Rotations

Congratulations on securing a position in an emergency medicine training program. Advancing to this level signifies your successful completion of medical school and your internship year. This next stage is crucial as you begin to independently approach and manage patients, a challenge for many new doctors. Here are some guidelines to aid in this transition:

• Review and Learning: Revisit your medical school education, particularly focusing on history taking and physical examinations. Develop skills in forming differential diagnoses and identifying potential complications related to different organ systems based on your initial assessments.

• Investigative Approaches: Understand which investigations are necessary to gather further information that will aid in managing patient care effectively.

• Management Skills: Learn to manage identified complications and underlying conditions. A practical method is to list each patient's problems, the corresponding investigations ordered, and the treatments administered or planned.

• Evidence-based Practice: Prioritize evidence-based practices over anecdotal evidence as you adapt to new practices. This approach ensures that your clinical decisions are grounded in the most reliable and current medical research.

• Specialty Rotations: The first two years of your program will primarily consist of rotations across various specialties. Aim to be an integral part of each specialty’s emergency team to maximize exposure to a broad range of emergency cases. Engage actively in the management plans and discuss cases with senior colleagues and consultants to deepen your understanding of emergency management from different specialty perspectives.

• Focus Areas: Pay attention to topics frequently encountered in emergency settings, as these will form the core of your practical emergency medicine training.

This phase of your career is about expanding your knowledge base and honing your practical skills to excel in emergency medicine. Embrace the learning curve, and always seek to apply evidence-based knowledge in your clinical practice.

On-Call Resources

• Easily accessible, quick-reference materials useful for immediate questions or queries.

• Particularly helpful during shifts and for answering focused questions quickly.

Thorough Study Resources

• Comprehensive resources aimed at broadening overall knowledge of illnesses and their management in emergency medicine.

• These resources are valuable for exam preparation and assessments.

Topic Related Resources

• Resources dedicated to specific topics, diseases, or complications.

• Ideal for preparing presentations or gaining a deeper understanding of particular illnesses.

GUIDANCE

• Duration: 1 month in Internal Medicine at institutions such as Aga Khan University Hospital, followed by 2 months in sub-specialties like Nephrology and Neurology. This module is more comprehensive than spending 3 months solely in Internal Medicine.

• Approach: 

  • Start the rotation early to develop a comprehensive approach to patient care, enhancing your ability to manage multiple organ issues simultaneously.

  • Review your final year's learning, focusing on examination methods and diagnostic approaches. Make a list of patient problems, ordered investigations, and ongoing treatments for a structured approach to patient care.

  • Actively engage in emergency cases within the medical teams of Neurology, Nephrology, and Cardiology. Discuss cases with senior specialists to better understand emergency management from their perspectives.

• Focus Areas:

  • Nephrology:

    • ABG interpretation

    • Emergency hemodialysis indications and complications

    • Management of fluid and electrolyte imbalances

    • Recognition of fluid overload and acidosis

  • Neurology:

    • Evaluation for neurological causes of drowsiness

    • Management of acute stroke

    • Indications and contraindications for tPA and mechanical thrombectomy

    • Seizure management

    • Interpretation of CT head and MRI sequences (DWI, ADC, SWI)

    • Differentiation between psychiatric and neurological symptoms

    • Basic neuroanatomy and lesion localization

    • Brain death identification and evaluation

  • Cardiology:

    • ECG interpretation

    • Management of acute myocardial infarction

    • Cardiomyopathy types and management

    • Valvular heart disease management

    • PCI indications and contraindications in acute coronary syndromes

    • Advanced Cardiac Life Support (ACLS)

ON-CALL RESOURCES

• General:

  • Uptodate - Practically useful when searching for the presentation and management of a medical illness, as well as the dose and frequency of drug administration. The key feature of this site is the algorithm of various illnesses. An easy way to use it is by searching the query on Google with 'UpToDate' at the end, and then, on the site, opening the summary and recommendations.

  • Medscape - Another site similar to UpToDate with similar features. Compared to UpToDate, it is more concise and free of cost. 

  • WikEM - The Global Emergency Medicine Wiki

  • PoCUS 101 - It is useful for volume assessment and checking cardiac function. 

THOROUGH STUDY RESOURCES

• • Macleod’s Clinical Examination - A pocket guide to physical examination and history taking by Barbara Bates. 

