _______ outstanding ______
Medical Knowledge 360 degree:          inadequate _____ adequate _______ outstanding ______
Medical Knowledge Self evaluation:     inadequate _____ adequate _______ outstanding ______
Medical Knowledge action plan initiated: no     yes_________________________________________
____________________________________________________________________________________

     Patient Care:
Patient Care monthly Evals:          inadequate _____ adequate _______ outstanding ______
Procedure log vs ACGME targets       inadequate _____ adequate _______ outstanding ______
Patient care Self evaluation:        inadequate _____ adequate _______ outstanding ______
Patient care 360 degree:             inadequate _____ adequate _______ outstanding ______
Patient Care action plan initiated: no     yes_____________________________________________
____________________________________________________________________________________

    Practice-Based Learning & Improvement:
Journal Club attendance 70 %:              yes      no
20 patient follow-ups completed:           yes      no
PB learning monthly evals:          inadequate _____ adequate _______ outstanding ______
PB learning Self eval:              inadequate _____ adequate _______ outstanding ______
PB learning 360 eval:               inadequate _____ adequate _______ outstanding ______
PB learning action plan initiated: no    yes ______________________________________________
____________________________________________________________________________________

    Systems Based Practice:
SBP Monthly Evaluation:            inadequate _____ adequate _______ outstanding ______
SBP 360 degree                     inadequate _____ adequate _______ outstanding ______
SBP Self evaluation:               inadequate _____ adequate _______ outstanding ______
Systems Based Practice action plan initiated: no   yes ____________________________________
____________________________________________________________________________________

    Professionalism:
Professionalism monthly evals:     inadequate _____ adequate _______ outstanding ______
Prof 360 degree                    inadequate _____ adequate _______ outstanding ______
Prof Self evaluation:              inadequate _____ adequate _______ outstanding ______
Conference attendance >70 % yes            no
Professionalism action plan completed: no       yes ________________________________________
____________________________________________________________________________________

    Interpersonal Communication Skills:
ICS monthly evals:            inadequate _____ adequate _______ outstanding ______
ICS 360 degree:               inadequate _____ adequate _______ outstanding ______
ICS Self evaluation:          inadequate _____ adequate _______ outstanding ______
ICS action plan completed:    no      yes ______________________________________________
____________________________________________________________________________________
____________________________________________________________________________________


Resident signature__________________________________________
Program Director___________________________________________
    LSUHSC Emergency Medicine Residency Handbook 10-11                                                       81




Final summary

Meeting Date:______________________

Date started residency__________________ Graduation date______________________


The graduation requirements met for:
        Medical Knowledge:                           yes    no
        Patient Care:                                yes    no
        Practice Based Learning:                     yes    no
        Systems Based Practice:                       yes    no
        Professionalism:                             yes    no
         Interpersonal Communication Skills           yes    no

Based on the observations of the program director and faculty of the LSU Emergency Medicine Residency Program,
this resident has demonstrated sufficient professional ability to practice independently and is eligible to take the
ABEM boards.

Resident signature & date _________________________________________________
Program Director & date __________________________________________________

Comments -
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
________________________________________________________________________________________
    LSUHSC Emergency Medicine Residency Handbook 10-11                                                         82




The ACGME which oversees all residency review committees has recommended that residents be taught and
evaluated using 6 core competencies. At LSUHSC-New Orleans, the Emergency Medicine residency program uses
the following parameters to evaluate our residents within the 6 core competencies.

1. Medical Knowledge: Residents must demonstrate knowledge about established and evolving biomedical,
clinical, and cognate (e.g. epidemiological and social-behavioral) sciences and the application of this knowledge to
patient care. Residents are expected to demonstrate an investigatory and analytic thinking approach to clinical
situations and to know and apply the basic and clinically supportive sciences which are appropriate to their
discipline. We use the monthly CORD tests, the annual National inservice and monthly resident evaluations to
evaluate medical knowledge and each year a Medical Knowledge (MK) action plan is developed by the program
director and the resident.

2. Patient Care: Residents must be able to provide patient care that is compassionate, appropriate, and effective
for the treatment of health problems and the promotion of health. Residents are expected to:
     1. communicate effectively and demonstrate caring and respectful behaviors when interacting with patients
          and their families
     2. gather essential and accurate information about their patients
     3. make informed decisions about diagnostic and therapeutic interventions based on patient information,
          preferences, up-to-date scientific evidence, and clinical judgment
     4. develop and carry out patient management plans
     5. counsel and educate patients and their families
     6. use information technology to support patient care decisions and patient education
     7. perform competently all medical and invasive procedures considered essential for the area of practice
     8. provide health care services aimed at preventing health problems or maintaining health
     9. work with health care professionals, including those from other disciplines, to provide patient-focused care

We use core competency based monthly evaluations and the yearly 360 degree evaluation to measure the ability of a
resident to provide acceptable patient care. Any deficiencies are addressed in a Patient Care (PC) action plan
developed by the program director and the resident.

3. Practice Based Learning and Improvement: Residents must be able to investigate and evaluate their patient
care practices, appraise and assimilate scientific evidence, and improve their patient care practices. Residents are
expected to:
     1. Analyze practice experience and perform practice-based improvement activities using a systematic
         methodology
     2. Obtain and use information about their own population of patients and the larger population from which
         their patients are drawn
     3. Locate, appraise, and assimilate evidence from scientific studies related to their patients’ health problems
     4. Apply knowledge of study designs and statistical methods to the appraisal of clinical studies and other
         information on diagnostic and therapeutic effectiveness
     5. Use information technology to manage information, access on-line medical information; and support their
         own education
     6. Facilitate the learning of students and other health care professionals

We evaluate our residents performance in the area of Practice Based Learning and Improvement by participation in
our monthly Journal Club, completion of assigned online problem based learning tasks, teaching ACLS, PALS
and/or ATLS, completion of monthly patient follow-ups and death summaries and monthly resident evaluations.
Any deficiencies are addressed in the year-end evaluation and a Problem Based Learning (PBL) action plan is
developed by the program director and the resident.

4. Systems Based Practice: Residents must demonstrate an awareness of and responsiveness to the larger context
and system of health care and the ability to effectively call on system resources to provide care that is of optimal
value. Residents are expected to:
    LSUHSC Emergency Medicine Residency Handbook 10-11                                                         83




    1.   Know how types of medical practice and delivery systems differ from one another, including methods of
         controlling health care costs and allocating resources
    2.   Practice cost effective health care and resource allocation that do not compromise quality of care
    3.   Advocate for quality patient care and assist patients in dealing with system complexities
    4.   Partner with health care managers and health care providers to assess, coordinate

We evaluate our resident’s progress in the area of Systems Based Practice by means of the monthly resident
evaluations and the yearly 360 degree evaluation. Any deficiencies are addressed in the year-end evaluation and a
System Based Practice (SBP) action plan is developed by the program director and the resident.


5. Professionalism: Residents must demonstrate a commitment to carrying out professional responsibilities,
adherence to ethical principles, and sensitivity to a diverse patient population. Residents are expected to:
1. Demonstrate respect, compassion and integrity
2. Demonstrate a commitment to ethical principles
3. Demonstrate sensitivity and responsiveness to patients’ culture, age, gender and disabilities

We evaluate Professionalism in our residents via the 360 degree evaluation and monthly evaluations, and
maintaining conference attendance of 70%. Any deficiencies are addressed in the year-end evaluation and a
Professionalism (P) action plan is developed by the program director and the resident.

6. Interpersonal and Communication Skills: Residents must be able to demonstrate interpersonal and
communication skills that result in effective information exchange and teaming with patients, their patients families,
and professional associates. Residents are expected to:
    1. create and sustain a therapeutic and ethically sound relationship with patients
    2. use effective listening skills and elicit and provide information using effective nonverbal, explanatory,
         questioning, and writing skills
    3. work effectively with others as a member or leader of a health care team or other professional group

We evaluate Interpersonal and Communication Skills in each resident via the monthly evaluations, yearly 360
degree evaluation and punctuality for assigned shifts. Any deficiencies are addressed in the year-end evaluation and
an Interpersonal and Communication Skills (ICS) action plan is developed by the program director and the resident.
   LSUHSC Emergency Medicine Residency Handbook 10-11                                         84




                                        Faculty Advisors

Evaluation of Resident Documents Policy
Residents must meet once a year with their faculty advisors to review their evaluations, discuss
their research project, present their procedure books, and generally give feedback regarding their
experiences and performance in the residency. An evaluation must be filled out, signed and
placed in the Resident file following each meeting,

HO I year –twice a year, HO II year - at six months HO III year - at six months HO IV year - at
six months`


All house officers will meet with the Residency Program Director to review goals, procedures
and future direction annually. Faculty advisor assignments for all residents are listed every year.
    LSUHSC Emergency Medicine Residency Handbook 10-11                                                                   85




                             Procedure and Patient Experience Documentation

Each resident must document patient experiences and procedures during residency. The program
must be able to demonstrate to its accrediting agency that you receive adequate experience. You
will also be asked to document your experience for future employers. This is considered part of
your residency portfolio and will be reviewed quarterly by the program director.

Residents without documentation of patient care experience will not be allowed to proceed to
next house officer level or graduate from the residency program. The residency director will not
certify your competence for your future employers if you have not documented adequate
competency in emergency medicine procedures.

Typical procedures that requiring minimal representation in procedure logs include intravenous
access, foley catheter placement, nasogastric tube placement, gastric lavage, extremity splinting,
simple suturing, simple incision and drainage, institution of mechanical ventilation. Typical
procedures requiring maximal representation include chest tubes, intubation rapid sequence
intubations, pediatric and adult sedation, central line placement, cricothyroidotomy,
throracotomy, fracture/dislocation reduction, urethrogram, cystogram, complex lacerations,
complex incision and drainage, intravenous pacemaker placements, trauma resuscitation, cardiac
arrest resuscitation, complex medical resuscitation, rape examinations, obstetrical deliveries, and
foreign body removal. Supervision and instruction of procedures should be documented on the
web based worksheet (Residency Partner).



Procedures And Resuscitations –ACGME goals
Numbers include both patient care and laboratory simulations

                             Adult medical resuscitation                                      45
                             Adult trauma resuscitation                                       35
                             ED Bedside ultrasound                                            #
                             Cardiac pacing                                                   06
                             Central venous access                                            20
                             Chest tubes                                                      10
                             Procedural sedation                                              15
                             Cricothyrotomy                                                   03
                             Dislocation reduction                                            10
                             Intubations                                                      35
                             Lumbar Puncture                                                  15
                             Pediatric medical resuscitation                                  15
                             Pediatric trauma resuscitation                                   10
                             Pericardiocentesis                                               03
                             Vaginal delivery                                                 10
 The primary responsibility for the determination of procedural competency rests with the program director and the faculty. The
RRC accredits programs, and does not certify or credential individuals. ACGME2007
# See ultrasound guidelines below.
   LSUHSC Emergency Medicine Residency Handbook 10-11                                       86




Ultrasound
The ACEP policy statement recommends that an emergency physician receive didactic training
and hands-on experience to become proficient in bedside emergency ultrasound. There are six
commonly recognized "primary applications" for bedside emergency ultrasound. These
applications, and the minimum number of training exams ACEP recommends for proficiency are
outlined below:
                  Primary Application                           Training Exams
                  FAST (Focused Abdominal Sonography in Trauma)       25
                  RUQ                                                 25
                  Renal                                               25
                  AAA                                                 25
                  Cardiac                                             25
                  Early pregnancy
                    transabdominal                                    25
                    transvaginal                                      25
The ACEP guidelines further state that in order for a training scan to count towards
credentialing, the findings of the scan must be confirmed by direct supervision, over-read of
saved images, other confirmatory testing (ultrasound, CT, MRI, etc.), or clinical outcome. These
must be documented on residency partner.




The residency is required to make a statement about each resident's competency in certain
procedures.

      Please remember to document all procedures, including simulation and cadaver labs in
       Residency Partner .
      You must complete all readings and Cord post-tests before the end of PGY2.
      You are required to submit, at minimum, documentation that you have completed the
       ACGME targets before you graduate.

We have provided yearly targets to help you stay on track. In addition, you must submit formal
evaluations of some procedures, which will be kept in you
    LSUHSC Emergency Medicine Residency Handbook 10-11                                       87




                                                    Removal of rust ring
Common Procedures                                   Tooth replacement
                                                                Hemodynamic Techniques
The following are Procedures and Skills             Arterial catheter insertion
                                                    Central venous access
Integral to the Practice of Emergency
                                                        1. Femoral
Medicine from the Model of the Clinical                 2. Femoral
Practice of Emergency Medicine                          3. Jugular
                                                        4. Subclavian
                Airway Techniques                       5. Umbilical
Airway adjuncts                                         6. Venous cutdown
Cricothyrotomy                                      Intraosseous infusion
Heimlich maneuver                                   Peripheral venous cutdown
Intubation                                          Blood and Component Therapy Administration
    1. Nasotracheal                                                      Obstetrics
    2. Orotracheal                                  Delivery of newborn
    3. Rapid sequence                                   1. Abnormal delivery
Mechanical ventilation                                  2. Normal delivery
Percutaneous transtracheal ventilation                              Other Techniques
                   Anesthesia                       Excision of thrombosed hemorrhoids
Local infiltration                                  Foreign body removal
Digital block                                       Gastric lavage
Regional nerve block                                Gastrostomy tube replacement
Sedation - analgesia for procedures                 Incision/Drainage
                                                    Physical restraints
               Diagnostic Procedures                Sexual assault examination
Anoscopy                                            Trephination, nails
Arthrocentesis                                      Wound closure techniques
Bedside ultrasonography                             Wound management
Cystourethrogram                                    Universal Precautions
Lumbar puncture                                                        Resuscitation
Nasogastric tube                                    Cardiopulmonary resuscitation (CPR)
Paracentesis                                        Neonatal resuscitation
Pericardiocentesis                                  PALS & ACLS
Peritoneal lavage                                   Adult and Pediatric ATLS
Slit lamp examination
Thoracentesis                                                      Skeletal Procedures
Tonometry                                           Fracture/Dislocation immobilization techniques
                  Genital/Urinary                   Fracture/Dislocation reduction techniques
Bladder catheterization                             Spine immobilization techniques
     1. Foley catheter                                                  Thoracic
     2. Suprapubic                                  Cardiac pacing
Testicular detorsion                                    1. Cutaneous
                   Head and Neck                        2. Transvenous
Control of epistaxis                                Defibrillation/Cardioversion
     1. Anterior packing                            Thoracostomy
     2. Cautery                                     Thoracotomy
     3. Posterior packing/Balloon placement
Laryngoscopy
Needle aspiration of peritonsillar abscess
   LSUHSC Emergency Medicine Residency Handbook 10-11                                    88




                                                   Follow-up/ Inpatient Course/ Autopsy
Follow-Up Log                                      report:
                                                   ____________________________________
                                                   ____________________________________
ED RESIDENT FOLLOW-UP                              ____________________________________
SHEET                                              ____________________________________
                                                   ____________________________________
                                                   ____________________________________
Initials: ________________                         ____________________________________
MR#: __________________
                                                   Final Diagnosis:
Case Details:                                      ____________________________________
____________________________________               ____________________________________
____________________________________               ____________________________________
____________________________________
____________________________________               Education Point:
____________________________________               ____________________________________
____________________________________               ____________________________________
____________________________________               ____________________________________
____________________________________               ____________________________________
____________________________________
____________________________________               Patient Feedback / Satisfaction:
____________________________________               ____________________________________
____________________________________               ____________________________________
____________________________________               ____________________________________
____________________________________               ____________________________________
____________________________________
____________________________________               ED Resident:
____________________________________               ____________________________________
________________________________
                                                   Must submit 10 patient follow-up forms per
ED Diagnosis:                                      year, including ED expirations referred to
____________________________________               ME/coroner. Follow-up can be achieved via
____________________________________               the cliq system. To obtain an autopsy report
____________________________________               done at MCLANO, email Dr. Robin
____________________________________               McGoey in the Dept of Pathology
                                                   (rmcgoe@lsuhsc.edu) with the patient’s
Return to mail box of Dr. Detiege                  name and medical record number. The
                                                   follow up documentation will be through
                                                   Residency Partner.
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                               89




                                            Residency Partner


RESIDENCY PARTNER COMPUTER SOFTWARE PROGRAM
House Officer will be required to comply with institutional policy regarding duty hours
monitoring / recording through the use of Residency Partner Computer Program. House Officer
must record their duty hours for ACGME compliance by entering the data in the Duty Hours
Module of Residency Partner. Periodic monitoring will be done to ensure that duty hours are
being logged into the system.

Residency Partner is the official web-based system for tracking all resident and fellow demographic
information and rotation schedules. It is also used by residents to complete duty hours, procedure logs
and evaluations.

Information for residents, fellows and attendings:

       Residency Partner login
       Quick Start Card
       Resident frequently asked questions

    For procedures: login to residency partner, go to “cases”, click on “new”, put in correct date, institution
    and supervisor; the default will be “Emergency Medicine” and “ACGME”. Under ACGME procedures
    you will find the main procedures you should be logging. If the procedure is not listed under ACGME,
    then look under ER. Please use the ACGME link preferentially and just write in under comments any
    specifics. (ie, “central venous access” is an ACGME procedure, then you can type in “femoral” or
    “subclavian” under comments). You can input more than one procedure per patient, but when you
    are finished inputting each procedure MAKE SURE you click “Add CPT to Experience” and then click
    “Save” when you are finished with that patient.

Information for Program Directors and Coordinators

       Gumbo server login
       Residency Partner user's guide
       Residency Partner frequently asked questions

Request Residency Partner Support - get help with obtaining access to Residency Partner.

.
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                   90




                                        Educational Stipend

The program has a Fund for the EM residents, which is managed by LSU. A total of $1,000.00
is allotted to each resident for conference expenses and medical texts aside from those that the
program provides. You must obtain ADVANCED approval by Dr. DeBlieux to use these funds.

The residency program will reimburse residents participating in conferences as presenters of case
reports and research above the allotted $1,000.00. Meetings located outside of the continental
U.S. are evaluated on a case-by-case basis.

In order to obtain reimbursement for books, palm pilots, software and subscriptions, the original
receipts must be turned in to the coordinator of the section of emergency medicine. This is
different from the forms for travel and the travel reimbursement. Laptops and personal
computers CANNOT be covered by the stipend.

For travel expenses and conference fees reimbursement, the request MUST be made 1 month
BEFORE the conference, NOT afterwards (or you may not be paid). Information that should
accompany the request is the following:

1.      Name and location of the conference.

2.      Date of conference.

3.     Registration Fee.

4.      Airfare.

5.      Official brochure of conference.

PLEASE NOTE:

The amount of money that is reimbursed for travel expenses is determined by state regulations
and may only partially cover airfare, food and lodging expenses.

In order to receive money, residents must be in good standing and must not have any outstanding
obligations to the residency program. All procedure logs, rotation evaluations, rotation study
guide answers, remedial assignments, faculty resident meetings, etc. must be completed before
checks can be issued.
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                                            Travel Forms

https://intranet.lsuhsc.edu/forms/
Get the Prior Approval Request For Travel Form PDF format, and
Travel Expense Voucher Form PDF format
For air travel you need to pay with the LSU corporate credit card
 VISA Application Form for Corporate Travel Card PDF format
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                   92




                                          Mailboxes/ Email

        Residents have a mailbox in the residency office on the 5th floor which serves as a major
means of communication in the program. Residents are expected to check their box daily and are
required to do so once a week in order to receive important memos and messages on a timely
basis. Ignorance of assigned activities due to failure to check your mailbox will not be
considered a legitimate excuse. The boxes in the residency office are for program
communications only. Please have journals and other mail sent to your home or your mailbox in
the Mailroom in the basement of the hospital. If you have email and wish to have your memos
delivered via this method as well as your traditional mail box notify the secretary of your
request. Each resident is required to maintain an active LSUHSC email account. You are
required to check your LSUHSC email at least once a week. Official LSU communications
are provided by LSU email.
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                                               Beepers

You are LOANED a beeper for your use during your residency. The beepers are leased by and
coordinated through LSU which gives a certain number to each residency program. The program
is given the responsibility of issuing beepers to you and receiving them back from you at the end
of your residency in order to reissue them to incoming residents. You are responsible for the
proper care and use of the beeper and for returning it in working condition to the residency
whenever requested.

If your beeper is stolen, lost, or broken, you must report this immediately to the residency
program. A $50 charge is assessed to the resident by the medical school to replace the beeper. A
check for $50.00 payable to LSU Medical Center should be given to the residency program
secretary who will forward it with appropriate paperwork in order to obtain a new beeper.

Replacement batteries are available in the Residency Office.


The residency program must be able to reach you by phone or beeper at all times.
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                                              Vacation

Each HO I receives 3 weeks of vacation which must be taken in one 2-week period and one
1-week period. The 1-week vacations must be taken during the first or last week of the month
and the 2-week vacations during the first or second half of the month, not during the middle. HO
II, II, and IV receive (2)two week vacations totaling 28 days. Interns and Residents who request
vacation during the second half of February must be in town to take the National InService Exam
which is given near the end of the month. Interns and Residents may not request vacation during
the last half of December.

Indicate your first and second choices for each of your vacation periods..

               Two-week Vacation                       Two-week Vacation

lst choice ____________ ____________            _____________ ____________
           (month)     (1st or 2nd half)         (month)      (1st or 2nd half)

2nd choice ____________ _____________ _____________ _____________
             (month)     (1st or 2nd half) (month)    (1st or 2nd half)

We will try to honor your requests but cannot guarantee that you will receive the choices
indicated above.

                                     Yearly Schedule Requests

Vacation requests -Vacation will be assigned based on seniority.

Once the annual schedule has been published, NO changes are allowed, other than due to
extraordinary circumstances. (Example: marriage, or birth of a child).

Concerns or questions regarding the annual schedule should be addressed in writing to the
Residency Director.

If a schedule change is made an official notification will be sent to the Residency Director, the
LSU payroll, the resident and the resident file.
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                    95




                                            ED Schedules

1. Seniority: Preference will be given to 5th years, then 4th years, then 3rd years concerning
   upper level schedules. Please be mindful of this when choosing your selections. The
   scheduling chief has data sheets on all residents in the program, and will be tracking your
   choices, special requests, schedule given, disaster calls, etc. The purpose is to accommodate
   all, while maintaining parity within the schedule.

