Article Review: Revised EM Clerkship Curriculum

Last year, I was fortunate to be involved in a 1-year consensus group building exercise in revising the 2006 EM Clerkship Curriculum. Led by my friend Dr. David Manthey (Wake Forest), members of the Clerkship Directors in Emergency Medicine (CDEM) debated and went through seemingly an infinite number of drafts of the updated curriculum.

The final manuscript was just published in Academic Emergency Medicine this month.

What we came up with was the 2010 EM Clerkship Syllabus. Four goals were addressed:
  1. Refining the objectives based on the ACGME core competencies
  2. Restructuring and refining the knowledge content
  3. Writing objectives for the procedures syllabus
  4. Identifying areas of the LCME guidelines which are addressed by the syllabus
What I'd like to highlight is #2:
Restructuring the EM clerkship's knowledge content

A major goal of the revised curriculum was to allow for an EM clerkship director to more easily cover the core content material of EM within a 4-week period. This was difficult to accomplish with the overly comprehensive original curriculum from 2006.

Basically, knowledge content was categorized into three areas:
  1. Fundamental set of emergent patient presentations
  2. Set of specific disease entities, unique to EM
  3. Procedural skills
Emergent Patient Presentations
We eliminated redundant topics and content that would likely be covered in other core clerkship rotations. This resulted in 10 emergent patient presentations that all EM students should be familiar with:
  • Abdominal pain
  • Altered mental status
  • Cardiac arrest
  • Chest pain
  • Gastrointestinal bleeding
  • Headache
  • Poisoning
  • Respiratory distress
  • Shock
  • Trauma

Specific disease entities include:
1. Cardiovascular
  • Abdominal aortic aneurysm
  • Acute coronary syndrome
  • Acute heart failure
  • Aortic dissection
  • DVT / pulmonary embolism
2. Endocrine / Electrolyte
  • Hyperglycemia
  • Hyperkalemia
  • Hypoglycemia
  • Thyroid storm
3. Environmental
  • Burns / smoke inhalation
  • Envenomation
  • Heat illness
  • Hypothermia
  • Near drowning
4. Gastrointestinal
  • Appendicitis
  • Biliary disease
  • Bowel obstruction
  • Massive GI bleed
  • Mesenteric ischemia
  • Perforated viscous
5. Genito-urinary
  • Ectopic pregnancy
  • PID / TOA
  • Testicular / ovarian torsion
6. Neurologic
  • Acute stroke
  • Intracranial hemorrhage
  • Meningitis
  • Status epilepticus
7. Pulmonary
  • Asthma
  • COPD
  • Pneumonia
  • Pneumothorax
8. Psychiatric
  • Agitated patient
  • Suicidal thought/ideation
9. Sepsis

Basic Understanding of Procedural Skills
Note that for basic procedures, students need to demonstrate basic skill competency. For more advanced skills (joint relocation, endotracheal intubation, FAST ultrasonography in trauma), students need to demonstrate a basic understanding of the skill.
  • Peripheral Access
  • Airway Management
  • Arrhythmia Management
  • NG tube placement
  • Foley catheterization
  • Dislocations and Splinting
  • Incision and Drainage
  • Trauma Management
  • Wound Care
For more specifics, download the article and the 3 online supplements which detail the entire EM clerkship curriculum.

Hot off the press
Preliminary online "chapters" of the emergent patient presentations and specific disease entities, which follow this 2010 EM clerkship syllabus template, can be found on CDEM's curriculum website: This site may become the free, go-to online textbook for EM clerkship students. This site will also eventually host my online DIEM (Digital Instruction in Emergency Medicine) cases, which were indirectly referenced in this article as adjunctive "online interactive learning modules".

Manthey, D., Ander, D., Gordon, D., Morrissey, T., Sherman, S., Smith, M., Rimple, D., Thibodeau, L., & , . (2010). Emergency Medicine Clerkship Curriculum: An Update and Revision Academic Emergency Medicine, 17 (6), 638-643 DOI: 10.1111/j.1553-2712.2010.00750.x

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