2. Final Schedule: The final schedule for a month will be finished by the 1st of the month prior.
   After the final schedule is made, the scheduling chief will not make changes to your schedule
   unless speaking with you first. If glaring concerns arise or if someone is pulled off the
   rotation, then the chief will have to readjust the schedules. Otherwise, the only changes
   made to a monthly schedule after being finalized will be switches among residents or
   switches make only after consultation with that individual resident/s.

3. Resident Switches: When a switch occurs, the switch must be emailed to the Scheduling
   Chief. BOTH RESIDENTS MUST EMAIL THE CHIEF THE SWITCH. Please always
   remember when you are working, as forgetting that you are working will not be tolerated by
   any of the Chiefs or the program director. Missed shift will result in (at minimum) making
   up that shift and being assigned an additional penalty shift. Once the switch is made and
   both residents have emailed me, then the switch is final and valid. The responsibility of the
   shift is then on the resident who accepted the shift, not the original resident who was working
   the shift. If both residents do not email me, then the responsibility of the shift lies with the
   resident who is on the original schedule. When switching occurs, be mindful that 2nd years
   can only switch with 2nd years. 3rd 4th and 5th s can switch with each other. The only
   exception is if the 2nd year switches a shift with an upper level into an area where second
   years are allowed. As long as there exists a 3rd and 4th year in the MER at all times, then the
   switch can occur.

4. Penalty Shift: This is something we all would like to avoid. Penalty shifts will be assigned
   at the discretion of the disciplinary chief resident and the program director. A penalty shift
   will be assigned to a resident exhibiting inappropriate behavior. This includes but is not
   limited to not showing up for an assigned shift without calling, forgetting that you were
   working a shift, two unexcused absences from conference in a quarter, being on disaster call
   and being unable to be found for an activation, or other inappropriate behavior that will be
   interpreted on a case-by-case basis
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                                            Disaster Call

Purpose: To provide a uniform, consistent approach for coverage of emergency department
(MER & FT) resident shifts left vacant or uncovered due to sudden illness, personal emergencies
and scheduled leave of absences, including maternity and paternity leave. Disaster call may be
activated for the community ED rotations and Acadian Helicopter Shifts, if necessary.
Typically, if a resident must miss a shift in the community or on Acadian, they can make it up
that same month. Disaster call may also be activated for the MICU.

Description: The back-up call system will be addressed by two mechanisms: standard back-up
policy and extended backup policy. These systems will remedy short-term and long-term
absences, respectively. The short-term policy will be utilized for absences less than five days,
while the extended policy will be invoked for absences of five days or greater.

*Standard Back-Up Policy

Residents on off service rotations such as, Elective, Toxicology, and all others may be scheduled
for Disaster Call. If at all possible, and if the resident is needed to report for ED back-up work,
that resident will not be required to do more than 2 days of ED work. The residents providing
back-up coverage will be PGY II, III, IV.

*Extended Back-up Call Schedule

If the resident's absence extends beyond the coverage of the standard back-up schedule, the
extended to five days or greater or unexpectedly is extended to five days or greater, one resident
will be pulled from his/her rotation to cover the remaining portion of the month or the entire
month if the absence is anticipated prior to the first of the month. The resident will be pulled
from the rotation from which he or she is most expendable and which impacts ACGME training
requirements the least. The order of preference is the same as listed for the standard back-up
policy.

*In the event of no emergency medicine coverage of the above listed off-service rotations, the
Residency Director and the Assistant Residency Director, in conjunction with the chief residents,
will select an appropriate resident, or residents, for back-up coverage.

Qualifying situations: Situations deemed appropriate for the use of the disaster call schedule are
inclusive, but not limited to, the following events:

      Illness
      Family death
      Maternity/ Paternity leave (as defined by LSU under the Family Medical Leave Act)
      Suspension of hospital privileges
      Personal hardship (evaluated on an individual basis)
      Emotional hardship/illness (as defined by LSU Human Resources Dept)
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                       97




Program Benefits:The program and administration will benefit from a pre-determined back-up
call schedule. In the event of a crisis, the solution is available prior to the problem. This should
negate late scheduling difficulties and most conflicts, while maintaining the pre-determined
resident man-power needs of all areas of the emergency department.

Resident Benefits:The resident working in the emergency department will benefit from a secured
resident work force in the emergency department. No resident will ever be expected to assume
the responsibilities and work load of two residents. The resident requiring time off will not be
responsible for making up shifts for the back-up call residents. This debt is forgiven by each
resident functioning as the back-up call resident while rotating on the above mentioned services.
No resident will be allowed to abuse the use of the back-up call schedule system. However, if a
resident requests coverage from another resident for a shift in the emergency department for
personal reasons not deemed appropriate for official back-up coverage, the resident must repay
that shift to the covering resident. Furthermore, if a resident has an un-excused absence from a
shift in the emergency department, he or she must repay the covering resident for the shifts
covered. Residents repaying back-up call residents must work the same number of hours which
were covered during their absence.

Disaster Call Scheduling

1.Disaster Call schedules will be made in accordance with the monthly ED Schedule. Any
special requests concerning disaster call should be made 6 weeks prior to the month. The
number of calls taken per month will be dependent on seniority and needs of the schedule. A full
month disaster call can result in a maximum of 5 calls, and a ½ month of disaster call can result
in a maximum of 3 calls. If extra coverage is required beyond this, residents working an ED
month may have to take 12-24 hours of disaster call per month. These situations are rare but
may arise.

2. Covering Rotations: Residents on the following rotations will be on disaster call for that
particular month: Elective, Toxicology and Administration. 1st years do not take disaster call.
Disaster call is taken by 2nd, 3rd, 4th and 5th years only.

3. Time Covered: REMEMBER, the disaster call day starts at 7am, the morning of your date,
and ends at 7am the next day. This coincides with the shifts. Even though M3 and F3 shifts go
into another day, they started on the previous day.


4. Disaster Activations:
     A disaster call activation will be made by the Chief Resident on call that day.
     The resident with an emergency is to call the Chief Resident pager- 423-2537. Always
       call this pager when an emergency occurs or for any disaster activation.
     The Chief on call will have a copy of the schedule and disaster call and activate the
       disaster resident.
     If you are on call, it is your responsibility to have your pager on AT ALL TIMES.
     If you are unable to be found while on disaster call, this will result in a penalty shift.
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                  98




    The chief residents will serve as back-up disaster call in case two activations occur in one
       day. Each chief will take one week of back-up call per month. This year, each chief will
       be taking 3 months of back-up disaster call throughout the year.

5. Disaster switches: Email all switches to the Scheduling Chief Resident and copy ALL parties
involved in the switch.

Disaster Call & Duty Hours

Under no circumstances, will disaster duties exceed ACGME duty hour guidelines. See Duty
Hours - Emergency Medicine
Update April, 2004
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                                  Code Grey – Hurricane Guidelines

These guidelines have been setup in coordination with the Directors of Emergency Preparedness,
Dr. Aiken and Dr. Hardy, for the 2008 Hurricane season.

      Category 1 Hurricane — winds 74-95 mph--No real damage to buildings.
      Category 2 Hurricane — winds 96-110 mph--Some damage to building roofs, doors and windows. Some
       trees blown down.
      Category 3 Hurricane — winds 111-130 mph (Katrina at landfall) Some structural damage to small
       residences and utility buildings. Large trees blown down. Terrain may be flooded well inland.
      Category 4 Hurricane — winds 131-155 mph. Major erosion of beach areas. Terrain may be flooded well
       inland.
      Category 5 Hurricane — winds 156 mph and up. Complete roof failure on many residences and industrial
       buildings. Some complete building failures with small utility buildings blown over or away. Flooding
       causes major damage to lower floors of all structures near the shoreline. Massive evacuation of residential
       areas may be required.

Definitions:

      Media Definitions (what you will see on the news)
            o   A HURRICANE WATCH- you could experience hurricane conditions within 36 hours.
            o   A HURRICANE WARNING -winds of at least 74 mph are expected within 24 hours or less.

      Hospital Definitions:
          o Code Grey- Hurricane
                       Code Grey Watch: expected landfall 96 hours (4 days out)
                       Code Grey Warning: expected landfall 72 hours (3 days out)
                       Code Grey Activation: expected landfall 48 hours until 24 hours after landfall
                       Code Grey Recovery: 24 hours after landfall
                       Code Grey Evacuation: Hospital evacuation may be required and will be coordinated
                        by the Directors of Emergency Preparedness.

Overview:

      At the beginning of each academic year, the chief residents will develop a list of residents
       for the activation and recovery teams.
      Assignment to the activation team is strictly voluntary and will provide coverage for
       hospital and off-sites areas that we will cover during a storm.
      The activation team is committed to be in-house 48 hours before landfall and will stay
       until the recovery team arrives.
      When a Code Grey is initiated, the chief residents will assign residents currently rotating
       in the UH ED, toxicology, administration and local electives to the activation team and
       recovery team.
      The activation team consists of 9 residents. (3/shift in the ED, 2/shift off-site coverage)
      The recovery team consists of 9 residents—this will allow equal time off for the
       activation team after the storm threat has passed. In theory, the recovery time period will
       cover the same amount of time as the activation time period.
      Residents will be assigned to 12-hour shifts either in the ED or at an off-site staging area.
      Potential Off-Site Staging Areas: Lakefront airport, Convention Center, etc, to be
       assigned by the Directors of Emergency Preparedness.
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      Residents not assigned to either team are expected to be available during the recovery
       period for unexpected assignments.
      The recovery team is expected to be prepared to report for duty 24 hours after landfall.
      EM residents in the MICU and TICU will follow the MICU and TICU protocol for
       activation and recovery.
      Residents on community ED rotations will be released from duty at the onset of Code
       Grey Activation for Category 3 or above.
      All interns will must follow the guidelines on the service where assigned that month—in
       general, expect to be released from duties, if not needed to help in evacuation of patients
       on your service in the setting of a Category 3 or above storm.
      The EM offices on the 5th floor UH will act as the Residency Central Command Center
       and will be staffed by the program director and a chief resident during the Code Grey
       Warning phase.


Section of Emergency Medicine Telephone Activation Tree

         The purpose is to facilitate the flow of information from the Program Director to all
members of the residency. The tree will be activated at the onset of Code Grey Watch, and at
least every 12 hours thereafter, until termination of the Code Grey, or termination of recovery. It
is the responsibility of every faculty member to provide the Program Director with 2 reliable
telephone numbers, and 1 alternative email address. Please sign up for the LSU emergency
notification alert system: http://www.lsuhsc.edu/alerts/

        In addition, Dr. Haydel will serve as EM section communication officer during code grey
activations. It is anticipated that she will evacuate at the onset of code grey activation, and
establish a location from which she can act as a central point of contact and will disperse updates
via email and cell phone text messaging. In the event of a major storm with hospital service
disruption, the program directors, program coordinators and chief residents will meet at a pre-
assigned location to continue with the oversight of the residency. In the event that
communications are compromised the yahoo website will be updated regularly, and temporary
access will be given to family members and friends that identify themselves as looking for
information about a specific resident on the activation team:
http://health.groups.yahoo.com/group/LSUEM/

Phone Tree:
                                 Elder              PGY4s
                        Chief Pager
                                 Stevens            PGY3s
              Haydel
                                 Zorub              PGY2s
              &
              Avegno             Cole               PGY1s
                     IM/EM Chief McKay              IM/EM residents
                                                    on EM side
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Timeline

Under the direction of the Section Chief, the program director will activate the notification tree,
based upon the anticipated time required for residents to secure their homes and initiate their
personal hurricane plans. This will be no later than initiation of the hospital wide plan.

            96 hours to landfall (Code Grey Watch)
                 o Program Director and Chief Residents meet and establish the command center
                    for residency in 5th floor EM offices.
                 o A list of the Activation team must be sent to the medical director's office as
                    soon as a Code Grey Watch is announced.
                 o Activation Team notified in order to pack and prepare for activation.
            72 hours to landfall (Code Grey Warning)
                 o Activation Team physically checks into hospital to obtain arm bands, call
                    rooms, parking passes and discuss plan of action with Chiefs and Program
                    Director in EM office/5th floor. After checking in, the activation team may
                    leave the hospital to continue home preparation and packing.
                 o 12-hour shifts implemented in order to facilitate preparations.
            48 hours to landfall (Code Grey Activation)
                 o Activation Team must remain in-house until recovery team arrives.
                 o Community ED residents released from duty if Cat 3 or above.
                 o Non-essential interns released from duty at UH.

Advanced Personal Preparation: Each resident is urged to formulate a personal hurricane
preparation plan. This should include:
        A list of critical actions that must be accomplished during the short time available
           before the storm, such as securing pets, evacuation of family, securing the home.
        A list of items to pack, including 10-14 days of clothing, non-perishable food, water,
           bedding.
        A list of items that should be purchased in advance, such as rechargeable lights and
           batteries, a power inverter for your car (to recharge cell phones, lights, radios when
           the electricity fails), toiletries.
        A list of items needed to return to work during recovery, assuming that the city will
           be without power and water at the time return to work is required.
        Secure professional paperwork, licenses, personal photos, etc in ziplock bags.

What to expect if you stay at UH during a Cat 3 or above storm: Power will go out and generators will go on.
Generator power means no a/c, no elevators, no pumps in the basement, no pumping of water up to upper floors. No
sewer system and no drinkable tap water. Upper floor windows will be blown out by strong winds. Communication
within the hospital will be compromised, and communication with people outside the hospital will be almost
nonexistent: The pager system and intranet can be expected to fail. Cell towers will be lost—although text
messaging may remain intact for some. Patients and equipment will have to be moved from the first floor to the
second floor if flooding occurs. Residents in the hospital will provide care to inpatients and walk-ins until the
hospital is evacuated or the recovery team arrives. Residents assigned to off- site areas will provide care to patients
who are at the staging areas awaiting evacuation. If the hospital is closed due to damages, the Recovery teams will
be assigned (with faculty) to other sites to provide emergency care until the hospital can be reestablished.
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                    102




Advanced Life Support Programs Policy

                                        Revised May, 2004
 All Emergency Medicine and Emergency Medicine/Internal Medicine combined program
 Residents must maintain certification at the provider level for Basic Life Support
 Healthcare Provider (BLS-HP), Advanced Cardiac Life Support (ACLS), Pediatric
 Advanced life Support (PALS), and Advanced Trauma Life Support (ATLS). BLS, ACLS,
 and PALS courses are provided through the LSU Emergency Medicine / American Heart
 Association Community Training Center. ATLS courses are provided through Tulane
 University Hospital Life Support Office. Certification in each of these courses must be
 completed before December 31 of the intern year, and maintained throughout
 residency. The costs of initial provider courses are covered by the residency program.
 ATLS re-certification course costs are the responsibility of the resident. Failure to attend a
 scheduled provider course without the prior approval of the Residency Director will result
 in rescheduling of the course at the resident’s expense.

 All residents are required to become certified as ACLS and PALS instructors. Normally,
 Emergency Medicine house officers (PGY-I) receive ACLS and PALS instructor courses
 during intern orientation. Transferees or those who have an excused absence from these
 courses must complete a course before December 31 of the intern year. Instructor
 status is maintained throughout residency by participation in a minimum of 2 ACLS
 courses each year. At each course, the resident must provide 1 lecture and teach the
 corresponding small group session. Instructor and provider status are kept current by
 meeting the teaching requirement and successfully completing the ACLS provider test
 every 2 years, before expiration of the current instructor card. (It is the responsibility of
 each resident to complete re-certification before expiration of his/her current instructor
 card. The AHA does not allow a grace period under any circumstances. Failure to re-
 certify will require that the resident take a full provider and instructor course again.)
 Additionally, all residents are encouraged to certify as an instructor in 1 of the 2 other
 disciplines (ATLS, BLS).

 ATLS Instructor programs are offered through Tulane University Hospital Department of
 Community Education. Participation in the instructor program is by invitation of the
 Residency Program Director. Instructors may sign a contract with Tulane agreeing to
 provide service as an instructor in lieu of paying course tuition. The cost of the course is
 usually paid after teaching at 4-5 courses. Instructors must teach a lecture and
 corresponding small group session at least once per year. At the end of each 4 year cycle,
 an instructor in good standing may take the ATLS provider test to renew provider and
 instructor status. Schedules for ATLS courses are available through Tulane at 588-2212.

 Scheduling of instructors for ACLS, PALS, and BLS courses is the responsibility of the
 Chief Residents and the Training Center Coordinator. Failure to teach at an assigned
 course without prior notice will result in disciplinary action. (In the event that a resident
 encounters an unforeseen emergency that interferes with a scheduled course, he must notify
 the responsible Chief Resident 72 hours in advance of the course. Excuses less than 72
 hours in advance require the approval of the Director of the CTC, or the Residency
 Director.
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                     103




 Confirmation of compliance with this policy is required at each faculty advisor interval
 evaluation. Failure to satisfy the policy requirements will result in disciplinary action, at
 the discretion of the residency director. Disciplinary action may include suspension of
 moonlighting privileges and additional life support teaching responsibilities.
Revision 05/08/04 RS

Addendum – ACLS/PALS Course Directors (effective July 2004)
ACLS/PALS teaching and scheduling are an important part of resident education, community
outreach, and chief responsibility. Previously, however, non-chief residents with a real interest
in ACLS/PALS had little opportunity for initiative or responsibility. The following change seeks
to improve resident investment in the ACLS/PALS courses without compromising the courses’
quality.

Chief Residents will continue to make the overall master schedule for the year of who teaches
what when. Every month, the 4th (and possibly 3rd) year resident on elective will be that month’s
ACLS/PALS director. This resident is responsible for reminding residents scheduled to teach
and assigning a lecture/small group slot to each; touching base with Nona and Kathleen in the
immediate pre-course period to confirm room locations etc.; supervising resident lectures; and
filling in when there is a gap in one of the lectures or stations. Directors will each receive a
handout with information and a timeline that would have to be completed and turned in to the
Chief Residents at the completion of the course for documentation and quality assurance
purposes. Being the director would count as one’s ACLS/PALS requirement for the year –
chiefs would oversee the activities of the director and remain ―on-call‖ as double back-up for
lectures, etc.

Chiefs, in coordination with the monthly ACLS/PALS director, would handle any disciplinary
issues related to residents not showing up to teach, not doing a good job, etc. Any failure to
teach when assigned and properly notified ahead of time would result in an extra ED shift (as
noted above).

Commencing January 2001, interval faculty advisor/resident evaluations will include
confirmation that the resident has:

      successfully completed provider courses in ACLS, PALS, and ATLS.
      achieved instructor status in ACLS.
      achieved instructor status in BLS, PALS, or ATLS.
      met all teaching requirements as specified by the AHA or ACS for maintenance of
       instructor status.

Commencing January 2001, the penalty for noncompliance with the stated policy may include
actions outlined above, including suspension of moonlighting privileges.

Questions or comments regarding this policy should be directed to a Chief Resident, or to the
Program Director.
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                                      104




                                                 Moonlighting Policy

All residents must read and sign the attached acknowledgement to confirm that you are aware of and understand the
residency program's policies regarding moonlighting.

1. Although it is recognized that supplemental income from moonlighting is used by residents to offset financial
obligations from undergraduate and medical school training, moonlighting activities can in no way be permitted to
compromise your school functions as a House Officer or to detract from your learning experience.

2. Moonlighting is permitted for emergency medicine residents who maintain a satisfactory academic status (see
section on Liaison & Oversight Policy) and meet all their residency associated clinical and teaching
responsibilities. Specifically, residents who wish to moonlight must:
         a. Take and pass monthly cord exams by the prescribed completion dates.
         b. Adhere to all conference attendance policies. Any absence due to moonlighting will result in a
              permanent loss of moonlighting privileges.
         c. Take and teach BLS, ACLS, PALS or any residency associated course when assigned.
         d. Meet all scheduling requirements of each monthly rotation. Schedules will not be will not modified to
              accommodate moonlighting commitments.
         e. Complete all medical records in a timely fashion.
         f. Meet any and all requirements that may be set forth regarding moonlighting.
         g. Pass the National In-service Exam with a score of 75% or more.

3. Residents may not enter into any contractual agreements to provide any type of medical service on a regularly
scheduled basis as this would interfere with the resident's clinical duties. Contracts which do not require regular and
consistent moonlighting may be acceptable and should be submitted to the program director for approval.

4. Any resident who has been placed on probation may not moonlight during the probation period and for at least
three months thereafter. Permission of the residency director must be obtained before moonlighting.

5. Per ABEM regulations, no resident will be allowed to work more than 6 consecutive days. All residents
   must have 10 hours of rest between duty periods. Failure to abide by these agreements will result in loss
   of moonlighting privileges and possible disciplinary action. Moonlighting hours must be documented in
   Residency Partner. (see ACGME governed Resident Duty Hours and the Working Environment)

6. It is recognized that the residency position is offered with the understanding that this residency is the primary and
central responsibility of the house officer. Where moonlighting activity is perceived to interfere with a resident's
performance, the resident will be required to stop the activity.

7. Should sub-par resident performance related in any way to moonlighting be identified, or if RRC duty hour
violations occur (Paragraph 5) due to moonlighting, or if moonlighting activity is not accurately reported in Resident
Partner, the resident will be put on academic probation and a remediation plan will be implemented by the program
director.

8. Residents should understand that they are protected by state of Louisiana malpractice coverage only when
performing residency assigned duties, and not when engaged in moonlighting.


ACKNOWLEDGEMENT OF MOONLIGHTING POLICY

         I have read and understand the Emergency Medicine Department's Moonlighting Policy and agree to accept
         the terms and conditions set forth in such policy.

Name_________________________________Signed______________________Date________
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                     105




                                             Call Room

A call room is available for you to use if you would like to rest after a night shift. It is Call
Room #5 and is shared with the MICU. Please obtain the key from the chief residents if you
would like to use the room.
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                    106




                                             Sick Leave

Residents are awarded sick leave as a fringe benefit of their employment. In order to use this
benefit, the following policy must be adhered to while on all rotations:

      The resident must notify the Chief Resident (Pager # 423-2537) immediately in order to
       activate disaster call.
      The resident must notify the residency director in writing of any and all sick leave taken
       on any rotation within one week of the day(s) missed.
      The resident must notify the residency director and the staff on duty at his emergency
       department rotation site by phone of his illness as early as possible before the assigned
       shift.
      On inpatient services, the resident should notify both the chief resident of the service and
       the resident's immediately supervising resident by phone as early as possible before the
       assigned duty.
      In order to obtain an excused absence from a scheduled shift due to illness, the resident
       MUST REPORT to the ED where they are assigned to see the staff person on duty who
       will help the resident manage his illness and email the residency director.

Shifts missed due to illness do not need to be "made up" if the above policy is followed unless, in
the opinion of the residency director and the director of the service, the resident received an
educational experience due to a prolonged illness. The American Board of Emergency Medicine
also has minimum time requirements which must be met if the resident is to be eligible to take
the board exam.

Failure to adhere to this policy will result in the missed shifts being considered an unauthorized
absence. The missed time must be made up and disciplinary action taken.
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                  107




                                Conference Attendance Policy
                                      (July 2008 update)
                 Didactic Resident Conference is 7am-11am, each Wednesday
                           University Hospital Basement Classroom

                 Journal Club is 7pm-10pm the 2nd Thursday of each month.

Conference and journal club attendance is mandated by the Emergency Medicine Residency
Review Committee. Conference is comprised of 4 hours of didactic lectures per week and 4
hours of non-didactic learning per month. The non-didactic learning is comprised of 2 hours of
Journal Club and 2 hours of computer based learning modules each month. Go to the LSU EM
home page and click on ―home study‖ to reach the schedule. The learning modules may be done
earlier than the month scheduled, but no later than 1 month after the scheduled month.

 Emergency Medicine Residents must attend 70 % of conferences (didactic and non-didactic).



       You are excused from conference and journal club while you are Vacation.




If you have difficulty being released from your clinical duties, address this problem
immediately with the chief residents or Program Director. If you think conference attendance
is in violation of your duty hours, please notify the Program Director immediately.


Attendance Goals:
Our goal is > 80% lecture attendance, when accounting for vacation and excused absences. The
RRC requires 70% minimum attendance throughout the year, without considering excused
absences.

       If less than 80%: The program director will notify the resident
       If less than 70%: The program director will notify the scheduling chief to assign
        penalties:
                 -65-69%: Extra Disaster Call Shift
                 -60-64%: Extra Disaster Call Shift AND Extra Fast Track Shift
       If less than 70% three consecutive months or if <60% two consecutive months: The
        resident will be required to meet with the program director to determine a remediation
        plan.
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10             108




                                         Monthly CORD Exam

                                            (7/08 updated)

Re: Monthly CORD Exams

The online monthly in-service exams must be completed by the day scheduled for discussion.
The exams will be scheduled at least one month in advance and are ―open book‖. Residents who
score less than 75% will be assigned additional questions in that topic.

Failure to complete more than three exams on time during one academic year will result in
probation and a letter in the permanent file.


2007-08
November 28: HEENT
December 18: EMS
Jan 31: Musculoskeletal
Feb 29: Trauma
Mar 31: Procedures
Apr 30: Cardiovascular
May 31: Anesthesia
June 30 OB


2008-09
July: Neuro
Aug: NeuroSurg
Sept: Cutaneous
Oct: Pediatrics
Nov: Toxicology
Dec: Environmental
Jan: Endocrine
Feb: Mock Inservice
Mar: ID
April: Abd/GI
May: Admin
June: Research
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                     109




Journal Club

2nd Thursday each Month 7:00 pm

The purpose of Journal Club is to discuss articles relevant to Emergency medicine. Whether
these articles are "good" or "bad" is not important. What is important is to gain an understanding
of research design, statistics, and interpretation of data. Hopefully this will enable you to gain a
better understanding of the article: you read as well as help you in your own research projects.

Journal Club Procedures will be as follows:

       a. The purpose of Journal Club is to discuss articles relevant to Emergency medicine,
          and to gain an understanding of research design, statistics, and interpretation of data.
       b. Dr Slaven is the director of Journal Club
       c. Each year one of the Chief Residents coordinates Journal Club dinner and makes the
          annual schedule of resident leaders and presenters.
       d. A PGY3 resident is assigned each month to be the Leader and select a topic and
          articles (approved by Haydel) and lead the discussion.
       e. 2-3 other residents will be Presenters and present the articles using the critique
          template which follows and is posted on the yahoo website.
       f. Articles will be distributed via email and the yahoo website one week prior to Journal
          Club: http://groups.yahoo.com/group/LSUEM/
       g. Unless excused or working, attendance and preparation are required.
       h. Failure to present for Journal Club may be grounds for disciplinary action.

Responsibilities of the Journal Club Leader:

The Leader of each Journal Club will be assigned by the chief residents prior to the start of each
academic year. As Leader, be sure that you are able to attend on your assigned date.

Pick an appropriate topic for your Journal Club Month. A list of suggested topics is posted on the
yahoo website: http://groups.yahoo.com/group/LSUEM/ If you need assistance in choosing
your topic, you can speak with any of the program directors. Your topic must be approved by Dr.
Haydel three weeks prior to journal club. Once your topic has been approved, you must choose 3
articles pertaining to your topic. These articles must then be submitted to Dr. Haydel for final
approval two weeks prior to journal club.

After your articles are approved, select one article for yourself to present, then assign the other
two articles to the other two presenters designated on the schedule.

Your articles must be submitted for approval at least two weeks prior to the Journal Club Date.

Once approved, submit your 3 articles to the section secretary for distribution to the residents and
staff. Please indicate the Journal Club Month on each article, as well as the order of presentation
of your 3 articles. For example, "Article #1- July 2002 Journal Club, etc."
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                   110




Journal Club Presenter Responsibilities

Make sure that you are off the night of your respective presentation date. Request to be off when
putting in your monthly schedule requests.

Stay in touch with the Leader of your Journal Club, so that you can receive your article well in
advance.

Adhere to the Standard Journal Club Presentation Format (Journal Club Literature Critique Form)

Finally, the Journal Club Chief Resident is responsible for organizing dinner and the location for
each Journal Club. The section secretary will notify all of the location each month once things
are lined up.
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                              111




Journal Club Literature Critique Form

Article title and journal:

Study objectives:

Hypothesis:

Outcome measures(dependent variables):

Methods                                             Design features
Design type _ Observational                           Randomized no yes:
            _ Case-control                            Blinded no yes: (single or double)
            _ Cohort                                  Prospective or Retrospective
            _ Experimental                            Controlled no yes :
            _ Cross-over
            _ Other: __________

Sample:             Number of data points or sample size (n) __________
Inclusion criteria:
Exclusion criteria:
Treatment (independent variables):

Sampling type: __ convenience              _ consecutive        _ randomized        _ systematic
__other:

Describe each treatment group and indicate number (n) for each:

Data type: __nominal (named ie yes, no) __ordinal (ordered, numbers) ___interval (specific differences)
Statistics: What statistical analysis is used?

Are the statistics used appropriate for the data?

What are the confidence intervals?

Results:
Is the hypothesis accepted or rejected?
Does the study answer the question asked?
How could the study be redesigned to better answer the question asked?
Were adverse effects of treatment, limitations to the study, and intention to treat discussed?

Conclusions:
Is the study biased?
Are conclusions supported by the data?
Is the study good or not?
Does it affect your practice?
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                  112




                                       M & M Presentations

The following will be presented in a PowerPoint Presentation.

This is a ―Question – Answer‖ case with HPI, H&P, Labs, ED course:

First Slides: HPI, Physical exam
The first question:          What is the differential diagnosis?

Other questions:    (Diagnostic) What tests would you order?
       (Management) Appropriate actions would include?

Second Slides: Course of action, what happened to the patient.

Presenting resident will summarize the case

At this point a member of the audience will be ask to critique the management of the case. Was
this the proper course of action?. Would you have done something different?. Why?.

Last Slides: two questions: (Clinicopathologic questions) Referenced,
       relevant and pertinent question to the case
       presented. (No true or false, No all the above.)
       In A, B, C, D, E best single answer format.

Example:

64 y/o Hispanic male arrives to the ED c/o Left flank pain of sudden onset of one hour duration.
PMH. - Left kidney stone 2 yr. ago. and Hypertension. Social - Smoker 1 ppd x 30 yr., retired.
Meds. - blood pressure meds. NKDA. PE - BP 90/60, 72, 98.2, 26. The patient appears in severe
pain, can't get comfortable on the stretcher. HEENT - Gr II HTN retinal changes, Neck - no JVD,
Lungs -Clear, Heart - rr, no murmur, Abd. - diffusely tender, quiet, Rectal - neg hemetest. Pulses
- 1+ Symmetric.

Q. #1. Differential Diagnosis:
Nephrolithiasis
Diverticulosis
Ruptured Viscus
Leaking/Ruptured AAA
Ischemic Bowel

Q. #2 Diagnostic:                      ABC"s           EKG
                                       IV x 2 - Fluid bolus, Labs
                                       02 high flow
Q. #3 Management:
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                    113




       Stat Surgical Consult

Clinical course:                       (Presenting Resident)         This patient was admitted to
the monitor cubicle, primary assessment, IV x 2 started, blood drawn for CBC, Chem., high flow
02, cardiac monitor, Secondary assessment. Pressure support with Dopamine, IV fluids. A CT
scan of the Abdomen was done 1 hour latter. The patient was taken from the CT table to Surgical
OR due to the patient's clinical deterioration and died while in Surgery.

Audience Critique: (Designated by Staff Present or Chief Resident) After initial resuscitation of
the patient and the initial ancillary tests this patient should have been moved to the OR for
immediate Surgical intervention. Even Though the mortality of a ruptured AAA is over 80% this
patient could have had a better chance if there would not have been a delay in administering
pressure support drugs and obtaining a CT scan.

Q. #4 Clinicopathological:

1.) The most common presentation of AAA is?

                                a.      painless, pulsatile mass found on routine exam
                                b.      tearing flank pain, like kidney stone
                                c.      patient usually dead on arrival
                                e.      chest pain
                                f.      nausea, vomit and abdominal cramping

       Answer:         a

2.) Indications for CT in pt's with AAA

                       a.)       unstable patients with no inmediate surgeon available
                       b.)       in differentiating pancreatitis from ruptured
                                 AAA with pt's V S P-130, BP- 90/60, R- 20
                       c.)       patients suspected of having chronic contained rupture
                       d.)       at surgeon's request for preparative planning
                                 in ruptured AAA
                       e.)       in differentiating AAA vs. appendicitis in pregnant female with
                                 history of Hypertension and tobacco use.

Answer                                  c

Ref. Tintinalli, Emergency Medicine - A Comprehensive Guide, 4th ed. ch.59
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                  114




                                           Medical Records
1.       Residents should make every attempt to complete their medical records while the patient
is still in the hospital by signing student notes, verbal orders, H & Ps, etc.

2.     Medical Records will notify the resident if he or she has delinquent charts. The resident
should correct this situation immediately. The hospital' JACHO accreditation is jeopardized by a
large number of delinquent medical records. Residents who do not complete delinquent charts
within the allowed period will be suspended by the Medical Director without pay.

3. To avoid this, residents should make an appointment with Medical Records to complete
these charts immediately upon notification. Residents should not just "drop by" to complete
charts or they will have to wait while charts are pulled.

    Residents are responsible for creating legible medical records that will be useful as
      documentation for patient care and billing purposes. Residents are required to use their
      name stamp or to print their name and 5 digit identification number under their signature
      on all medical records. They should date and time all medical record entries.
    Medical Records guidelines pertain to all hospitals that EM residents rotate through during
      their residency.


Electronic Signature

Medical records in Electronic Signature is an official requirement for our residency. This will
allow residents to sign any dictated document from any computer. They will not have to come in
to the hospital to sign records and they will be able to sign their UH discharge summaries, etc.,
while rotating at any other hospital. It will be convenient for them and will keep them off the
suspension list for delinquent medical records.

Please contact Ms. Jones in medical records to obtain your electronic signature:
djones5@lsuhsc.edu
         LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                        115




                                           LSU EM Reading Topics 2009-11
    Topics are all on an 18-month cycle (6 quarters) and have been adjusted for the 2010-11 year.
    Subjects are organized by quarter with the number of total pages in parenthesis—You can complete an entire text in
     an 18-month cycle.
    All four major ER texts are represented by edition (Tintinalli, Rosen, Harwood-Nuss & Adams).
    This list will also be posted to the LSUEM website.
    The national inservice is the third Wednesday of every February.

                                              # of
    Week of:       Staff      Topic           weeks:     Text reading:
                                                         Tintinalli 6th   Rosen 5th      Adams      Harwood/Nuss
    July 1 -15th                                         1537-1650        242-466        783-850    890-1124
    2009           Moreno     Trauma              3                                      953-961
                                                                          1583-1634      1139-      686-703
    July 22nd      Stafford   Allergy             1                       2491-2510      1206
                                                         1476-1493        892-907        247-265    150-163
    July 29th      Stafford   OMFS                1                                      277-288
                                                         1807-1846        1541-1582      2035-      634-653
    August 5 -                                           1891-1895        2511-2554      2144
    19th           Bennett    Psych               3      1900-1907        2591-2615
    August 26 -    Tuckler                               487-592          178-218        289-455    340-416
    September      Moreno                                                 1234-1359
    9th            Halton     GI                  3
    September                                            61-70, 132-      162-177        513-740    58-61, 246-
    16th -                                               137, 179-        1011-1233                 303
    October                                              202, 333-436
    14th           Haydel     Cardiology          5
    October                                              1319-1362        48-51          2091-      788-828
    28th           Mills      Hematology          1                       1665-1700      2145
                                                         141-148,         155-161,       455-505    6-42
                                                         219-251,         939-1010                  198-243
    November                                             437-486,
    4th - 25th     Deblieux   Pulmonary           4      1908-1911
    December                                             1865-1890
    2-9th          Slick      Radiology           2
                                                         1464-1475,       928-937        233-       163-195
    December       Van-                                  1494-1506                       247,
    16th - 23rd    Meter      ENT                 2                                      265-277
    January 6th                                          1363-1368        1701-1713      2091-      788-828
    2010           Mills      Oncology            1                                      2145
    January 13-                                          p1-60            2616-2649      97-111     1782-1791
    20th           Halton     EMS                 2
    January                                              1175-1282        1972-2062,     1435-      1720-1780
    27th           Moreno     Wilderness          1                       2698-2704      1499
      LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                   116




                                                     138-140,        119-154,     983-      89-109, 574-
                                                     252-256,        1433-1540    1138      587, 592-631
                                                     1369-1436,
February 3-
                                                     1441-1448
17th           Piazza      Neurology          3
February 24:               INSERVICE
March 10-                                            1507-1536       1635-1664    1999-     656-684
17th           Murphy      Dermatology        2                                   2013
                                                     487-592         178-218      289-455   340-416
March 24th     Bennett     GI                 1                      1234-1359
                                                     71-93, 727-     82-106,      181-210   1130-1267,
April 7th -                                          908             2218-2397              1274-1434
28th           Avegno  PEDS                   4
               Waggens                               1651-1768       233-241      867-977   534-572
May 5th -      pack                                                  467-736                1022-1099
26th           Lagasse Ortho                  4
                                                     94-98, 664-     219-232      1271-     470-491
                                                     726             2398-2484    1415
June 9th-                                                                         1429-
23rd           Moreno      Ob/Gyn             3                                   1434
June 30th      Hubbell     Ophtho             1      1449-1463       907-927      211-233   112-148
July 7th -                                           606-632         1556-1605    1207-     418-453
21st           Hubbell     GU                 3                                   1270
August 4th     Moreno      International      1
August 11th                Environment               1175-1282       1972-2062,   1435-     1720-1780
- 18th         Hardy       al                 2                      2698-2704    1499
August 25th                                          1283-1318       1955-1974    1717-     835-878
-September                                                           1985-2000    1824
1st            Mills       Endocrine          2
September      Santa-      Fluid/Electrol            149-178 593-    1524-1555    1207-     453-467 830-
8th - 15th     nilla       yte                2      605 633-646     1922-1933    1270      835 884-888
September                                            61-70, 132-     162-177      513-740   58-61, 246-
22-                                                  137, 179-       1011-1233              303
October20th Haydel         Cardiology         5      202, 333-436
November                                             1537-1650       242-466      783-850   890-1124
10th - 24th    Aiken       Trauma             3                                   953-961
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                      117




                                       Research Requirement
Every resident is required to participate significantly in a research project or scholarly activity in
order to successfully complete the residency program. The residency director will not certify
eligibility to take the ABEM exam unless this requirement has been met. Our goal is that
residents will gain an understanding of the research process by participating in an entire project
from origination of a hypothesis through submission of the completed article to a peer review
journal. We realize that not every resident may have the opportunity to perform each step
involved in a particular project. However, the Resident Research Director (Dr. Moreno) must
agree that the resident's participation has been adequate and significant and must certify this on
the following form before the resident completes the program. It is the resident's responsibility to
meet at least yearly with the Resident Research Director to review progress on fulfillment of the
research requirement. Those residents not inclined to do clinical research might be eligible to
spend time in the neuroscience laboratory and receive credit for this research requirement.


All rotations approved as research electives must have evaluation forms completed for the
prescribed time by the supervising faculty advisor.
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10    118




                        Resident's Research Proposal And Progress Form

Resident:
Faculty:

Proposal for Project:




Literature Search:



Methods:



IRB Form:


Data Gathering:



Statistical Analysis:



Progression With Abstract:



Plans to Submit to national meeting:



Manuscript Preparation:



Submit Manuscript:


Research Requirement Satisfied
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                 119




                                  Chief Resident Responsibilities

Scheduling residents for PALS, ATLS, ACLS
IGMEC – Graduate Medical Education Committee delegate monthly meeting
LSU Residency fair, junior medical student residency day
Journal Club
ED daily and annual Schedule
ED intern schedule
Graduation dinner
Discipline
Social/Wellness Coordination
Research Coordinator
Trauma Conference
SE-SAEM conference coordination
Annual review of goals and objectives for each rotation
ED conference coordinator
Quarterly newsletter
Black book annual review
Cadaver Lab
National Inservice Exam preparation/pearls
EM resident application review
Interview Coordination

Chief Resident Questionnaire
Third year residents are asked to respond to the following questions.

Please comment on the existing chief resident’s responsibilities. Would you suggest additions,
deletions, or other changes?


What do you think are the three most important issues facing the EM residency program and how
would you resolve these issues?

If considering becoming a Chief Resident, what would be your overall goal?

If considering becoming a Chief Resident, why do you think you are suited for the position of
Chief Resident?
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                120




                                      Residency Curriculum

The EM residency curriculum is composed of several components.

1.     The Clinical Rotations as described in the Rotation Guide (Guidelines To Rotations/Goals
       & Objectives)
2.     The Weekly didactics, following a comprehensive 18 month curriculum (LSU EM
       Reading Topics 20)
3.     The Assigned readings that correspond to the 18 month curriculum (LSU EM Reading
       Topics 20)
4.     The House officer year Special Topic Sessions
5.     Supplementary Advanced Life Support, Hazmat Training.

The didactics and reading 18 month curriculum is based upon the Model Curriculum for
Emergency Medicine, the RRC for Emergency Medicine Training Guidelines and the
ABEM certification goals.


Model For Emergency Medicine

Link to the Model Curriculum for Emergency Medicine Residency Training:

http://www.saem.org/model/intro.htm
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                 121




                                 Reference Book Loan-Out Policy

1. Medical center of Louisiana Library
        -reference books are not to be removed
        -computer cd's - can be accessed from many different terminals; can’t be checked out
    -EM main residency office
        -books may be checked out for 3 day intervals.
        -sign out sheet can be obtained by the section secretary
2. Slidell memorial hospital
        -emergency room
            -books are not to be removed
3. Ochsner medical library
             -books are not to be removed
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                               122




                                            Medical License

For up-to-date information on Louisiana Medical License go online to www.lsbme.louisiana.org

Louisiana License, Training Permit & STEP 3:

       All LSUHSC House Officers must have a valid license or permit to practice medicine in the
State of Louisiana. The Training Permit is only available during the PGY1 & PGY2 years (24month
period) when the resident has not yet taken and passed STEP 3 USMLE.
       From the LSBME website, ―The applicant who has not taken and passed the USMLE
Step 3 prior to the expiration of the PGY1 or PGY2 permit may not be licensed by the LSBME
until such time that the applicant has taken and passed the USMLE Step 3‖
       House Officers who fail to pass Step 3 by the start of PGY3 will be assigned non-clinical
duties until a valid Medical License has been obtained. Non-clinical rotations consist of any
unused vacation and non-clinical elective rotations for that training year. Once all non-clinical
rotations have been completed, the resident will be assigned to a leave-without-pay status and
will be dismissed from the EM program if the resident fails to obtain a Louisiana Medical
License within three months of starting the leave of absence.



Step 3 Checklist

      You must take and pass Step 3 prior to beginning your PGY3 year, therefore the EM
       residency requires you to complete the application process during your PGY 1 year.
       Prior to applying to take Step 3, you must meet the following requirements:

          Pass both USMLE Steps 1 and 2 (CK and CS).
          FMGs must obtain certification by the ECFMG.

      Once you choose a month to take Step 3, you will need to begin the application process
       4-8 weeks prior to the chosen month. Once you finish the process you will have 3 months
       to take the exam.
      USMLE Step 3 Applicants Can Simultaneously Apply for Credentials Verification
           o   The Federation Credentials Verification Service offers a service to USMLE candidates who
               complete their Step 3 application online. As a convenience to examinees, information entered on
               their Step 3 online application can be used to begin a personalized FCVS Physician Information
               Profile that contains their primary-source verified credentials. The state of Louisiana requires
               applicants for full licensure to complete the FCVS.
      Apply for Step 3 via the website at FSMB - Click on Exam Services the Step 3
       Homepage
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                                   123




        Check to make sure you are eligible for Louisiana License State Requirements - See
         2007-08 guidelines below:

                                                                                                 APPLICATION FOR
                                                                               POSTGRADUATE          LICENSURE
             STATE BOARD                  ATTEMPT LIMIT         TIME LIMIT         TRAINING       REQUIRED WHEN
                                                                               REQUIREMENTS        APPLYING FOR
                                                                                                       STEP 3

LOUISIANA                               Unli mite d atte mpts Unli mite d      None                      YES
You must check with the state           at USMLE Ste p 1.
medi cal board to dete rmine
lice nsure applicati on process ing     Four atte m pts at
ti me s. Your Ste p 3 applicati on can USMLE Step 2.
not be approve d until we receive
approval from the state medical         Four attempts at
board. If we have not receive d         USMLE Step 3.
approval by Se ptembe r 5, 2008,
your Ste p 3 appli cati on will be
cancelled.


State Licensure
After you have applied for you state license, it will come in the mail automatically after the state
receives your passing scores on Step 3.

                      Minimum
                      Postgraduate                                                    Time Limit for Completing
Full license rules                      Number of attempts at Licensing Examination
                      Training                                                        Licensing Examination Sequence
                      Required
Louisi ana
(504) 568-6820                          No limit at Step 1or COMLEX Level 1; 4
                      1 year; 3 years                                                 No limit on the USMLE or
License fee $382.00                     attempts each at Steps 2 and 3 or COMLEX
                      IMG                                                             COMLEX
non-refundable                          Levels
Requires FCVS




DEA number

        Apply for state CDS license first . Cost: $20 and needs to be mailed in.
        Once you have been approved for the state license, you can apply for a Federal DEA
         number . Select Form 224. Cost: $551 - will only take credit card if you do it online,
         otherwise mail it in with a check.



NPI number

        Goto http://www.cms.hhs.gov/NationalProvIdentStand/
        Tips for filling out the form:
             o The primary address should be LSUHSC 433 Bolivar NO,LA 70112
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                        124




           o   The mailing address may be your program office
           o   Use the program office phone number
           o   The taxonomy code is "Student in an Organized Health Care/Education/Training
               Program"
           o   Once they have their NPI numbers, then need to link it to Louisiana Medicaid, especially
               to write scripts @ http://www.lamedicaid.com/provweb1/Hipaa/npi.htm



Notary


Ms. Kathy Muslow, provides notary services each Wednesday from 12:00 noon to 1:00 PM for
university business only.
kmuslo@lsuhsc.edu
568-5135

Medical License or Permit

On July 1, 2008 all House Officers MUST have a valid Louisiana State Board of Medical
Examiners (LSBME) permit (GETP, PGY 1, PGY2, PGY3, or any other valid LSBME permit),
or license to practice Medicine in Louisiana and begin or continue residency/fellowship training.

In April, at the quarterly Coordinator’s meeting, Medical License information from residency
partner was handed out showing the expiration dates of each House Officer’s permit or license,
along with a document from the LSBME explaining the items needed to receive and renew each
type of permit, along with USMLE Step 3 information. This information was distributed to
avoid the submittal of late or no information to LSBME for initial permit/license or renewal of
permits.

 For the past few days we have printed LSBME License/Permit data from Residency Partner and
cross referenced it against the information on the LSBME website. There are MANY New Hire
House Officers with no permit/license information on the LSBME website and MANY
Continuing House Officers with Permits that will expire June 30, 2008 or shortly thereafter. We
know LSBME is in the process of updating many files on the website but there are also many
House Officers that have not submitted renewal fees or documents to LSBME


Yolanda Lundsgaard
Coordinator GME
LSUHSC School of Medicine
2020 Gravier St, Ste B
New Orleans, LA
(504) 568-3407
FAX: (504) 599-1453
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                   125




                          Guidelines To Rotations/Goals & Objectives

                                      Rotations and Scheduling


   1. All rotations at all hospitals begin on the first day of the month, regardless of the day of
      the week. The only exception to this is the month of January for which the Medical
      Director of MCLNO sets the first day in order to provide opportunity for all residents to
      have time off for either Christmas or New Years. This date will apply to all hospitals and
      rotations.

   2. Schedule requests must be submitted as delineated in the Rotation Guide. Be sure to
      request off the days you are assigned to take or teach advanced life support courses or to
      take In-Service Examination.


   3. Failure to report to work any assigned shift at any hospital or any service may result in
      suspension or dismissal. Residents are required to notify the emergency medicine staff
      person on duty at the hospital and the chief resident on duty (chief pager 423-2537) and
      the chief resident of the non-emergency department service to which they are assigned in
      advance if they are unable to report for duty. The resident must notify the residency
      office by phone on the day of the absence and the Residency Director in writing within
      one week of the reason of absence.

       In case of illness, residents are required to report to the emergency department for
       diagnosis and management.


   4. Residents are expected to be punctual for their shifts. Repeated tardiness will result in
      disciplinary action. Residents may not leave early without permission from the
      supervising attending.
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                    126




MCLANO Emergency Department

Dr.__________________________,

       You are assigned to the UH ED, for the month of__________________.

        Orientation: Mandatory for all interns, (day, night or off shift) at 7am on the first day
of the month. (see section below for orientation review for residents)

       Schedule: A choice of a prearranged schedule will be available on a first come first
serve basis around the middle of the month preceding your schedule rotation in the emergency
medicine office. Please see Kathy or the scheduling chief for schedule template.

        Responsibilities: Interns and Residents are expected to manage their individual patients
as well as assist in other areas as needs arise. It is the expectation that the intern and resident
will work in harmony with the ER RN to accomplish all tasks.

        Follow-ups: you are required to complete 2 follow-ups per month while in the ED and to
request autopsy results on all deaths while you are in the ED. Follow-up can be achieved via the
cliq system. To obtain an autopsy report, email Dr. Robin McGoey in the Dept of Pathology
(rmcgoe@lsuhsc.edu) with the patient’s name and medical record number. The follow up
documentation will be through Residency Partner. (See Follow-Up Log)

       Conference: All resident are expected to attend conferences on the appropriate day.

       Extras: All procedures must be recorded and turned in at the end of the month.

       Supervision: You will be supervised by board certified Emergency Medicine
physicians.

       Evaluations: Daily evaluations.

       Meals: Provided by UH.

What follows are the goals and objectives for the MCLANO ED rotation, that will range from a
2 week to 1 month rotation, as assigned by the Program Director. The rotation will take place at
the MCLANO University Hospital. The year of training may include PGY 1-5.

           MCLANO EMERGENCY DEPARTMENT RESIDENT ORIENTATION
General
    Be on time for start of your shift.
    Dress and act professionally. (see Dress Code)
    Place a note on every chart.
    Work with other residents and nurses to enhance patient flow in the ED and Fast Track.
    Notify attendings as soon as possible of disposition problems caused by lab, X-ray, or
      consultant delays.
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                    127




      Make frequent rounds with attendings and discuss management of complex cases
       prospectively.

Educational
    Give lectures as assigned by chief residents. (see M & M Presentations)
    Supervise and teach junior residents, interns, and students through their patient care
       experiences.
    Provide a written evaluation of each intern you work with using the form provided to you
       at the end of the month.
            o If an intern shows a consistent pattern of problems in any area including
               punctuality, attendance, attitude, knowledge, skills, or interpersonal relationships,
               notify Dr. DeBlieux, the EMS director immediately so that intern can be
               counseled.
            o No intern should receive a below average evaluation (4 or below) in any area
               without having feedback and an opportunity to improve.
            o Interns from other services such as OB-GYN and Pediatrics are allowed to attend
               their required Continuity Clinic one half-day per week when assigned to the ED.
               Surgery residents are allowed to attend conference on Saturday morning. They
               must "sign-out" with the emergency medicine resident before leaving to ensure
               continuity of patient care.
    Attend conference as required by Conference Attendance Policy (see Conference Attendance
       Policy)
      Document all procedures on Residency Partner (see Residency Partner)
      Request autopsy results on all deaths: email Dr. Robin McGoey in the Dept of Pathology
       (rmcgoe@lsuhsc.edu) These reports count toward your 20 patient follow-ups per year for
       your portfolio.

Documentation
    Document the initial time the patient was seen,
    Document the times consults placed and answered.
    Time all progress notes, procedure notes, and other significant events such as LOPA
     referrals, child abuse referrals, etc.
    Time all orders for lab, X-ray, medication, and other treatment.
    If you use a separate order sheet, write "See separate order sheet" in orders section on
     route sheet.
    Chart documentation must be legible and must conform to HCFA/AMA Guidelines.
    The appropriate boxes indicating patient disposition and condition at discharge must be
     checked and time and date of discharge filled in.
    Residents are to write the initial documentation of history, physical exam, medical
     decision-making, and management for all medical and trauma resuscitation patients
     including procedure notes. The resident who runs the resuscitation is to complete the
     chart.
    Consultants must document a written consult when they first evaluate the patient. If
     additional studies such as CT scans are requested, that should be included in the initial
     written consult. The consult can be updated and completed by the consultant when all
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                 128




       studies are complete. The initial consult should address on-going management issues,
       e.g., steroids for possible spinal injury.
      Be sure all imaging studies have been reviewed by a radiologist before discharging any
       patient and that documentation of results indicates this review.
      The Diagnosis box on the route sheet must always be filled in.
      When a patient leaves AMA or deserts during treatment or is a "No Answer x 3", this
       status must be recorded in the Diagnosis box on the route sheet, e.g., Diagnosis #1 Scalp
       laceration, Diagnosis #2 Desertion.
      An AMA form must be completed in layman's language and signed by the patient, the
       resident, and a witness for all AMA patients. Written discharge instructions should
       always be given to AMA patients and should indicate that patient has been encouraged to
       return at any time to complete treatment.

   Orders
    All X-ray and lab slips must have the intern or resident's name and the attending's name
      in the "ordering physician" blank.
    ICD-9 codes are mandatory on the lab and x-ray requests. The ECD-9 code list is located
      on the back of each billing sheet attached to the medical chart.
    All X-ray and lab slips must have an appropriate indicator in the-"reason for study" box.
          o The indicator must be a sign or symptom such as ankle pain, chest pain, or
              shortness of breath. "R/O" diagnoses and such things as "MVA" or "S/P fall" are
              not acceptable.
          o ICD- 9 codes are required on all x-ray and lab requests.
    Residents must use their name stamp below their signature on every medical record.

Consultation
    Be familiar with the various consult policies, e.g., faces, hands, MICU, spinal injuries,
       cellulitis, etc.
    Don't delay consults for lab results or other reasons when the need for consultation is
       clear from the initial history and physical exam.
    Document time of consult and time answered on ED medical record in space provided.
    All consults must be written on the hospital's consultation form.

Rapid Sequence Intubation
    The decision to use RSI, the selection of protocol, drug dosages, and the actual orders
       must be by the attending physician.
    Nurses cannot accept orders for RSI from a resident.
    The entire RSI procedure is supervised by the ED attending who makes all decisions
       regarding RSI.
    Interns may not participate in RSI.
    RSI must be documented on the chart in a procedure note and the RSI CQI form must be
       completed by the resident and signed by the resident and attending physician.

Medical Control
   Medical Control calls should be answered immediately.
   Medical Control must be provided by an HO 2 or greater level resident.
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                 129




      Interns may observe but may not provide medical control.
      Remember, all medical control calls are recorded.

Sexual Assault
    Residents must give this exam priority as forensic evidence disappears rapidly in these
       patients.
    Ovral is used for pregnancy prophylaxis when UPT negative.
           o Physician must document counseling of patient regarding risks and benefits.
           o Two pills are given in the ED and 2 are dispensed BY the physician to the patient
               to be taken in 12 hours.
           o The physician must write "Ovral 2 pills dispensed to patient by M.D. to be taken
               in 12 hours." in the Orders section of the chart. This language is needed by the
               Pharmacy Department when it undergoes JCAHO review.

Trauma Center
    Trauma Center patients are identified by anatomic, physiologic, and mechanism of injury
      criteria.
    All children up to and including 12 years of age must be "Room 4" activation level.
    Those patients greater than 12 years of age meeting only the mechanism criteria can be
      designated as "Trauma Bay" activation level by the emergency medicine attending
      physician only.
    All adult patients in Region One meeting anatomic or physiologic criteria are "Room 4"
      activations. Be familiar with the anatomic, physiologic, and mechanism criteria.
    All trauma center patients must receive ETOH and urine tox screens.
    Responsibility for patient assessment, communication with recording nurse, intubation,
      and performance of invasive procedures in Room 4 patients is that of the HO 2 or above
      resident and cannot be "passed down" to interns.
    Be sure all trauma center patients receive a written surgery consult.
    Interns may not sign the emergency blood release forms. Only a senior surgery or EM
      resident or EM or surgery faculty may sign.

Universal Precautions
    Residents are expected to use universal precautions (gloves, gown, mask, and eye shield)
       in the ED whenever performing exams or invasive procedures and to make sure that
       interns, students, and others under their supervision do so also.
    Any intern or resident who sustains a blood or body fluid exposure while on duty should
       report the exposure to the attending physician, complete a hospital incident report, and
       get a route sheet to obtain treatment and document the -exposure. Anti-viral treatment is
       immediately available through Employee Health during the day and in the ED after
       hours.

                               MCLANO/UH ED ROTATION
                             GENERAL GOALS and OBJECTIVES

At the completion of rotations in the MCLANO, the intern/resident will be able to:
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                 130




   1) Perform basic assessment of patients with a variety of moderate and major traumatic
      conditions.

   2) Formulate a differential diagnosis for patients with various kinds of traumatic conditions
      and mechanisms of injury.

   3) Order and interpret appropriate diagnostic laboratory and imaging studies for trauma
      patients.

   4) Understand the interrelationships of the pre-hospital, emergency department, and in-
      house trauma team and perform as a team member of the emergency department trauma
      team.

   5) Competently perform minor procedures such as suturing of lacerations, incision and
      drainage of the abscesses, insertion of nasogastric tubes and urinary catheters,
      venipuncture, insertion of peripheral intravenous catheters, lumbar puncture, splinting of
      fractures and sprains, spinal immobilization.

   6) Demonstrate basic understanding of the principles of ACLS resuscitation as applied to
      persons in cardio-respiratory arrest.

   7) Achieve ability to perform an adequate history and physical exam, prioritize conditions,
      and form a differential diagnosis in adults with acute and chronic medical problems of
      varying severity presenting to the ED for care.

   8) Learn proper methods for stabilization of patients with life threatening conditions such as
      sepsis, respiratory failure, acute MI, CHF, status epilepticus, status asthmaticus, cardiac
      arrhythmias, severe GI bleeds, and overdose.

   9) Learn to evaluate, diagnose and initiate any needed therapy for a variety of specific
      medical problems such as asthma, seizures, anemia, stroke, GI disorders, urinary tract
      infections, pneumonias, and other respiratory illness.

   10) Learn to evaluate and appropriately manage a variety of patient complaints such as chest
       pain, abdominal pain, dizziness, headache, syncope, etc.

   11) Learn to perform an adequate history and physical exam in female patients with
       gynecologic problems or problems related to early pregnancy including abdominal
       bleeding, infection, threatened abortion, and ectopic pregnancy.

   12) Learn appropriate use of diagnostic lab and imaging studies for emergency patients and
       to have basic competence in their interpretations.

   13) Learn to use the following diagnostic aids: central venous pressures, pulse oximetry,
       arterial blood gases, EKG’s.
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                   131




   14) Perform the following procedures with basic competency and to know indications and
       contraindications: venipuncture, starting an IV or heparin lock, arterial puncture,
       insertion of a Foley catheter, placement of a central venous line, thoracentesis,
       paracentesis, lumbar puncture, urinalysis with microscopic, wet prep of vaginal
       secretions.

   15) Become familiar with common medico-legal problems which present in emergency
       medical practice such as: consent, desertion, AMA, restraints, impaired patients, child or
       adult abuse or neglect.

   16) Be able to arrange appropriate follow-up for discharged patients and give adequate
       discharge instructions.

   17) Learn and use the available contributions of the Social Services Dept. to patient care in
       the ED and for discharge planning.

   18) Learn appropriate medical evaluation of mentally disturbed patients including techniques
       for restraint and control of violent patients.

Residents and interns will participate in the management of all emergency department patients
under the supervision of emergency medicine faculty.

The clinical and didactic experiences used to meet those objectives included daily patient care of
the MCLANO Emergency Department patients, along with bedside teaching. The rotating
resident is to attend lectures as part of the greater emergency medicine curriculum, as scheduled
by the LSU EM residency program.

The feedback mechanisms and methods used to evaluate the performance of the resident include
daily self and faculty evaluations. Immediate feedback may also be given to the resident, and
any significant problems will be discussed during the rotation with the LSU EM administration.

The resources and facilities in the institution that will be available to each resident include
computer access to Up To Date and the LSU Library services, including current texts in surgery
and emergency medicine. The residents will have access to the resources of the hospital
including call rooms, the LSU Medical Library, Emergency medicine texts, medical records and
meals.

The clinical experiences, duties and responsibilities the resident will have on the rotation:
Residents will act as a part of the Emergency Medicine team under the supervision of a staff
physician. The residents will participate in the management of patients in the emergency
department.

The relationship that will exist between emergency medicine residents and faculty on the service:
The overall goals of resident education and patient care will govern the relationship between
faculty and residents. Residents will receive 24 hour supervision while on the rotation. All
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                          132




patient care and medical charts will be reviewed and signed by the EM faculty prior to patient
discharge.

Duty hours for this rotation will not exceed an average of 60hrs/week, call not longer and will
include 1 in 7 days off.

This rotation summary has been reviewed and agreed to by the service director and LSU
Program Director.


MCLANO ED: Specific Competency-based Goals & Objectives: PGY1-4

   1. While in the MCLANO ED, the resident will demonstrates skill in “Data Gathering” that
      includes but not limited to:
          a. PGY1: Perform an appropriate focused history and physical exam (* PC, MK, ICS, PR)
          b. PGY2: Appropriate ordering and interpretation of ancillary tests (* PC, MK, SBP)
          c. PGY3: Gather essential and accurate information from all available sources (* PC, SBP)
          d. PGY4 Challenges assumptions. Able to establish rapport in order to obtain historical
              date in difficult situations. (* PC, IPC & PR)

   2. While in the MCLANO ED, the resident will demonstrates skill in “Problem Solving” that
      includes but not limited to:
          a. PGY1: Generate an appropriate and complete differential diagnosis for an
              undifferentiated patient (* PC, MK)
          b. PGY2: Appropriate organization of data collection in relation to patient management
              decisions (* PC, MK, PBL)
          c. PGY3: Generate an expanded differential diagnosis including possible atypical
              presentations (* PC, MK, PBL)
          d. PGY4: Able to supervise and teach problem-solving skills to lower level residents. (* PC,
               MK, PBL)

   3. While in the MCLANO ED, the resident will demonstrates skill in “Patient Management” that
      includes but not limited to:
          a. PGY1: Development of a basic treatment plan (* PC, MK, SBP)
          b. PGY2: Prompt recognition and appropriate emergency stabilization of the unstable
              patient (*PC, MK, SBP)
          c. PGY3: Institutes appropriate advanced treatment plans autonomously (* PC, MK, ICS, PR,
               SBP)
           d. PGY4 Multitasks, appropriately utilizes resources, facilitates patient flow. (* PC, MK, ICS,
               SBP)

   4. While in the MCLANO ED, the resident will demonstrates skill in “Medical Knowledge”
      appropriate for level of training that includes but not limited to:
          a. PGY1: Demonstrates a basic fund of medical knowledge (*MK)
          b. PGY2: Understands the scientific basis for their decisions (*MK, PBL)
          c. PGY3: Demonstrates an advanced fund of medical knowledge (*MK)
          d. PGY4: Demonstrates an advanced fund of knowledge and challenges assumptions using
              problem-based learning techniques. (*MK, PBL)

   5. While in the MCLANO ED, the resident will demonstrates technical proficiency in “Procedural
      Skills” consistent with level of training that includes but not limited to:
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           a. PGY1: Suturing, lumbar puncture, splinting, I/D abscess (*PC)
           b. PGY2: Endotracheal intubation, central venous access, direction of medical and trauma
              resuscitation (*PC)
           c. PGY3: Conscious sedation, ultrasound, and direction of medical and trauma resuscitation
               (*PC)
           d. PGY4: As above, but also skilled in teaching procedures to lower level residents.

   6. While in the MCLANO ED, the resident will demonstrates skill in “Efficiency” of care that
      includes but not limited to:
          a. PGY1: Effectively manages 1 patients per hour (*PC, MK, SBP)
          b. PGY2: Effectively manages 1.5 patients per hour (*PC, MK, SBP)
          c. PGY3: Effectively multi-tasks and adjusts to increased patient care demands as needed,
              with a goal of 2 patients per hour (*PC, MK, SBP)
          d. PGY4 Effectively multi-tasks and adjusts to increased patient care demands as needed,
              with a goal of >2 patients per hour (*PC, MK, SBP

   7. While in the MCLANO ED, the resident will demonstrate appropriate “Interpersonal and
      Communication Skills” that includes but not limited to:
         a. PGY1: Demonstrates effective information exchange with patients, their families, and
              professional associates (*ICS, PR)
         b. PGY2: Demonstrates appropriate conflict resolution skills (*ICS, PR)
         c. PGY3: Works effectively with others as a leader (*ICS, PR)
         d. PGY4: Teaches leadership skills


   8. While in the MCLANO ED, the resident will demonstrate appropriate “Professionalism” that
      includes but not limited to:
          a. PGY1: Introduces self to patient and/or family (*PR)
          b. PGY2: Respectful of patient’s privacy and confidentiality (*PR)
          c. PGY3: Demonstrates respect, compassion, and integrity (*PR)
          d. PGY4: Models and teaches respect, compassion, and integrity (*PR)


   9. While in the MCLANO ED, the resident will demonstrates skills in proper “Documentation”
      that includes but not limited to:
           a. PGY1: Medical record is accurate, complete, timely, and appropriate (*PC)
           b. PGY2: Appropriately documents medical decision making (*PC)
           c. PGY3: Documents MCLANO ED course including re-evaluation of patient if applicable
               (*PC)
           d. PGY4: Models and teaches appropriate and timely documentation in the ED to lower leve
              residents. (*PC)

   10. While in the MCLANO ED, the resident will demonstrates an understanding of a “Systems-
       Based Practice” that includes but not limited to:
          a. PGY1: Understands basic resources available for care of the emergency department
               patient (*SBP)
          b. PGY2: Utilizes the consultation process appropriately (*SBP, PC)
          c. PGY3: Provides appropriate medical command to pre-hospital providers (*SBP, PC)
          d. PGY4 : Models and teaches Systems-Based Practice to lower levels. (*SBP, PC)
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    11. While in the MCLANO ED, the resident will demonstrate an awareness of the importance of
        “Practice Based Learning and Improvement” that includes but not limited to:
           a. PGY1: Uses appropriate information resources (ie, texts, online web sites, etc.) for care
                of patient (* PBL, PC)
           b. PGY2: Applies knowledge of scientific studies to care (* PBL, PC)
           c. PGY3: Facilitates the learning of professional associates (* PBL, MK)
           d. PGY4: Models and teaches practice based learning to lower levels. (* PBL, MK)


(* denotes core competency area: PC-Patient Care, MK-Medical Knowledge, ICS-Interpersonal and Communication skills, PR-
Professionalism, SBP-Systems Based Practice, PBL-Practice Based Learning and Improvement).
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ANESTHESIA & ENT

Dr.______________________________,

       You are assigned to Anesthesia & ENT for the month of____________________.

       Orientation: Report to the Anesthesia Office on at West Jefferson

        Schedule: Report to Anesthesia at 6am on the first weekday of the month. Introduce
yourself to the coordinator, Miss Suzaunne. (in the anesthesia lounge/work room) You will work
a full week orienting yourself in the Department of Anesthesia. On the first and following
Wednesdays, you will report to ENT clinic. Starting the second week of the month, each
Monday will also be spent in ENT Clinic. You will take two home calls for ENT each week.

         Responsibilities: Email Dr. Zuzukin (vzuzuk@lsuhsc.edu) or cell: 214-934-0200 prior
to starting the month to confirm your call schedule and meeting places. All schedule request
changes must be accompanied by an approval letter from the program director.

       Conference: You are to attend ENT clinic and will be excused from conference.

       Extras: All procedures must be recorded and turned in at the end of the month.

       Evaluations: Global Rotation evaluation

       Supervision: All intubations, rapid sequence inductions and associated procedures are
supervised by Anesthesia faculty and CRNA’s. All laryngoscopies will be supervised by ENT
staff.

       Meals: The resident’s responsibility.


                                   Anesthesia & ENT Rotation

                                   GOALS and OBJECTIVES

The year of training is typically PGY 1.

OVERALL OBJECTIVES:

Anesthesia: To gain the greatest possible mastery of: airway management, placement and the
interpretation of non-invasive and invasive monitors, clinical pharmacology and physiology
relevant to the administration of as types of Anesthesia, techniques of providing general and
regional Anesthesia.

ENT: The EM Resident will gain experience and knowledge of the anatomy, physiology, and
pathophysiology of the ear, nose, and throat pertinent to the practice of Emergency Medicine.
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The EM Resident will acquire the ability to manage ear, nose, and throat problems associated
with the practice of Emergency Medicine. The EM Resident will demonstrate an understanding
of the nature and principles of airway management including awake intubation, laryngoscopy,
and tracheostomy.



GENERAL GOALS:

Residents will participate in the evaluation and management of patients admitted for
surgery. Residents will function as a member of the anesthesiology team and assist with the
direct management of patients undergoing Anesthesia. The ENT experience will allow the EM
residents to gain experience in the normal ENT anatomy and pathophysiology.

The clinical and didactic experiences used to meet those objectives include evaluation of pre
operative patients, post operative patients, intubation and management of general Anesthesia,
along with bedside teaching. ENT clinic and call will allow the EM resident the opportunity to
evaluate patients with ENT pathology as well at normal ENT anatomy. This rotation experience
is part of the greater emergency medicine curriculum, including weekly didactics concerning
airway management and topics relating to Anesthesia and ENT (part of the overall didactic
curriculum).

The feedback mechanisms and methods used to evaluate the performance of the resident include
an end of rotation global evaluation. Immediate feedback may also be given to the resident, and
any significant problems will be discussed during the rotation with the LSU EM administration.

The resources and facilities in the institution that will be available to each resident include
computer access to Up To Date and the LSU Library services, including current texts in
Anesthesia and emergency medicine. The residents will have access to the resources of the
hospital including medical texts, medical records, doctor’s lounge and cafeteria.

The clinical experiences, duties and responsibilities the resident will have on the
rotation: Residents will act as a part of the Anesthesia team in a community hospital under the
supervision of a staff physician.

The relationship that will exist between emergency medicine residents and faculty on the
service: The overall goals of resident education and patient care will govern the relationship
between faculty and residents. Residents will receive 24 hour supervision while on the
rotation. All patient care and medical charts will be reviewed and signed by the faculty prior to
patient discharge.

Duty hours for this rotation will not exceed an average of 80hrs/week, does include home call,
and will include 1 in 7 days off.
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This rotation summary has been reviewed and agreed to by the service director and LSU
Program Director.



Anesthesia: Specific Competency Based Goals & Objectives

    1. While on Anesthesia, the resident will demonstrates skill in “Data Gathering” that includes
       appropriate focused history and physical exam and ordering and interpretation of ancillary tests (*
         PC, MK, ICS, PR)

    2. While on Anesthesia, the resident will demonstrate skills in “Problem Solving” that includes
       appropriate and complete differential diagnosis for an undifferentiated patient. Appropriate
       organization of data collection in relation to patient management decisions. (* PC, MK, PBL)

    3. While on Anesthesia, the resident will demonstrates skills in “Patient Management” that
       includes a basic treatment plans and timely recognition of complicated anesthesia patients. (* PC,
         MK, SBP)

    4. While on Anesthesia, the resident will demonstrate skill in “Medical Knowledge” appropriate
       for level of training that demonstrates a basic fund of medical knowledge and the ability to seek
       the scientific basis for their patient care decisions (*MK, PBL)

    5. While on Anesthesia, the resident will demonstrate technical proficiency in “Procedural Skills”
       consistent with level of training that includes supervised intubations, central venous access and
       arterial access. (*PC)

    6. While on Anesthesia, the resident will demonstrate appropriate “Interpersonal and
       Communication Skills” that includes effective information exchange with patients, their
       families, and professional associates. Demonstrates appropriate conflict resolution skills. (*ICS,
         PR)

    7. While on Anesthesia, the resident will demonstrate appropriate “Professionalism” that includes
       introduces self to patient and/or family. Respectful of patient’s privacy and confidentiality (*PR)

    8. While on Anesthesia, the resident will demonstrates an understanding of a “Systems-Based
       Practice” that includes understanding basic resources available for care of the anesthesia patient.
         (*SBP, PC)

    9. While on Anesthesia, the resident will demonstrate “Practice Based Learning and
       Improvement” skills that includes use of appropriate information resources (ie, texts, online web
       sites, etc.) for care of patient (* PBL, PC)


(* denotes core competency area: PC-Patient Care, MK-Medical Knowledge, ICS-Interpersonal and Communication skills, PR-
Professionalism, SBP-Systems Based Practice, PBL-Practice Based Learning and Improvement).
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                                     ENT Goals & Objectives
GOALS

   The EM Resident will acquire and demonstrate knowledge of the anatomy, physiology, and
    pathophysiology of the ear, nose, and throat pertinent to the practice of Emergency Medicine.
   The EM Resident will demonstrate the ability to manage ear, nose, and throat problems
    associated with the practice of Emergency Medicine.
   The EM Resident will demonstrate an understanding of the nature and principles of airway
    management including awake intubation and tracheostomy.

OBJECTIVES
a. Patient Care: Upon completion of this rotation, residents will
demonstrate knowledge of and skills in ENT examination of patients with
head and neck diseases or injuries. They will:
         i. Demonstrate the ability to perform adequate history and physical
         examination.
         ii. Demonstrate the ability to identify acute airway problems relating
         to head and neck cancers.
b. Medical Knowledge: Upon completion of this rotation, residents will be
able to:
         i. Demonstrate an understanding the anatomy, physiology and
         pathophysiology of ear, nose and throat.
         ii. Demonstrate an understanding of the initial management of head and
         neck trauma.
c. Practice-based learning: Residents are expected to
         i. Be able to evaluate own performance,
         ii. Incorporate feedback into improvement activities;
         iii. Effectively use technology to manage information for patient care
         and self-improvement.
d. Interpersonal and communication skills: Residents are expected to:
         i. Create and sustain a therapeutic and ethically sound relationship
         with patients.
         ii. Use effective listening skills and elicit and provide information
         using effective nonverbal, explanatory, questioning, and writing
         skills.
         iii. Work effectively with others as a member of the ENT team.
e. Professionalism: Residents are expected to demonstrate a commitment to
carrying out professional responsibilities, adherence to ethical principles,
and sensitivity to a diverse patient population. They are expected to:
         i. Demonstrate respect, compassion, and integrity; a responsiveness
         to the needs of patients that supercedes self-interest; accountability
         to patients; and a commitment to excellence and on-going
         professional development.
         ii. Demonstrate a commitment to ethical principles pertaining to
         confidentiality of patient information and informed consent.
         iii. Demonstrate sensitivity and responsiveness to patients’ culture,
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        age, gender, and disabilities.
f. Systems-based practice: Residents are expected to:
        i. Demonstrate understanding of how their patient care and other
        professional practices affect other health care professionals and the
        hospital.
        ii. Practice cost-effective health care and demonstrate knowledge of
        resource allocation that does not compromise quality of care
        iii. Advocate for quality patient care and assist patients and families in
        dealing with the complexities of the system.
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CHABERT Medicine Wards


Dr._________________,

You are assigned to Leonard J. Chabert Medical Center for the month _____________.

Orientation: Report for 8:00 a.m. on the first day of the month to the Department of Medicine.
You will be brought to Classroom 2, 2nd floor, for orientation. Dr. Thomas Ferguson is the
Director (985-873-1207).

Schedule: Daily rounds and in house call not to exceed Duty Hour policy

       Housing: One bedroom furnished apartments are available for your use. All the
apartments have been recently refurnished. Kitchen utensils are furnished; there are sheets on
the bed, and a limited number of towels available in each apartment. You are responsible for
leaving housing in good condition with sheets and towels washed when you leave. You are
encouraged to make use of the apartment, particularly when you are post-call.

        Directions: See attached map and driving directions. The hospital is located at 1978
Industrial Blvd. The hospital directions include a warning to be careful as this entrance has two
lanes of traffic and other vehicles cross in front of each other without realizing it. They think it
is two-way traffic. To be sure to arrive in time, allow an hour and a half travel time the first time
you make the trip.

      For assistance along the way, call Maddy Pitre (985-873-1265) of Liz Ferguson (985-
873-1207)

       Conference: You are required to attend conference and journal club. You will be
released from your duties at 6am after signing out your patients to the nurse practitioner on
conference days to be able to come in for conference. Please remind the faculty and other team
members that your conference day is on Wednesdays and Journal Club is the second Thursday of
each month.

       Extras: All procedures must be recorded and turned in at the end of the month.

       Supervision: Internal Medicine faculty

       Evaluations: Composite evaluation at the end of the rotation


                                   GOALS and OBJECTIVES

What follows are the goals and objectives for the Chabert Medicine rotation, that will range from
a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take place
at the Chabert Hospital. The year of training is assigned in the PGY1.
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OBJECTIVES:
Gain expertise in the management of adult medical emergencies. Learn the priorities and
procedures medicine wards. Become an integral part of the Medicine team.

GOALS:
The educational goals include gaining knowledge about initial management and inpatient care of
medicine ward patients
Participate in daily teaching rounds
Evaluate Medicine patients in the Emergency Department
Participate in Procedures.
Participate in the routine care of Medicine patients
Participate in consults to the Medicine Service
Follow inpatients through discharge, including discharge planning

The clinical and didactic experiences used to meet those objectives included daily patient care of
MEDICINE patients, along with bedside teaching. The rotating resident is encouraged to attend
lectures pertaining to the care of the MEDICINE patient. This rotation experience is part of the
greater emergency medicine curriculum, also including weekly didactics (part of the overall
didactic curriculum).

The feedback mechanisms and methods used to evaluate the performance of the resident include
an end of rotation global evaluation. Immediate feedback may also be given to the resident, and
any significant problems will be discussed during the rotation with the LSU EM administration.

The resources and facilities in the institution that will be available to each resident include
computer access to Up To Date and the LSU Library services, including current texts in
MEDICINE and emergency medicine. The residents will have access to the resources of the
hospital including call rooms, the LSU Medical Library, Hospital medical texts, medical records
and the cafeteria.

The clinical experiences, duties and responsibilities the resident will have on the rotation:
Residents will act as a part of the MEDICINE team under the supervision of a staff physician.
The residents will participate in the initial management and care of MEDICINE patients.

The relationship that will exist between emergency medicine residents and faculty on the service:
The overall goals of resident education and patient care will govern the relationship between
faculty and residents. Residents will receive 24 hour supervision while on the rotation. All
patient care and medical charts will be reviewed and signed by the MEDICINE faculty daily and
prior to patient discharge.

Duty hours for this rotation will not exceed an average of 80hrs/week, call not longer than 24
consecutive hours and will include 1 in 7 days off.

This rotation summary has been reviewed and agreed to by the service director and LSU
Program Director.
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EMS- New Orleans EMS

Dr._________________,

       You are assigned to New Orleans EMS the month of _____________.

Orientation: 2 weeks prior to beginning your rotation, contact Jeffrey Elder, M.D. at
jmelder@cityofno.com or 504-818-8139 to discuss the rotation and confirm your schedule.

Schedule: You will work eight 12 hour shifts over 2 weeks. The shifts will be 11am-11pm.
Changes in shift times will only be accepted if approved by EMS administration.

Directions: Report to 300 Calliope at the beginning of each shift. Obtain your radio from the
Paramedic in the Rescue office. (Trailer on the left) Return the radio to the charger at the end of
each shift. You will be required to check out an ANSI reflective jacket and traffic vest prior to
the beginning of the rotation and to return the equipment at the end of the rotation. According to
federal law, all first responders are to wear the reflective gear while on the interstate highway
system.

Uniform: Residents will be required to wear the issued LSU Emergency Medicine polo shirt,
tucked in. Pants will be either blue or kaki. A brown or black belt must be worn to secure the
medical control radio. Boots are preferred over tennis shoes.

Conference: You are required to attend conference.

Extras: All procedures must be recorded and turned in at the end of the month.

Supervision: Dr. Jullette Saussy and the EMS fellow on duty.

Evaluations: From Dr. Saussy or the EMS fellows. Contact one of the EMS physicians during
the rotation to complete your evaluation.



                         LSU Emergency Medicine Residency Program
                                New Orleans EMS Rotation

                                   GOALS and OBJECTIVES

What follows are the goals and objectives for the New Orleans EMS rotation, a 2 week rotation,
as assigned by the Program Director. The rotation will take place in the prehospital environment
under the direction of the New Orleans EMS physicians. The year of training may include PGY
2-5.
The educational goals and objectives for the New Orleans EMS rotation are to provide residents
with an opportunity to experience and learn about the initial evaluation and management of
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emergency patients in the prehospital environment. The resident will also learn about EMS
system management, leadership and education.

   1) Perform basic assessment of patients with a variety of moderate and major medical and
      traumatic conditions.

   2) Develop a working knowledge of EMS Systems

   3) Become familiar with all the components of EMS Systems and how they integrate.


   4) Understand the duties, responsibilities and authority of an EMS Medical Director.


   5) Work as online medical control for New Orleans EMS via radio communications.

   6) Perform on scene medical control for New Orleans EMS, interacting with New Orleans
      EMS Paramedics as well as direct patient care.

   7) Become familiar with the many elements of MCI management and Disaster Planning
      including but not limited to Incident Command, Field Triage and Communications.

   8) Demonstrate basic understanding of the principles of ACLS, PALS and ATLS
      resuscitation as applied to persons in prehospital cardio-respiratory arrest.


The feedback mechanisms and methods used to evaluate the performance of the resident include
an end of rotation global evaluation. Immediate feedback may also be given to the resident, and
any significant problems will be discussed during the rotation with the LSU EM administration.

The clinical experiences, duties and responsibilities the resident will have on the rotation:
Residents will act as a part of the New Orleans Emergency Medical Services. The resident will
work as online medical control as well as assist in direct patient care.

The relationship that will exist between emergency medicine residents and faculty on the service:
The overall goals of resident education and patient care will govern the relationship between
faculty and residents.

Duty hours for this rotation will not exceed an average of 60hrs/week, and will include 1 in 7
days off.
This rotation summary has been reviewed and agreed to by the service director and LSU
Program Director.
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CHILDREN’S HOSPITAL


Dr.__________________________,

       You are assigned to Children’s Hospital for the month of_________________.

        Orientation: Dr. Mangat, the head of the LSU Pediatrics Emergency Medicine Division,
will orient you to the ER on the first weekday of the month. It will be held at 8am in
Administration Conference Room B on the first floor of Children’s Hospital. If you have any
questions for Dr. Mangat, it’s best to contact her by email: rmanga@lsuhsc.edu.
Dr. Druby Hebert is the Director (896-9229). The ER # is 896-9474 and the main # is 899-9511.


       Schedule: If you do not receive an email from the Peds Chief resident two weeks before
your rotation, please call their office: 896-9329. You will work approximately 15 shifts in a
month. Please do not schedule a shift during conference or Journal club: each Wed 7a11a or the
2nd Thurs each month 7a10p. You can view your shift schedule at http://www.amion.com. The
password is ―lsupeds‖. If you have any questions or requests, you can call us at (504) 896-9329


       Directions: Children’s Hospital is located in Uptown New Orleans, near Audubon Park
and Tulane University. Take Henry Clay Avenue off St. Charles Avenue and Magazine Street
toward the river and Children’s Hospital will be on the right as you
Approach the Mississippi River. The address is 200 Henry Clay Avenue.

       Conference: You are required to attend conference.

       Extras: All procedures must be recorded and turned in at the end of the month.

       Supervision: Provided by PER faculty.

       Evaluations: Compiled and pooled from evaluations of the PER faculty.

       Meals: Lunch is provided by Children’s Hospital.

      Lab System (CERNER): You will be assigned a unique username for the cerner lab
computers; come by the Chief Resident’s office to pick up a form to sign for the lab department.
The Chief’s office is at Children’s Hospital in the Ambulatory Care Center on the 2nd floor –
room 2304.

                                   GOALS and OBJECTIVES
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What follows are the goals and objectives for the CHILDRENS’ Pediatric ED rotation, that will
range from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will
take place at the CHILDRENS’ Hospital in the Pediatric ED.

The educational objectives of the CHILDRENS’ Pediatric ED rotation are to:

   1) Gain expertise in the recognition and management of pediatric emergencies.

   2) Gain expertise in pediatric resuscitation, including Pediatric Advanced Life Support,
      emergent intubation, fluid administration, and drug dosages.

   3) Become familiar with the management of non-emergent pediatric conditions which
      commonly present to the Emergency Department.

   4) Gain expertise in the performance of routine procedures such as venipuncture and arterial
      puncture.

   5) Become familiar with pediatric medication dosages.

The clinical and didactic experiences used to meet those objectives included daily patient care in
the CHILDRENS’ Pediatric ED, along with bedside teaching. The rotating resident is
encouraged to attend lectures available at CHILDRENS’ pertaining to the care of the pediatric
patient. This rotation experience is part of the greater pediatric emergency medicine curriculum,
also including PALS provider and instructor certification and weekly didactics (part of the
overall didactic curriculum).

The feedback mechanisms and methods used to evaluate the performance of the resident include
an end of rotation global evaluation. Immediate feedback may also be given to the resident, and
any significant problems will be discussed during the rotation with the LSU EM administration.

The resources and facilities in the institution that will be available to each resident include
computer access to Up To Date and the LSU Library services, including current texts in
pediatrics and emergency medicine. There is a rent free, secure apartment available during the
rotation for resident use. The residents will have access to the resources of the hospital including
medical texts, medical records and cafeteria.

The clinical experiences, duties and responsibilities the resident will have on the rotation:
Residents will act as a part of the Emergency Medicine team in a community pediatric hospital
under the supervision of a staff physician. The residents will participate in the initial
management of emergency department patients, to include pediatric trauma and general medical
patients.

The relationship that will exist between emergency medicine residents and faculty on the service:
The overall goals of resident education and patient care will govern the relationship between
faculty and residents. Residents will receive 24 hour supervision while on the rotation. All
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patient care and medical charts will be reviewed and signed by the ED faculty prior to patient
discharge.

Duty hours for this rotation will not exceed an average of 60hrs/week, and will include 1 in 7
days off.

This rotation summary has been reviewed and agreed to by the service director and LSU
Program Director.
Children’s ED: Specific Competency Based Goals & Objectives:

   1. While in the pediatric ED at Children’s Hospital, the resident will demonstrates skill in “Data
      Gathering” that includes appropriate focused history and physical exam and ordering and
      interpretation of ancillary tests (* PC, MK, ICS, PR)

   2. While in the pediatric ED at Children’s Hospital, the resident will demonstrate skills in “Problem
      Solving” that includes appropriate and complete differential diagnosis for an undifferentiated
      pediatric ED patient. Appropriate organization of data collection in relation to patient
      management decisions. (* PC, MK, PBL)

   3. While in the pediatric ED at Children’s Hospital, the resident will demonstrates skills in “Patient
      Management” that includes a basic treatment plans and timely recognition of complicated
      pediatric ED patients. (* PC, MK, SBP)

   4. While in the pediatric ED at Children’s Hospital, the resident will demonstrate skill in “Medical
      Knowledge” appropriate for level of training that demonstrates a basic fund of medical
      knowledge and the ability to seek the scientific basis for their patient care decisions (*MK, PBL)

   5. While in the pediatric ED at Children’s Hospital, the resident will demonstrate technical
      proficiency in “Procedural Skills” consistent with level of training that includes supervised
      suturing, abscess I&D, dislocation reductions, ultrasound, pediatric medical and trauma
      resuscitations,conscious sedation, intubations, central venous access and arterial access. (*PC)

   6. While in the pediatric ED at Children’s Hospital, the resident will demonstrate appropriate
      “Interpersonal and Communication Skills” that includes effective information exchange with
      patients, their families, and professional associates. Demonstrates appropriate conflict resolution
      skills. (*ICS, PR)

   7. While in the pediatric ED at Children’s Hospital, the resident will demonstrate appropriate
      “Professionalism” that includes introduces self to patient and/or family. Respectful of patient’s
      privacy and confidentiality (*PR)

   8. While in the pediatric ED at Children’s Hospital, the resident will demonstrates an understanding
      of a “Systems-Based Practice” that includes understanding basic resources available for care of
      the pediatric ED patient. (*SBP, PC)

   9. While in the pediatric ED at Children’s Hospital, the resident will demonstrate “Practice Based
      Learning and Improvement” skills that includes use of appropriate information resources (ie,
      texts, online web sites, etc.) for care of patient (* PBL, PC)
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MICU

Dr.____________________________,

           You are assigned to the MICU for the month of________________________.

        Schedule: Contact the LSU Medicine Chief Resident 568-5600, 2 weeks prior to your
rotation to receive your schedule and/or make any schedule requests. Call: Your call will be
every third night. Every attempt will be made to provide each resident with one full weekend
off. Weekends are managed by two of the three call teams.

        Responsibilities: The MICA residents will function as a team leader responsible for the
care of all patients in the MICU. Additionally, the MICU resident is responsible for all consults
in MER/AR/FT and floor for MICU admission. The MICU resident must also respond to all
codes within the hospital. An intern and possibly medical students will be assigned to your team.
The resident is responsible for supervision, education and directions for the call team.

       Conference: You are excused from conference. Attempts should be made in attending
medicine conference, which is held at 12 noon Monday through Friday.

           Extras: All procedures must be recorded and turned in at the end of the month.

      Supervision: The 1st two weeks are staffed by LSU Pulmonary and Tulane Cardiology.
      nd
The 2 two weeks are staffed by Tulane Pulmonary and LSU Cardiology.

        Evaluations: Compiled from pooling all LSU/Tulane Pulmonary Critical Care faculty
and fellows who supervised you throughout the month. You are responsible for delivering your
evaluations to the faculty at the completion of their 2-week supervision.

           Meals: The resident’s responsibility.

           Location: The MICU and MICU call room is located on the 6th floor of UH.

                                    GOALS and OBJECTIVES

What follows are the goals and objectives for the University Hospital MICU rotation, that will
range from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will
take place at the MCLANO University Hospital. The year of training is typically PGY 1 and 3.

OBJECTIVES:
The educational objectives of the MICU rotation is to provide residents with an opportunity to
experience and learn about the initial evaluation and management of MICU patients in the
community setting and to become proficient in the diagnosis and treatment of: CHF, pulmonary
edema, pneumonia, pneumothorax, pulmonary embolus, ARDS, respiratory distress, asthma,
COPD, AMI, acute coronary syndrome, cardiomyopathym, pericarditis, HTN, stroke,
pancreatitis, acute renal failure, hepatitis, pyelonephritis, acute hepatic failure, toxicologic
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emergencies, acute drug overdose, consultation, living wills, do not resuscitate, rehabilitation, IV
access, induction and paralytic agents. Hemodynamic monitoring, airway and ventilator
management, sedative/hypnotic agents. .

GOALS:
Residents will act as a part of the MICU team in a community hospital, under the supervision of
a staff physician. The resident will participate in the management of MICU patients, to include
evaluation, admission management of all MICU requests from the floor and emergency
department as well as patients already in the MICU. The resident is responsible for the daily
management and disposition planning of all patients admitted by his/her team. Rounds occur
daily with the ICU staff, pulmonary fellow and cardiology staff. The resident is responsible for
attending and leading all in house cardiac arrests and subsequent management.

The clinical and didactic experiences used to meet those objectives include evaluation of ICU
patients, in the ED and in the ICU, along with bedside teaching. This rotation experience is part
of the greater emergency medicine curriculum, including weekly didactics concerning critically
ill and injured patients (part of the overall didactic curriculum).

The feedback mechanisms and methods used to evaluate the performance of the resident include
an end of rotation global evaluation. Immediate feedback may also be given to the resident, and
any significant problems will be discussed during the rotation with the LSU EM administration.

The resources and facilities in the institution that will be available to each resident include
computer access to Up To Date and the LSU Library services, including current texts in ICU
care. The residents will have access to the resources of the hospital including call rooms,
medical texts, medical records, and meals.

The clinical experiences, duties and responsibilities the resident will have on the rotation:
Residents will act as a part of the ICU team in under the supervision of a staff physician.

The relationship that will exist between emergency medicine residents and faculty on the service:
The overall goals of resident education and patient care will govern the relationship between
faculty and residents. Residents will receive 24 hour supervision while on the rotation. All
patient care and medical charts will be reviewed and signed by the faculty each day and prior to
patient discharge.

Duty hours for this rotation will not exceed an average of 80hrs/week, call not to exceed 24
hours, and will include 1 in 7 days off.

This rotation summary has been reviewed and agreed to by the service director and LSU
Program Director.

Specific Competency Based Goals & Objectives based on Level of Training:

   1. While in the MICU, the resident will demonstrates skill in “Data Gathering” that includes but
      not limited to:
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           a. PGY1: Perform an appropriate focused history and physical exam and ordering and
              interpretation of ancillary tests (* PC, MK, ICS, PR)
           b. PGY3: Gather essential and accurate information from all available sources. Challenges
              assumptions. Able to establish rapport in order to obtain historical data in difficult
              situations. (* PC, IPC SBP & PR)

   2. While in the MICU, the resident will demonstrates skill in “Problem Solving” that includes but
      not limited to:
          a. PGY1: Generate an appropriate and complete differential diagnosis for an
              undifferentiated patient. Appropriate organization of data collection in relation to patient
              management decisions. (* PC, MK, PBL)
          b. PGY3: Generate an expanded differential diagnosis including possible atypical
              presentations. Able to supervise and teach problem-solving skills to lower level residents.
               (* PC, MK, PBL)

   3. While in the MICU, the resident will demonstrates skill in “Patient Management” that includes
      but not limited to:
          a. PGY1: Development of a basic treatment plan and timely recognition and appropriate
               emergency stabilization of the unstable patient (* PC, MK, SBP)
          b. PGY3: Institutes appropriate advanced treatment plans autonomously. Multitasks,
               appropriately utilizes resources, facilitates triage of patient care in the MICU. (* PC, MK,
               ICS, PR, SBP)

   4. While in the MICU, the resident will demonstrates skill in “Medical Knowledge” appropriate for
      level of training that includes but not limited to:
          a. PGY1: Demonstrates a basic fund of medical knowledge. Seeks the scientific basis for
               their patient care decisions (*MK, PBL)
          b. PGY3: Demonstrates an advanced fund of knowledge and challenges assumptions using
               problem-based learning techniques. (*MK, PBL)

   5. While in the MICU, the resident will demonstrates technical proficiency in “Procedural Skills”
      consistent with level of training that includes but not limited to:
         a. PGY1: lumbar puncture, closely supervised intubations and central venous access(*PC)
         b. PGY3: Conscious sedation, ultrasound, and direction of medical resuscitation, generally
              supervised intubations and central venous access (*PC)

   6. While in the MICU, the resident will demonstrate appropriate “Interpersonal and
      Communication Skills” that includes but not limited to:
         a. PGY1: Demonstrates effective information exchange with patients, their families, and
              professional associates (*ICS, PR)
         b. PGY3: Works effectively with others as a leader. Demonstrates appropriate conflict
              resolution skills (*ICS, PR)

   7. While in the MICU, the resident will demonstrate appropriate “Professionalism” that includes
      but not limited to:
          a. PGY1: Introduces self to patient and/or family. Respectful of patient’s privacy and
               confidentiality (*PR)
          b. PGY3: Demonstrates respect, compassion, and integrity. Models compassionate
               approach to patient care in all circumstances. (*PR)
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    8. While in the MICU, the resident will demonstrates an understanding of a “Systems-Based
       Practice” that includes but not limited to:
          a. PGY1: Understands basic resources available for care of the MICU patient. Utilizes the
               consultation process appropriately (*SBP, PC)
          b. PGY3: Makes appropriate bed triage decisions. Makes appropriate step-down and
               transfer decisions. (*SBP, PC)

    9. While in the MICU, the resident will demonstrate “Practice Based Learning and
       Improvement” skills that includes but not limited to:
          a. PGY1: Uses appropriate information resources (ie, texts, online web sites, etc.) for care
               of patient (* PBL, PC)
          b. PGY3: Facilitates the learning of professional associates. Applies knowledge of scientific
               studies to care (* PBL, MK, PC)


(* denotes core competency area: PC-Patient Care, MK-Medical Knowledge, ICS-Interpersonal and Communication skills, PR-
Professionalism, SBP-Systems Based Practice, PBL-Practice Based Learning and Improvement).
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OBSTERICS

                                OB-GYN ROTATION at Chabert


Dr.______________________,

You are scheduled for LSU OB at Chabert:

Director: Dr. Brent Hemelt, Chief OB/GYN @ Chabert
OB Contact Person: Tammy Pellegrini (tpell1@lsuhsc.edu) 985-873-2285
Apartment information: Georgette Hartman (ghartm1@lsuhsc.edu) 985-873-1285

Housing: One bedroom furnished apartments are available for your use. Kitchen utensils are
furnished; there are sheets on the bed, and a limited number of towels available in each
apartment. You are responsible for leaving housing in good condition with sheets and towels
washed when you leave. You are encouraged to make use of the apartment, particularly when
you are post-call.

Directions: The hospital is located at 1978 Industrial Blvd. The hospital directions include a
warning to be careful as this entrance has two lanes of traffic and other vehicles cross in front of
each other without realizing it. Allow an hour and a half travel time the first time you make the
trip. General directions:

1. Take I-10 west for 13 miles (out past the airport)
2. Exit onto I-310 south to Houma/Boutte and go 12 miles
3. Exit onto Highway 90 west to Houma (for 22 miles)
4. Exit (go left) 182 (Houma) on LA-182W/US-90-BR W and go 3.6 miles
5. Turn left at LA-3087 S and go 5 miles
6. Continue on Prospect Blvd 1.1 miles
7. Turn left at Grand Caillou Rd/LA-57 and go 0.7 miles
8. Turn right at Industrial Blvd.

      For assistance along the way, call Maddy Pitre (985-873-1265) of Liz Ferguson (985-
873-1207)

Learning Modules: You must complete the following learning modules and take the post-test
within 2 weeks of completing the rotation. You may complete them as early as you like and the
tests are open book. You must achieve 80% to get credit for completing the modules. The
learning modules can be found under the Home Study link on the LSUEM residency page. The
tests will be available on ResidencyPartner, but you can also email your answers to Kathy
Whittington (klwhit@lsuhsc.edu) if you have trouble accessing RP.

   Modules: 1. Early Pregnancy Emergencies               2. 2nd & 3rd Trimester Emergencies
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                                   GOALS and OBJECTIVES

What follows are the goals and objectives for the OBGYN rotation, that will range from a 2
week to 1 month rotation, as assigned by the Program Director. The rotation will take place at
University Hospital. The year of training is assigned in the PGY1 year but may include PGY 1-
5.

OBJECTIVES:
Gain expertise in the management of obstetrical and gynecological emergencies. Learn the
priorities and procedures of labor and delivery. Become an integral part of the OBGYN team
and respond to deliveries along with junior, senior and staff OBGYN’s. Gain exposure to OR
sterile techniques and surgical techniques.

GOALS:
   The educational goals include gaining knowledge about the progression of normal labor,
    delivery and immediate post-partum care. The resident will also gain expertise in the
    initial management of gynecological emergencies.
   Participate in daily teaching rounds
   Evaluate OBGYN patients in the Emergency Department
   Participate in OBGYN Procedures, both in the OR and in Labor and Delivery: the
    ACGME recommends that you document participation in 10 vaginal deliveries.
   Participate in the routine care of OBGYN patients
   Participate in consults to the OBGYN Service
   Follow inpatient OBGYN patients through discharge, including discharge planning

The clinical and didactic experiences used to meet those objectives included daily patient care of
OBGYN patients, along with bedside teaching. The rotating resident is encouraged to attend
lectures pertaining to the care of the OBGYN patient. This rotation experience is part of the
greater emergency medicine curriculum, also including weekly didactics (part of the overall
didactic curriculum).

The feedback mechanisms and methods used to evaluate the performance of the resident include
an end of rotation global evaluation. Immediate feedback may also be given to the resident, and
any significant problems will be discussed during the rotation with the LSU EM administration.

The resources and facilities in the institution that will be available to each resident include
computer access to Up To Date and the LSU Library services, including current texts in OBGYN
and emergency medicine. The residents will have access to the resources of the hospital
including call rooms, the LSU Medical Library, Hospital medical texts, medical records and the
cafeteria.

The clinical experiences, duties and responsibilities the resident will have on the rotation:
Residents will act as a part of the OBGYN team under the supervision of a staff physician. The
residents will participate in the initial management and care of OBGYN patients.
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The relationship that will exist between emergency medicine residents and faculty on the service:
The overall goals of resident education and patient care will govern the relationship between
faculty and residents. Residents will receive 24 hour supervision while on the rotation. All
patient care and medical charts will be reviewed and signed by the OBGYN faculty daily and
prior to patient discharge.

Duty hours for this rotation will not exceed an average of 80hrs/week, call not longer than 24
consecutive hours and will include 1 in 7 days off.

This rotation summary has been reviewed and agreed to by the service director and LSU
Program Director.

Addendum: 12/1/2008

The following tasks are expected of every resident that rotates through OB at Chabert:

        The ER resident rounds at the board on L&D daily and resides on the L&D unit during
         the day to triage, admit and labor patients along with the help of the OB resident and
         medical students.

        If the ER resident has participated in care of the patient during labor, he or she delivers
         the baby.

        The ER resident also participates in evening board rounds with the residents and
         students.

        The students write progress notes on inpatients, so the ER residents don't need to do that.

        The ER resident should also take one call every 7th night and can leave post call at
         9AM.


         EM Core Competency Specific G&O
Goal: Develop the ability to evaluate, stabilize, and treat OB patients in a manner consistent with the
     expectations of the knowledge and skills of an Emergency Physician.

Objectives:

    1.   Communicate effectively with patients, their families, and professional associates (*ICS).
    2.   Demonstrate respect, compassion, and integrity (*PR).
    3.   Demonstrate the ability to perform an appropriate history and physical exam (*PC).
    4.   Demonstrate the ability to develop an appropriate differential diagnosis and treatment plan
         (*MK).
    5.   Demonstrate appropriate clinical decision making skills (*PC).
    6.   Learn the principles of fetal monitoring techniques (*PC).
    7.   Demonstrate the ability to perform a vaginal delivery (*PC).
    8.   Demonstrates the principles of basic obstetrical ultrasonography (*PC).
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   9. Learn the basic resources available for the care of the obstetrical patient (*SBP).
   10. Learn the appropriate information resources (i.e., textbooks, handbooks, online resources, etc.)
       available for care of obstetrical patient (*PBL).
 (* denotes core competency area: PC-patient care, MK-medical knowledge, ICS-interpersonal
   and communication skills, PR-professionalism, SBP-systems based practice, PBL-practiced
                              based learning and improvement)
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OLOL Pediatric ED


Dr.__________________________,

You are assigned to OLOL Hospital for the month:

Orientation: Orientation to the OLOL Hospital on the first day of the month.

Contact person at GME office: Leigh Salvant (leigh.salvan@ololrmc.com) 225-765-7730
Director of ED: Dr. Steve Narang (snarang@pcsofbr.com)
Schedule requests: Kyle Fitzgerald (kfitzg3@gmail.com)

Schedule: 15 shifts a month, 7a7p, 7p7a or 2p2a.

Directions: I-10 west to Baton Rouge (73 miles), Exit 160 Essen Lane go left 0.5 miles, Right
on Hennessy Blvd. OLOL: 5000 Hennessy Blvd

Conference: You are required to attend conference and journal club.


Learning Modules: You must complete the following learning modules and take the post-test
within 2 weeks of completing the rotation. You may complete them as early as you like and the
tests are open book. You must achieve 80% to get credit for completing the modules. The
learning modules can be found under the Home Study link on the LSUEM residency page. The
tests will be available on ResidencyPartner, but you can also email your answers to Kathy
Whittington (klwhit@lsuhsc.edu) if you have trouble accessing RP.

        Modules: 1. Febrile Infant (PGY2) 2. ALTE (PGY4) 3. Peds Tox (PGY4)

Extras: All procedures must be recorded and turned in at the end of the month. Housing is
provided. Call Ms Salvant 225-765-7730

Supervision: Provided by OLOL PER faculty.

Evaluations: Compiled and pooled from evaluations of the OLOL faculty.

Meals: Lunch is provided by OLOL Hospital.

                                   GOALS and OBJECTIVES

What follows are the goals and objectives for the OLOL Pediatric ED rotation, that will range
from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take
place at the OLOL Hospital in the Pediatric ED. The year of training may include PGY 1-5.
The educational objectives of the OLOL Pediatric ED rotation are to:

   1) Gain expertise in the recognition and management of pediatric emergencies.
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   2) Gain expertise in pediatric resuscitation, including Pediatric Advanced Life Support,
      emergent intubation, fluid administration, and drug dosages.

   3) Become familiar with the management of non-emergent pediatric conditions which
      commonly present to the Emergency Department.

   4) Gain expertise in the performance of routine procedures such as venipuncture and arterial
      puncture.

   5) Become familiar with pediatric medication dosages.

The clinical and didactic experiences used to meet those objectives included daily patient care in
the OLOL Pediatric ED, along with bedside teaching. The rotating resident is encouraged to
attend lectures available at OLOL pertaining to the care of the pediatric patient. This rotation
experience is part of the greater pediatric emergency medicine curriculum, also including PALS
provider and instructor certification and weekly didactics (part of the overall didactic
curriculum).

The feedback mechanisms and methods used to evaluate the performance of the resident include
an end of rotation global evaluation. Immediate feedback may also be given to the resident, and
any significant problems will be discussed during the rotation with the LSU EM administration.

The resources and facilities in the institution that will be available to each resident include
computer access to Up To Date and the LSU Library services, including current texts in
pediatrics and emergency medicine. There is a rent free, secure apartment available during the
rotation for resident use. The residents will have access to the resources of the hospital including
medical texts, medical records and cafeteria.

The clinical experiences, duties and responsibilities the resident will have on the rotation:
Residents will act as a part of the Emergency Medicine team in a community pediatric hospital
under the supervision of a staff physician. The residents will participate in the initial
management of emergency department patients, to include pediatric trauma and general medical
patients.

The relationship that will exist between emergency medicine residents and faculty on the service:
The overall goals of resident education and patient care will govern the relationship between
faculty and residents. Residents will receive 24 hour supervision while on the rotation. All
patient care and medical charts will be reviewed and signed by the ED faculty prior to patient
discharge.

Duty hours for this rotation will not exceed an average of 60hrs/week, and will include 1 in 7
days off.

This rotation summary has been reviewed and agreed to by the service director and LSU
Program Director.
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OCHSNER ED

Dr._________________,


       You are assigned to Ochsner Clinic Foundation the month of _____________.

Orientation: Report for 7:00 a.m. on the first day of the month to the Emergency department.
Dr. Joseph Guarisco is the Director (842-4433). Prior to beginning your rotation, contact
Reonda Victor of the Ochsner GME Department (842-4937) to schedule a time to get your ID
and parking cards. You will be required to give a $10 refundable deposit for the cards. Detailed
information concerning orientation and the rotation are in the Ochsner resident handbook you
have been given.


Schedule: You will work 15 shifts per month; half of the scheduled residents will work 16 in
months with 31 days. Each resident will be required to work one Friday-Saturday night shift
each month.

Directions: Directions to the hospital are included in the Ochsner resident handbook.

Conference: You are required to attend conference and journal club.

Extras: All procedures must be recorded and turned in at the end of the month.

Supervision: Dr. Guarisco and staff physicians provide Supervision.

Evaluations: Compiled and pooled from evaluations by the staff physicians.



                         LSU Emergency Medicine Residency Program
                             Ochsner Clinic Foundation Hospital
                              Emergency Department Rotation

                                   GOALS and OBJECTIVES

What follows are the goals and objectives for the Ochsner ED rotation, that will range from a 2
week to 1 month rotation, as assigned by the Program Director. The rotation will take place at
the Ochsner ED. The year of training may include PGY 1-5.

The educational goals and objectives for the Ochsner ED rotation are to provide residents with
an opportunity to experience and learn about the initial evaluation and management of
emergency patients in the community, health maintenance organization setting, including the
following:
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   9) Perform basic assessment of patients with a variety of moderate and major traumatic
       conditions.
   10) Formulate a differential diagnosis for patients with various kinds of traumatic conditions
       and mechanisms of injury.

   11) Order and interpret appropriate diagnostic laboratory and imaging studies for trauma
       patients.

   12) Competently perform minor procedures such as suturing of lacerations, incision and
       drainage of the abscesses, insertion of nasogastric tubes and urinary catheters,
       venipuncture, insertion of peripheral intravenous catheters, lumbar puncture, splinting of
       fractures and sprains, spinal immobilization.

   13) Demonstrate basic understanding of the principles of ACLS, PALS and ATLS
       resuscitation as applied to persons in cardio-respiratory arrest.

   14) Achieve ability to perform an adequate history and physical exam, prioritize conditions,
       and form a differential diagnosis in adults with acute and chronic medical problems of
       varying severity presenting to the ED for care.

   15) Learn proper methods for stabilization of patients with life threatening conditions such as
       sepsis, respiratory failure, acute MI, CHF, status epilepticus, status asthmaticus, cardiac
       arrhythmias, severe GI bleeds, and overdose.

   16) Learn to evaluate, diagnose and initiate any needed therapy for a variety of specific
       medical problems such as asthma, seizures, anemia, stroke, GI disorders, urinary tract
       infections, pneumonias, and other respiratory illness.

   17) Learn to evaluate and appropriately manage a variety of patient complaints such as chest
       pain, abdominal pain, dizziness, headache, syncope, etc.

   18) Learn to perform an adequate history and physical exam in female patients with
       gynecologic problems or problems related to early pregnancy including abdominal
       bleeding, infection, threatened abortion, and ectopic pregnancy.

   19) Learn to evaluate the pediatric patient in the emergency department, including fever of
       unknown origin and other common pediatric presenting complaints.

   20) Learn appropriate use of diagnostic lab and imaging studies for emergency patients and
       to have basic competence in their interpretations.

   21) Learn to use the following diagnostic aids: central venous pressures, pulse oximetry,
       arterial blood gases, EKG’s.

   22) Perform the following procedures with basic competency and to know indications and
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       contraindications: venipuncture, starting an IV or heparin lock, arterial puncture,
       insertion of a Foley catheter, placement of a central venous line, thoracentesis,
       paracentesis, lumbar puncture, urinalysis with microscopic, wet prep of vaginal
       secretions.

   23) Become familiar with common medico-legal problems which present in emergency
       medical practice such as: consent, desertion, AMA, restraints, impaired patients, child or
       adult abuse or neglect.

   24) Be able to arrange appropriate follow-up for discharged patients and give adequate
       discharge instructions.

   25) Learn and use the available contributions of the Social Services Dept. to patient care in
       the ED and for discharge planning.

   26) Learn appropriate medical evaluation of mentally disturbed patients including techniques
       for restraint and control of violent patients.

   27) Learn about billing as it pertains to ED patients.

   28) Learn about transplant patients.

   29) Learn about geriatric presenting complaints.

The clinical and didactic experiences used to meet those objectives included daily patient care in
the Ochsner ED, along with bedside teaching. This rotation experience is part of the greater
emergency medicine curriculum, also including PALS/ACLS/ATLS provider and instructor
certification and weekly didactics (part of the overall didactic curriculum).

The feedback mechanisms and methods used to evaluate the performance of the resident include
an end of rotation global evaluation. Immediate feedback may also be given to the resident, and
any significant problems will be discussed during the rotation with the LSU EM administration.

The resources and facilities in the institution that will be available to each resident include
computer access to Up To Date and the LSU Library services, including current texts in
emergency medicine. The residents will have access to the resources of the hospital including
medical texts, medical records, doctor’s lounge and cafeteria.

The clinical experiences, duties and responsibilities the resident will have on the rotation:
Residents will act as a part of the Emergency Medicine team in a community hospital under the
supervision of a staff physician. The residents will participate in the initial management of
emergency department patients, to include trauma, psychiatric, obgyn, pediatric and general
medical patients.

The relationship that will exist between emergency medicine residents and faculty on the service:
The overall goals of resident education and patient care will govern the relationship between
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                      160




faculty and residents. Residents will receive 24 hour supervision while on the rotation. All
patient care and medical charts will be reviewed and signed by the ED faculty prior to patient
discharge.

Duty hours for this rotation will not exceed an average of 60hrs/week, and will include 1 in 7
days off.

This rotation summary has been reviewed and agreed to by the service director and LSU
Program Director.

Community ED: Specific Competency-based Goals & Objectives, based on Level of Training:
PGY1-4

   1. While in the community ED, the resident will demonstrate skill in “Data Gathering” that
      includes but not limited to:
          a. PGY1: Perform an appropriate focused history and physical exam (* PC, MK, ICS, PR)
          b. PGY2: Appropriate ordering and interpretation of ancillary tests (* PC, MK, SBP)
          c. PGY3: Gather essential and accurate information from all available sources (* PC, SBP)
          d. PGY4 Challenges assumptions. Able to establish rapport in order to obtain historical
              date in difficult situations. (* PC, IPC & PR)

   2. While in the community ED, the resident will demonstrate skill in “Problem Solving” that
      includes but not limited to:
          a. PGY1: Generate an appropriate and complete differential diagnosis for an
              undifferentiated patient (* PC, MK)
          b. PGY2: Appropriate organization of data collection in relation to patient management
              decisions (* PC, MK, PBL)
          c. PGY3: Generate an expanded differential diagnosis including possible atypical
              presentations (* PC, MK, PBL)
          d. PGY4: Able to supervise and teach problem-solving skills to lower level residents. (*
              PC, MK, PBL)

   3. While in the community ED, the resident will demonstrate skill in “Patient Management” that
      includes but not limited to:
          a. PGY1: Development of a basic treatment plan (* PC, MK, SBP)
          b. PGY2: Prompt recognition and appropriate emergency stabilization of the unstable
              patient (*PC, MK, SBP)
          c. PGY3: Institutes appropriate advanced treatment plans autonomously (* PC, MK, ICS,
              PR, SBP)
          d. PGY4 Multitasks, appropriately utilizes resources, facilitates patient flow. (* PC, MK,
              ICS, SBP)

   4. While in the community ED, the resident will demonstrate skill in “Medical Knowledge”
      appropriate for level of training that includes but not limited to:
          a. PGY1: Demonstrates a basic fund of medical knowledge (*MK)
          b. PGY2: Understands the scientific basis for their decisions (*MK, PBL)
          c. PGY3: Demonstrates an advanced fund of medical knowledge (*MK)
          d. PGY4: Demonstrates an advanced fund of knowledge and challenges assumptions using
              problem-based learning techniques. (*MK, PBL)
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   5. While in the community ED, the resident will demonstrate technical proficiency in “Procedural
      Skills” consistent with level of training that includes but not limited to:
          a. PGY1: Suturing, lumbar puncture, splinting, I/D abscess (*PC)
          b. PGY2: Endotracheal intubation, central venous access, direction of medical and trauma
              resuscitation (*PC)
          c. PGY3: Conscious sedation, ultrasound, and direction of medical and trauma resuscitation
              (*PC)
          d. PGY4: As above, but also skilled in teaching procedures to lower level residents.

   6. While in the community ED, the resident will demonstrate skill in “Efficiency” of care that
      includes but not limited to:
          a. PGY1: Effectively manages 1 patients per hour (*PC, MK, SBP)
          b. PGY2: Effectively manages 1.5 patients per hour (*PC, MK, SBP)
          c. PGY3: Effectively multi-tasks and adjusts to increased patient care demands as needed,
              with a goal of 2 patients per hour (*PC, MK, SBP)
          d. PGY4 Effectively multi-tasks and adjusts to increased patient care demands as needed,
              with a goal of >2 patients per hour (*PC, MK, SBP

   7. While in the community ED, the resident will demonstrate appropriate “Interpersonal and
      Communication Skills” that includes but not limited to:
         a. PGY1: Demonstrates effective information exchange with patients, their families, and
              professional associates (*ICS, PR)
         b. PGY2: Demonstrates appropriate conflict resolution skills (*ICS, PR)
         c. PGY3: Works effectively with others as a leader (*ICS, PR)
         d. PGY4: Models and teaches leadership skills to lower level residents. (*ICS, PR)

   8. While in the community ED, the resident will demonstrate appropriate “Professionalism” that
      includes but not limited to:
          a. PGY1: Introduces self to patient and/or family (*PR)
          b. PGY2: Respectful of patient’s privacy and confidentiality (*PR)
          c. PGY3: Demonstrates respect, compassion, and integrity, even under stressful situations
              (*PR)
          d. PGY4: Models and teaches professionalism skills to lower level residents. (*PR)

   9. While in the community ED, the resident will demonstrates skills in proper “Documentation”
      that includes but not limited to:
           a. PGY1: Medical record is accurate, complete, timely, and appropriate (*PC, ICS)
           b. PGY2: Appropriately documents medical decision making (*PC, ICS)
           c. PGY3: Documents ED course including re-evaluation of patient if applicable (*PC, ICS)
           d. PGY4: Models and teaches verbal and written documentation skills to lower level
               residents. (*PC, ICS)

   10. While in the community ED, the resident will demonstrates an understanding of a “Systems-
       Based Practice” that includes but not limited to:
          a. PGY1: Understands basic resources available for care of the emergency department
               patient in the community setting. (*SBP)
          b. PGY2: Utilizes the consultation process appropriately (*SBP, PC)
          c. PGY3: Provides appropriate medical command to pre-hospital providers (*SBP, PC)
          d. PGY4 Models and teaches system-based practice skills to lower level residents. (*SBP)
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   11. While in the community ED, the resident will demonstrate skills in “Practice Based Learning
       and Improvement” that includes but not limited to:
          a. PGY1: Uses appropriate information resources (ie, texts, online web sites, etc.) for care
               of patient (* PBL, PC)
          b. PGY2: Applies knowledge of scientific studies to patient care decisions (* PBL, PC)
          c. PGY3: Facilitates the learning of professional associates (* PBL, MK)
          d. PGY4: Models and teaches practice based learning and self-improvement skills to lower
               level residents. (*PBL)
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SLIDELL ED

You are assigned to Slidell Memorial Hospital for the month:

Orientation: There is no formal orientation for this rotation. Dr. Eddie Lirette and Kumar
Amaraneni are the Directors of the Emergency Department at SMH.

 Scheduling: You will do sixteen 10-hour shifts each month from 11am to 9pm. Your default
schedule is: Monday, Tuesday and Friday, and the first and third Saturday and Sunday of each
month. If the aforementioned shifts involve more than sixteen dates in a month, then cap your
work hours with the sixteenth shift. If you would like to deviate from this schedule, then you
must obtain permission at least two weeks prior to starting the rotation from Dr. Lirette
(edlirette@cox.net) and submit the approved schedule to Kathy Whittington.
(klwhit@lsuhsc.edu)

       Responsibilities: the daily management of all patients in the ED while on shift.

        Directions: Take I-10 East towards Slidell and exit at Gause Blvd (exit #266), the third
Slidell exit. Turn left at the light on Gause Blvd. and go approximately 2 miles. The entrance to
the ED will be on the left after you pass the red light at the end of the hospital.

       Conference: you must attend conference and journal club.

       Extras: All procedures must be recorded and turned in at the end of the month.

       Supervision: you will work side by side with an Emergency Medicine board certified
physician.

       Evaluations: Pooled and compiled by Dr. Kumar and Dr. Stafford.

       Meals: Provided by SMH.

                 Slidell Memorial Hospital Emergency Department Rotation

                                   GOALS and OBJECTIVES

What follows are the goals and objectives for the Slidell ED rotation, that will range from a 2
week to 1 month rotation, as assigned by the Program Director. The rotation will take place at
the Slidell ED. The year of training may include PGY 1-5.

The educational goals and objectives for the Slidell ED rotation are to provide residents with an
opportunity to experience and learn about the initial evaluation and management of emergency
patients in the community setting as well as the following:

   1) Perform basic assessment of patients with a variety of moderate and major traumatic
      conditions.
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   2) Formulate a differential diagnosis for patients with various kinds of traumatic conditions
      and mechanisms of injury.

   3) Order and interpret appropriate diagnostic laboratory and imaging studies for trauma
      patients.

   4) Competently perform minor procedures such as suturing of lacerations, incision and
      drainage of the abscesses, insertion of nasogastric tubes and urinary catheters,
      venipuncture, insertion of peripheral intravenous catheters, lumbar puncture, splinting of
      fractures and sprains, spinal immobilization.

   5) Demonstrate basic understanding of the principles of ACLS resuscitation as applied to
      persons in cardio-respiratory arrest.

   6) Achieve ability to perform an adequate history and physical exam, prioritize conditions,
      and form a differential diagnosis in adults with acute and chronic medical problems of
      varying severity presenting to the ED for care.

   7) Learn proper methods for stabilization of patients with life threatening conditions such as
      sepsis, respiratory failure, acute MI, CHF, status epilepticus, status asthmaticus, cardiac
      arrhythmias, severe GI bleeds, and overdose.

   8) Learn to evaluate, diagnose and initiate any needed therapy for a variety of specific
      medical problems such as asthma, seizures, anemia, stroke, GI disorders, urinary tract
      infections, pneumonias, and other respiratory illness.

   9) Learn to evaluate and appropriately manage a variety of patient complaints such as chest
      pain, abdominal pain, dizziness, headache, syncope, etc.

   10) Learn to perform an adequate history and physical exam in female patients with
       gynecologic problems or problems related to early pregnancy including abdominal
       bleeding, infection, threatened abortion, and ectopic pregnancy.

   11) Learn appropriate use of diagnostic lab and imaging studies for emergency patients and
       to have basic competence in their interpretations.

   12) Learn to use the following diagnostic aids: central venous pressures, pulse oximetry,
       arterial blood gases, EKG’s.

   13) Perform the following procedures with basic competency and to know indications and
       contraindications: venipuncture, starting an IV or heparin lock, arterial puncture,
       insertion of a Foley catheter, placement of a central venous line, thoracentesis,
       paracentesis, lumbar puncture, urinalysis with microscopic, wet prep of vaginal
       secretions.
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   14) Become familiar with common medico-legal problems which present in emergency
       medical practice such as: consent, desertion, AMA, restraints, impaired patients, child or
       adult abuse or neglect.

   15) Be able to arrange appropriate follow-up for discharged patients and give adequate
       discharge instructions.

   16) Learn and use the available contributions of the Social Services Dept. to patient care in
       the ED and for discharge planning.

   17) Learn appropriate medical evaluation of mentally disturbed patients including techniques
       for restraint and control of violent patients.

   18) Learn about billing as it pertains to ED patients.

The clinical and didactic experiences used to meet those objectives included daily patient care in
the Slidell ED, along with bedside teaching. This rotation experience is part of the greater
emergency medicine curriculum, also including PALS/ACLS/ATLS provider and instructor
certification and weekly didactics (part of the overall didactic curriculum).

The feedback mechanisms and methods used to evaluate the performance of the resident include
an end of rotation global evaluation. Immediate feedback may also be given to the resident, and
any significant problems will be discussed during the rotation with the LSU EM administration.

The resources and facilities in the institution that will be available to each resident include
computer access to Up To Date and the LSU Library services, including current texts in
emergency medicine. The residents will have access to the resources of the hospital including
medical texts, medical records, doctor’s lounge and cafeteria.

The clinical experiences, duties and responsibilities the resident will have on the rotation:
Residents will act as a part of the Emergency Medicine team in a community hospital under the
supervision of a staff physician. The residents will participate in the initial management of
emergency department patients, to include trauma, psychiatric, obgyn, pediatric and general
medical patients.

The relationship that will exist between emergency medicine residents and faculty on the service:
The overall goals of resident education and patient care will govern the relationship between
faculty and residents. Residents will receive 24 hour supervision while on the rotation. All
patient care and medical charts will be reviewed and signed by the ED faculty prior to patient
discharge.

Duty hours for this rotation will not exceed an average of 60hrs/week, and will include 1 in 7
days off.
This rotation summary has been reviewed and agreed to by the service director and LSU
Program Director.
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Community ED: Specific Competency-based Goals & Objectives, based on Level of Training:
Slidell Memorial PGY4

   1. While in the community ED, the resident will demonstrate skill in “Data Gathering” that
      includes but not limited to:
          a. PGY1: Perform an appropriate focused history and physical exam (* PC, MK, ICS, PR)
          b. PGY2: Appropriate ordering and interpretation of ancillary tests (* PC, MK, SBP)
          c. PGY3: Gather essential and accurate information from all available sources (* PC, SBP)
          d. PGY4 Challenges assumptions. Able to establish rapport in order to obtain historical
              date in difficult situations. (* PC, IPC & PR)

   2. While in the community ED, the resident will demonstrate skill in “Problem Solving” that
      includes but not limited to:
          a. PGY1: Generate an appropriate and complete differential diagnosis for an
              undifferentiated patient (* PC, MK)
          b. PGY2: Appropriate organization of data collection in relation to patient management
              decisions (* PC, MK, PBL)
          c. PGY3: Generate an expanded differential diagnosis including possible atypical
              presentations (* PC, MK, PBL)
          d. PGY4: Able to supervise and teach problem-solving skills to lower level residents. (*
              PC, MK, PBL)

   3. While in the community ED, the resident will demonstrate skill in “Patient Management” that
      includes but not limited to:
          a. PGY1: Development of a basic treatment plan (* PC, MK, SBP)
          b. PGY2: Prompt recognition and appropriate emergency stabilization of the unstable
              patient (*PC, MK, SBP)
          c. PGY3: Institutes appropriate advanced treatment plans autonomously (* PC, MK, ICS,
              PR, SBP)
          d. PGY4 Multitasks, appropriately utilizes resources, facilitates patient flow. (* PC, MK,
              ICS, SBP)

   4. While in the community ED, the resident will demonstrate skill in “Medical Knowledge”
      appropriate for level of training that includes but not limited to:
          a. PGY1: Demonstrates a basic fund of medical knowledge (*MK)
          b. PGY2: Understands the scientific basis for their decisions (*MK, PBL)
          c. PGY3: Demonstrates an advanced fund of medical knowledge (*MK)
          d. PGY4: Demonstrates an advanced fund of knowledge and challenges assumptions using
              problem-based learning techniques. (*MK, PBL)

   5. While in the community ED, the resident will demonstrate technical proficiency in “Procedural
      Skills” consistent with level of training that includes but not limited to:
          a. PGY1: Suturing, lumbar puncture, splinting, I/D abscess (*PC)
          b. PGY2: Endotracheal intubation, central venous access, direction of medical and trauma
              resuscitation (*PC)
          c. PGY3: Conscious sedation, ultrasound, and direction of medical and trauma resuscitation
              (*PC)
          d. PGY4: As above, but also skilled in teaching procedures to lower level residents.

   6. While in the community ED, the resident will demonstrate skill in “Efficiency” of care that
      includes but not limited to:
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           a. PGY1: Effectively manages 1 patients per hour (*PC, MK, SBP)
           b. PGY2: Effectively manages 1.5 patients per hour (*PC, MK, SBP)
           c. PGY3: Effectively multi-tasks and adjusts to increased patient care demands as needed,
              with a goal of 2 patients per hour (*PC, MK, SBP)
           d. PGY4 Effectively multi-tasks and adjusts to increased patient care demands as needed,
              with a goal of >2 patients per hour (*PC, MK, SBP

   7. While in the community ED, the resident will demonstrate appropriate “Interpersonal and
      Communication Skills” that includes but not limited to:
         a. PGY1: Demonstrates effective information exchange with patients, their families, and
              professional associates (*ICS, PR)
         b. PGY2: Demonstrates appropriate conflict resolution skills (*ICS, PR)
         c. PGY3: Works effectively with others as a leader (*ICS, PR)
         d. PGY4: Models and teaches leadership skills to lower level residents. (*ICS, PR)

   8. While in the community ED, the resident will demonstrate appropriate “Professionalism” that
      includes but not limited to:
          a. PGY1: Introduces self to patient and/or family (*PR)
          b. PGY2: Respectful of patient’s privacy and confidentiality (*PR)
          c. PGY3: Demonstrates respect, compassion, and integrity, even under stressful situations
              (*PR)
          d. PGY4: Models and teaches professionalism skills to lower level residents. (*PR)

   9. While in the community ED, the resident will demonstrates skills in proper “Documentation”
      that includes but not limited to:
           a. PGY1: Medical record is accurate, complete, timely, and appropriate (*PC, ICS)
           b. PGY2: Appropriately documents medical decision making (*PC, ICS)
           c. PGY3: Documents ED course including re-evaluation of patient if applicable (*PC, ICS)
           d. PGY4: Models and teaches verbal and written documentation skills to lower level
               residents. (*PC, ICS)

   10. While in the community ED, the resident will demonstrates an understanding of a “Systems-
       Based Practice” that includes but not limited to:
          a. PGY1: Understands basic resources available for care of the emergency department
               patient in the community setting. (*SBP)
          b. PGY2: Utilizes the consultation process appropriately (*SBP, PC)
          c. PGY3: Provides appropriate medical command to pre-hospital providers (*SBP, PC)
          d. PGY4 Models and teaches system-based practice skills to lower level residents. (*SBP)

   11. While in the community ED, the resident will demonstrate skills in “Practice Based Learning
       and Improvement” that includes but not limited to:
          a. PGY1: Uses appropriate information resources (ie, texts, online web sites, etc.) for care
               of patient (* PBL, PC)
          b. PGY2: Applies knowledge of scientific studies to patient care decisions (* PBL, PC)
          c. PGY3: Facilitates the learning of professional associates (* PBL, MK)
          d. PGY4: Models and teaches practice based learning and self-improvement skills to lower
               level residents. (*PBL)
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TOXICOLOGY

Dr. ________, you are assigned to Toxicology for the month of _________.

Orientation: There is a mandatory orientation for this rotation. Dr. Tuckler is the director of the
toxicology rotation. Contact him one week prior to starting the rotation. Orientation occurs on
the first day of each month. Vacation and time off are not allowed during the rotation. There is
an exit interview on the last day of the rotation that you must attend. All required materials are
due at that time.

Scheduling: The majority of your time on this rotation will be spent performing consults, taking
call, attending lectures, and giving lectures. When you meet with Dr. Tuckler, you will be given
a list of lectures and persons giving you those lectures. It is your responsibility to contact each
lecturer and schedule the date and time of each lecture.

Responsibilities:
               1.    Daily rounds on all toxicology patients in the MER, ICUs and wards.
               2.    Responding to all ED and in house toxicology consults.
               3.    Giving intern and resident lectures.
               4.    Giving one conference lecture.
               5.    Attendance to the Trauma Conference.
               6.    Presenting at M & M conference.
               7.    Attending all emergency medicine conferences and journal club.
               8.    Availability for Disaster call.
               9.    Completing a "toxicology case of the month". Report due at the end of the month.
               10.   Completing one toxicology oral board scenario case.
               11.   Completing a set of ―written board‖ toxicology questions.
               12.   Attending an interactive review session of past toxicology cases.
               13.   Goals, objectives and responsibilities will be given to you during orientation.
               14.   Meeting with Dr. Tuckler for toxicology teaching.

Conferences: You must attend all conferences.

Extras: All consults and required paper work must be turned in to Dr. Tuckler on the last day of
the month.

Supervision: Per Dr. Tuckler

Evaluation: Compiled and pooled from all faculty and Dr. Tuckler.


                           LSU Emergency Medicine Residency Program
                                         MCLANO
                                     Toxicology Rotation

                                      GOALS and OBJECTIVES

What follows are the goals and objectives for the MCLANO Toxicology rotation, that will range
from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take
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place at the MCLANO University Hospital. The year of training is assigned in the PGY4 year
but may include PGY 1-5.

Toxicology is a core component of the Emergency Medicine curriculum mandated by the
Residency Review Committee.


1. ROUNDS and CALL at MCLNO
The most important part of your rotation will be DAILY ROUNDS as a stimulus to further your
education in emergency toxicology. You are expected to make rounds with the interns and
emergency medicine residents caring for poisoned patients. These rounds should be geared to
educate the residents and interns as to the appropriate evaluation, treatment, and disposition of
the patient, as well as the pathophysiology of the agent or agents causing the overdose. You
should be available to the residents to answer questions that may arise regarding treatment of
overdoses and perform consults on those patients admitted. Document these rounds by having
the ESU staff sign your daily round sheet. Also, document the date, patient's name, hospital
number, type of overdose, and location of all patients seen.

In addition YOU WILL BE ON CALL (24 hour call). A schedule will be provided.

You will be required to round with the toxicology staff when they ask you to round with them.
You will consult with the staff when you are called for a consult. You will be required to follow
patients admitted to the hospital.

DAILY PROGRESS NOTES need to be written and placed in the patient’s chart.

You will also be made familiar with the HAZMAT disaster protocol and you and the staff will be
called to come to the hospital in the event of a citywide HAZMAT incident. NO VACATION
TIME SHOULD BE PLANNED DURING YOUR TOXICOLOGY MONTH.

YOU ARE REQUIRED TO ATTEND ALL RESIDENT CONFERENCES. NO EXCUSES!!!

You will be required to LECTURE TO THE INTERNS AND RESIDENTS IN THE ED. The
subjects of these lectures will be given to you at the beginning of the month. You should also
PREPARE A HANDOUT for the interns covering the lecture material. Please provide copies of
the lectures to Dr. Tuckler when you check out at the end of the month. The date, time, and
subject of these lectures should be documented on the toxicology rotation checklist provided
with this packet. You will be REQUIRED TO HAVE A TOXICOLOGY LECTURE LOG
SIGNED by all persons attending your lecture. ONE LOG SHEET PER LECTURE


2. MEETINGS: Toxicology meetings will be held with members of the faculty who have a
interest in toxicology, namely, Drs. Edward Halton, Keith Van Meter, and Victor Tuckler. You
will be provided with a Topics Form, which will list the topics and designate which the faculty
will discuss each topic with you. It is your responsibility to establish the time and place with
each faculty member. Please do not wait till the end of the month to have these lectures. These
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meetings will provide one-on-one interaction and allow the discussion of varied issues in
toxicology.

3. LECTURE: Each resident is expected to give a hour long lecture to the Emergency Medicine
residents. The lecture is to be given on the Last Wednesday of the month at 11:00 a.m. The topic
of your lecture will be assigned on the first day of the month so that adequate preparation time is
available. HANDOUTS AND SLIDES ARE REQUIRED FOR THIS LECTURE. FIVE
BOARD TYPE QUESTIONS REGARDING YOUR LECTURE ARE REQUIRED. Please
provide a copy of the handout in a floppy disk to Dr. Tuckler. A copy of the handout will be
added to the toxicology file. Please meet with the toxicology staff prior to your presentation to
review your presentation and discuss possible changes.

4. QUESTIONS: One hundred well documented questions of a national board type are required
to be handed in at the end of the rotation. These questions will be discussed at the end of the
month with Dr. Tuckler during your check out meeting.

5. PATIENT LOG: YOU WILL NEED TO KEEP A LOG OF ALL PATIENTS SEEN
DURING THIS ROTATION. PLEASE LIST THEM ON THE PROVIDED CHECKLIST. Use
extra sheet if needed. At the end of the rotation please place all materials to Dr. Tuckler.

6. TOXICOLOGY ORAL BOARD SESSION AND WRITTEN EXAM REVIEW:
You will have one oral board scenario practice session with Dr. Tuckler. Please arrange the date
and time with Dr. Tuckler. You will also have a review session with Dr. Tuckler over written
exam topics and questions.

7. TOXICOLOGY CASE OF THE MONTH You will have one toxicology case to solve during
the month. The case will be provided to you at the beginning of the month by Dr. Tuckler. Please
answer all the questions, provide a diagnosis, and explain why you reached the diagnosis that
you did.

8. TOXICOLOGY CASES REVIEW: You will review toxicology cases with Dr. Tuckler and
will be asked to discuss and answer questions regarding toxidromes and pathophysiology.


10. HAZMAT/DISASTER MEDICINE Please contact Dr. Aiken and Dr. Hardy to help with
teaching Hazmat and attending Hazmat drills.

11. MONTHLY EVALUATIONS: A final evaluation of your performance and completion of all
the above requirements are submitted to Dr. Haydel/Avegno to be put in your file. You are
required to turn in to Kathy a copy of your lecture, case of the month answers, a copy of the one
hundred questions, patient log, sign in sheets, and lectures attended.


For any concerns or questions call Dr. Tuckler at 664-5383.
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TRAUMA ICU


Dr.______________________,

You are scheduled for LSU Trauma ICU from______________to _______________.

Schedule: Contact the LSU Surgery chief resident 2-3 weeks prior to your rotation to receive
your schedule and /or submit a schedule request. All schedule requests should be directed to the
Chief Residents.

Responsibilities: Care of MCLANO Trauma Surgery Patients.

Conference: You must attend conference.

Extras: All procedures must be recorded and turned in at the end of the month.

Supervision: Provided by LSU Surgery faculty and senior level residents.

Evaluations: Compiled by LSU faculty and senior level residents at the completion of the
rotation. The resident is responsible for delivering the evaluation forms to the appropriate
faculty or chief resident at the completion of the rotation.

Meals: available at University Hospital.

                         LSU Emergency Medicine Residency Program
                                       MCLANO
                                 Trauma Surgery Rotation

                                   GOALS and OBJECTIVES

What follows are the goals and objectives for the MCLANO Surgery rotation, that will range
from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take
place at the MCLANO University Hospital. The year of training is assigned in the PGY2 year.

OBJECTIVES:
Gain expertise in the management of surgical emergencies. Learn the priorities and procedures
of trauma resuscitation. Become an integral part of the trauma team and respond to all trauma
resuscitations along with junior, senior and staff surgeons. Gain exposure to OR sterile
techniques and surgical techniques.

GOALS:
Participate in daily teaching rounds
Evaluate Surgical patients in the Emergency Department
Participate in Surgical Procedures, both in the OR and on the floor
Participate in the routine care of Surgical patients
Participate in consults to the Surgical Service
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Follow inpatient surgical patients through discharge, including discharge planning

The clinical and didactic experiences used to meet those objectives included daily patient care of
the MCLANO Surgical Service Patients, along with bedside teaching. The rotating resident is
encouraged to attend lectures available at MCLANO pertaining to the care of the surgery patient.
This rotation experience is part of the greater emergency medicine curriculum, also including
weekly didactics (part of the overall didactic curriculum).

The feedback mechanisms and methods used to evaluate the performance of the resident include
an end of rotation global evaluation. Immediate feedback may also be given to the resident, and
any significant problems will be discussed during the rotation with the LSU EM administration.

The resources and facilities in the institution that will be available to each resident include
computer access to Up To Date and the LSU Library services, including current texts in surgery
and emergency medicine. The residents will have access to the resources of the hospital
including call rooms, the LSU Medical Library, Hospital medical texts, medical records and the
cafeteria.

The clinical experiences, duties and responsibilities the resident will have on the rotation:
Residents will act as a part of the Surgery team under the supervision of a staff physician. The
residents will participate in the initial management of surgery patients, to include pediatric and
adult trauma and general surgery patients.

The relationship that will exist between emergency medicine residents and faculty on the service:
The overall goals of resident education and patient care will govern the relationship between
faculty and residents. Residents will receive 24 hour supervision while on the rotation. All
patient care and medical charts will be reviewed and signed by the Surgery faculty daily and
prior to patient discharge.

Duty hours for this rotation will not exceed an average of 80hrs/week, call not longer than 24
consecutive hours and will include 1 in 7 days off.

This rotation summary has been reviewed and agreed to by the service director and LSU
Program Director.

Specific Competency Based Goals & Objectives:

1. While in the TICU, the resident will demonstrates skill in “Data Gathering” that includes
   appropriate focused history and physical exam and ordering and interpretation of ancillary tests (* PC,
    MK, ICS, PR)

2. While in the TICU, the resident will demonstrates skill in “Problem Solving” that includes
   appropriate and complete differential diagnosis for an undifferentiated patient. Appropriate
   organization of data collection in relation to patient management decisions. (* PC, MK, PBL)

3. While in the TICU, the resident will demonstrates skill in “Patient Management” that includes a
   basic treatment plans and timely recognition and appropriate emergency stabilization of the unstable
   patients. (* PC, MK, SBP)
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4. While in the TICU, the resident will demonstrate skill in “Medical Knowledge” appropriate for level
   of training that demonstrates a basic fund of medical knowledge and the ability to seek the scientific
   basis for their patient care decisions (*MK, PBL)

5. While in the TICU, the resident will demonstrates technical proficiency in “Procedural Skills”
   consistent with level of training that includes supervised intubations, central venous access, chest
   tubes and trauma resuscitations. (*PC)

6. While in the TICU, the resident will demonstrate appropriate “Interpersonal and Communication
   Skills” that includes effective information exchange with patients, their families, and professional
   associates. Demonstrates appropriate conflict resolution skills. (*ICS, PR)

7. While in the TICU, the resident will demonstrate appropriate “Professionalism” that includes
   introduces self to patient and/or family. Respectful of patient’s privacy and confidentiality (*PR)

8. While in the TICU, the resident will demonstrates an understanding of a “Systems-Based Practice”
   that includes understanding basic resources available for care of the TICU patient. Utilizes the
   consultation process appropriately. Assists in appropriate bed triage decisions. Assists in appropriate
   step-down and transfer decisions. (*SBP, PC)

9. While in the TICU, the resident will demonstrate “Practice Based Learning and Improvement”
   skills that includes use of appropriate information resources (ie, texts, online web sites, etc.) for care
   of patient (* PBL, PC)


(* denotes core competency area: PC-Patient Care, MK-Medical Knowledge, ICS-Interpersonal and Communication skills, PR-
Professionalism, SBP-Systems Based Practice, PBL-Practice Based Learning and Improvement).
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WEST JEFFERSON ED

Dr.______________________,

You are scheduled for West Jefferson ED from______________to _______________.

Schedule: Contact the director of the ED, Dr. Chugden (chugden@charter.net) 2-3 weeks prior to
your rotation to submit a schedule. Send a copy of your schedule to Kathy Whittington. A
resident will do 15 shifts a month; 12noon to 12midnight. No more than one resident per
shift. Don't schedule more that half of your shifts on conference or journal club days. Please
make a schedule to be posted in their ER prior to the start of the month.

Responsibilities: You will be responsible for the care of individual patients in the ED.

Conference: You must attend conference.

Extras: A patient list must be maintained and turned in with your procedure log at the end of
the month.

Supervision: You will be supervised by board certified Emergency Medicine physicians.

Evaluations: Daily evaluations.

Meals: provided in the West Jefferson cafeteria and doctor’s lounge.

                               GOALS and OBJECTIVES

The following are the goals and objectives for the West Jefferson ED rotation, which will range
from a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take
place at the West Jefferson ED. The year of training may include PGY 1-5.

The educational goals and objectives for the West Jefferson ED rotation are to provide residents
with an opportunity to experience and learn about the initial evaluation and management of
emergency patients in the community setting as well as the following:

   1. Prehospital emergency medical services

   2. Multicasualty incidents and disasters

   3. Legal aspects of emergency care

   4. Emergency procedures

   5. Emergency department consultation
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   6. Billing

The clinical and didactic experiences used to meet those objectives included daily patient care in
the West Jefferson ED, along with bedside teaching. This rotation experience is part of the
greater emergency medicine curriculum, also including PALS/ACLS/ATLS provider and
instructor certification and weekly didactics (part of the overall didactic curriculum).

The feedback mechanisms and methods used to evaluate the performance of the resident include
an end of rotation global evaluation. Immediate feedback may also be given to the resident, and
any significant problems will be discussed during the rotation with the LSU EM administration.

The resources and facilities in the institution that will be available to each resident include
computer access to Up To Date and the LSU Library services, including current texts in
emergency medicine. The residents will have access to the resources of the hospital including
medical texts, medical records, doctor’s lounge and cafeteria.

The clinical experiences, duties and responsibilities the resident will have on the
rotation: Residents will act as a part of the Emergency Medicine team in a community hospital
under the supervision of a staff physician. The residents will participate in the initial
management of emergency department patients, to include trauma, psychiatric, obgyn, pediatric
and general medical patients.

The relationship that will exist between emergency medicine residents and faculty on the
service: The overall goals of resident education and patient care will govern the relationship
between faculty and residents. Residents will receive 24 hour supervision while on the
rotation. All patient care and medical charts will be reviewed and signed by the ED faculty prior
to patient discharge.

Duty hours for this rotation will not exceed an average of 60hrs/week, and will include 1 in 7
days off.

This rotation summary has been reviewed and agreed to by the service director and LSU
Program Director.

WEST JEFFERSON ED-Pediatrics & FastTrack

You are scheduled for West Jefferson ED: Pediatric & FastTrackfor the month:

Schedule: Two weeks prior to starting, contact Dr. Andrew Mayer
(andrewmayer@cox.net) and Kacy Petit in their GME office (kacy.petit@wjmc.org). You will
do 8-hour shifts monday-friday 7a3p, except on wednesdays, when you will attend EM
conference 7a11am and then will report to the ED by 12noon and work 12 noon to 8pm.

Responsibilities: You will be responsible for the care of individual patients in the Pediastric
ED.
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Conference: You must attend conference and Journal Club.

Extras: A patient list must be maintained and turned in with your procedure log at the end of
the month.

Supervision: You will be supervised by board certified Emergency Medicine physicians.

Evaluations: Monthly evaluations.

Meals: provided in the West Jefferson cafeteria and doctor’s lounge.

          Learning Modules: You must complete the following learning modules and take the
post-test within 2 weeks of completing the rotation. You may complete them as early as you like
and the tests are open book. You must achieve 80% to get credit for completing the modules.
The learning modules can be found under the Home Study link on the LSUEM residency page.
The tests will be available on ResidencyPartner, but you can also email your answers to Kathy
Whittington (klwhit@lsuhsc.edu) if you have trouble accessing RP.

Modules: 1. Pediatric Emergencies             2. The Nightmare Neonate


                                   GOALS and OBJECTIVES

What follows are the goals and objectives for the WJ Pediatric ED rotation, that will range from
a 2 week to 1 month rotation, as assigned by the Program Director. The rotation will take place
at the West Jeff Hospital in the ED where you will see pediatric and fast track patients. The year
of training will typically include PGY 1 residents only.

The educational objectives of the West Jefferson Pediatric ED rotation are to:

   1) Gain expertise in the recognition and management of pediatric emergencies.

   2) Gain expertise in pediatric resuscitation, including Pediatric Advanced Life Support,
      emergent intubation, fluid administration, and drug dosages.

   3) Become familiar with the management of non-emergent pediatric conditions which
      commonly present to the Emergency Department.

   4) Gain expertise in the performance of routine procedures such as venipuncture and
      arterial puncture.

   5) Become familiar with pediatric medication dosages.

The clinical and didactic experiences used to meet those objectives included daily patient care in
the Pediatric ED, along with bedside teaching. The rotating resident is encouraged to attend
lectures available at West Jefferson pertaining to the care of the pediatric patient. This rotation
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                    177




experience is part of the greater pediatric emergency medicine curriculum, also including PALS
provider and instructor certification and weekly didactics (part of the overall didactic
curriculum).

The feedback mechanisms and methods used to evaluate the performance of the resident include
an end of rotation global evaluation. Immediate feedback may also be given to the resident, and
any significant problems will be discussed during the rotation with the LSU EM administration.

The resources and facilities in the institution that will be available to each resident include
computer access to Up To Date and the LSU Library services, including current texts in
pediatrics and emergency medicine. There is a rent free, secure apartment available during the
rotation for resident use. The residents will have access to the resources of the hospital including
medical texts, medical records and cafeteria.

The clinical experiences, duties and responsibilities the resident will have on the rotation:
Residents will act as a part of the Emergency Medicine team in a community pediatric hospital
under the supervision of a staff physician. The residents will participate in the initial
management of emergency department patients, to include pediatric trauma and general medical
patients.

The relationship that will exist between emergency medicine residents and faculty on the service:
The overall goals of resident education and patient care will govern the relationship between
faculty and residents. Residents will receive 24 hour supervision while on the rotation. All
patient care and medical charts will be reviewed and signed by the ED faculty prior to patient
discharge.

Duty hours for this rotation will not exceed an average of 60hrs/week, and will include 1 in 7
days off.

This rotation summary has been reviewed and agreed to by the service director and LSU
Program Director.

Community ED: Specific Competency-based Goals & Objectives, based on Level of Training: West
Jefferson Medical Center PGY1-3

   1. While in the community ED, the resident will demonstrate skill in “Data Gathering” that
      includes but not limited to:
          a. PGY1: Perform an appropriate focused history and physical exam (* PC, MK, ICS, PR)
          b. PGY2: Appropriate ordering and interpretation of ancillary tests (* PC, MK, SBP)
          c. PGY3: Gather essential and accurate information from all available sources (* PC, SBP)
          d. PGY4 Challenges assumptions. Able to establish rapport in order to obtain historical
              date in difficult situations. (* PC, IPC & PR)

   2. While in the community ED, the resident will demonstrate skill in “Problem Solving” that
      includes but not limited to:
          a. PGY1: Generate an appropriate and complete differential diagnosis for an
              undifferentiated patient (* PC, MK)
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                      178




           b. PGY2: Appropriate organization of data collection in relation to patient management
              decisions (* PC, MK, PBL)
           c. PGY3: Generate an expanded differential diagnosis including possible atypical
              presentations (* PC, MK, PBL)
           d. PGY4: Able to supervise and teach problem-solving skills to lower level residents. (*
              PC, MK, PBL)

   3. While in the community ED, the resident will demonstrate skill in “Patient Management” that
      includes but not limited to:
          a. PGY1: Development of a basic treatment plan (* PC, MK, SBP)
          b. PGY2: Prompt recognition and appropriate emergency stabilization of the unstable
              patient (*PC, MK, SBP)
          c. PGY3: Institutes appropriate advanced treatment plans autonomously (* PC, MK, ICS,
              PR, SBP)
          d. PGY4 Multitasks, appropriately utilizes resources, facilitates patient flow. (* PC, MK,
              ICS, SBP)

   4. While in the community ED, the resident will demonstrate skill in “Medical Knowledge”
      appropriate for level of training that includes but not limited to:
          a. PGY1: Demonstrates a basic fund of medical knowledge (*MK)
          b. PGY2: Understands the scientific basis for their decisions (*MK, PBL)
          c. PGY3: Demonstrates an advanced fund of medical knowledge (*MK)
          d. PGY4: Demonstrates an advanced fund of knowledge and challenges assumptions using
              problem-based learning techniques. (*MK, PBL)

   5. While in the community ED, the resident will demonstrate technical proficiency in “Procedural
      Skills” consistent with level of training that includes but not limited to:
          a. PGY1: Suturing, lumbar puncture, splinting, I/D abscess (*PC)
          b. PGY2: Endotracheal intubation, central venous access, direction of medical and trauma
              resuscitation (*PC)
          c. PGY3: Conscious sedation, ultrasound, and direction of medical and trauma resuscitation
              (*PC)
          d. PGY4: As above, but also skilled in teaching procedures to lower level residents.

   6. While in the community ED, the resident will demonstrate skill in “Efficiency” of care that
      includes but not limited to:
          a. PGY1: Effectively manages 1 patients per hour (*PC, MK, SBP)
          b. PGY2: Effectively manages 1.5 patients per hour (*PC, MK, SBP)
          c. PGY3: Effectively multi-tasks and adjusts to increased patient care demands as needed,
              with a goal of 2 patients per hour (*PC, MK, SBP)
          d. PGY4 Effectively multi-tasks and adjusts to increased patient care demands as needed,
              with a goal of >2 patients per hour (*PC, MK, SBP

   7. While in the community ED, the resident will demonstrate appropriate “Interpersonal and
      Communication Skills” that includes but not limited to:
         a. PGY1: Demonstrates effective information exchange with patients, their families, and
              professional associates (*ICS, PR)
         b. PGY2: Demonstrates appropriate conflict resolution skills (*ICS, PR)
         c. PGY3: Works effectively with others as a leader (*ICS, PR)
         d. PGY4: Models and teaches leadership skills to lower level residents. (*ICS, PR)
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                       179




   8. While in the community ED, the resident will demonstrate appropriate “Professionalism” that
      includes but not limited to:
          a. PGY1: Introduces self to patient and/or family (*PR)
          b. PGY2: Respectful of patient’s privacy and confidentiality (*PR)
          c. PGY3: Demonstrates respect, compassion, and integrity, even under stressful situations
              (*PR)
          d. PGY4: Models and teaches professionalism skills to lower level residents. (*PR)

   9. While in the community ED, the resident will demonstrates skills in proper “Documentation”
      that includes but not limited to:
           a. PGY1: Medical record is accurate, complete, timely, and appropriate (*PC, ICS)
           b. PGY2: Appropriately documents medical decision making (*PC, ICS)
           c. PGY3: Documents ED course including re-evaluation of patient if applicable (*PC, ICS)
           d. PGY4: Models and teaches verbal and written documentation skills to lower level
               residents. (*PC, ICS)

   10. While in the community ED, the resident will demonstrates an understanding of a “Systems-
       Based Practice” that includes but not limited to:
          a. PGY1: Understands basic resources available for care of the emergency department
               patient in the community setting. (*SBP)
          b. PGY2: Utilizes the consultation process appropriately (*SBP, PC)
          c. PGY3: Provides appropriate medical command to pre-hospital providers (*SBP, PC)
          d. PGY4 Models and teaches system-based practice skills to lower level residents. (*SBP)

   11. While in the community ED, the resident will demonstrate skills in “Practice Based Learning
       and Improvement” that includes but not limited to:
          a. PGY1: Uses appropriate information resources (ie, texts, online web sites, etc.) for care
               of patient (* PBL, PC)
          b. PGY2: Applies knowledge of scientific studies to patient care decisions (* PBL, PC)
          c. PGY3: Facilitates the learning of professional associates (* PBL, MK)
          d. PGY4: Models and teaches practice based learning and self-improvement skills to lower
               level residents. (*PBL)
LSUHSC Emergency Medicine Residency Policies and Rotation Guide 09-10                   180




ELECTIVE

Dr.__________________________________,

       You are scheduled for Elective from ________________to_______________.

       Schedule: As required by your rotation. The program director and program coordinator
must be informed of your selected elective 2 weeks prior to starting the rotation.

        Responsibilities: As required by the rotation. Obtain these from the director of the
elective rotation you take.

       Conference: You are expected to attend conference.

       Extras: All procedures must be recorded and turned in at the end of the month.

       Available Electives:
                 -Radiology                -Critical Care     -Pathology (autopsy)
                 -ENT                      -EMS               -Toxicology
                 -Ophthal                   -Teaching         -International EM
                 -OMFS                     -Dermatology
                 -Hyperbarics               -Board Preparation
                 -Research

*Note, all electives must be approved by the residency program director, 2 weeks prior to start of
the elective or you will default to University ED.

        Evaluations: Responsibility of resident to identify supervising faculty for rotation and
obtain summative evaluation sheet.

				
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