  • Emergency Medicine Cases

  • Tintinalli's Emergency Medicine: A Comprehensive Study Guide - Section 3, 4, 7, 8, 9, 10, 13 (151), 14, 17

  • MRCEM Success

  • Emergency Radiology Course - Radiopedia

TOPIC RELATED RESOURCES

• • Asymptomatic Hypertension

  • Interpretation of the Adult Chest X-Ray

  • Endocrinology: Part 1, Part 2

  • Emerging Issues in Anticoagulation

  • Allergy

  • The Geriatric Emergency Department

  • Antimicrobial Therapy: An Empiric Approach

  • Dermatology: Part 1, Part 2

  • Gastroenterology: Part 1, Part 2

• Nephrology:

  • Arterial Blood Gases Interpretation: Luke Wells, Carlo Oller

  • Acute Kidney Injury

  • Chronic Kidney Disease

  • Asymptomatic Hypertension

  • Electrolyte Disorders

  • Joe Cath Insertion

  • Central Line Insertion

• Neurology:

  • National Institute of Health Stroke Scale: Part 1, Part 2, Part 3, Part 4

  • Bedside Swallow Screen

  • Neurological Examination of the Unconscious Patient

  • Cranial Nerve Examination

  • Lower Limb Neurology Exam

  • Upper Limb Neurology Exam

  • Cerebellum Examination

  • Brain Death Examination

  • Introduction to CT Head

• Cardiology:

  • Cardiovascular Examination

  • Chest Pain Risk Stratification

  • Electrocardiography of Cardiac Ischemia

  • Arrhythmias - Flipped Classroom

  • Bardydysrhythmias & Tachydysrhythmias

  • Cardiogenic Syncope

  • Potentially Lethal ECGs

GUIDANCE

• Duration: 2 months, with an emphasis on emergency cases.

• Focus Areas:

  • Abdominal and peri-anal examination, including DRE and Proctoscopy

  • Management of peri-anal diseases such as infections, abscesses, and haemorrhoids

  • Diagnosis and management of acute abdomen

  • Identification of malignancy signs

  • ATLS protocols, including eFAST

  • Abdominal CT and X-ray interpretation

  • Wound care and various closure techniques (sutures, steri-strips, tissue glue)

  • Management of diabetic foot and necrotising fasciitis

  • Assessment and management of acute and chronic limb ischemia

ON-CALL RESOURCES

• WikEM - The Global Emergency Medicine Wiki

• Abdominal Emergency Radiology Course - Radiopedia

• PoCUS 101 - It is useful for bedside FAST and eFAST. It is also helpful for detecting cholecystitis, cholelithiasis, and CBD distension.

THOROUGH STUDY RESOURCES

• Tintinalli's Emergency Medicine: A Comprehensive Study Guide - Section 9

• Trauma Assessment

  • Oxford Medical Education, Scenario 1, Scenario 2, Scenario 3, Scenario 4, Scenario 5, Scenario 6

  • NHS Foundation Trust

• Abdominal Examination 

• Digital Rectal Examination

• Maxillofacial Examination

TOPIC RELATED RESOURCES

• Suture Techniques

• Wound Care

• Abdominal Emergencies

• Mesenteric Ischemia

• Approach to Abdominal Pain

• Acute Apeendicitis on CT

• Bowel Obstruction & Ileus on AXR

GUIDANCE

• Duration: 3 months. This rotation is an opportunity to learn the fundamentals of Orthopedics, which is often not thoroughly covered in medical school.

• Focus Areas:

  • Revision of clinically important anatomy and body mechanics

  • Orthopedic history taking and examination

  • Management of orthopedic injuries and fractures

  • Non-operative management and complication recognition

  • Joint aspiration, skin traction, and cast removal techniques

  • X-ray and CT scan interpretation from an orthopedic viewpoint

ON-CALL RESOURCES

• OrthoBullets - A site originally meant for orthopaedic residents. As an EM physician, it can provide you with information on non-operative management of fractures, the type of back-slab suitable for a certain type of fracture, and when an operation is needed.

• WikEM - The Global Emergency Medicine Wiki

• EM Cases Digest: Volume 1 - MSK & Trauma - Emergency Medicine Cases

• Emergency Medicine Radiology - Academic Life in Emergency Medicine

THOROUGH STUDY RESOURCES

• Trauma Radiology Course - Radiopedia

• Accident & Emergency Radiology

• MRCEM Part C: 125 OSCE Stations

• MRCEM Success

EXAMINATION VIDEOS:

• Shoulder Examination

• Cervical Spine Examination

• Lumbar Spine Examination

• Elbow Examination

• Wrist Examination

• Hand Examination

• Hip Examination

• Knee Examination

• Ankle Examination

• Foot Examination

GUIDANCE

• Duration: 3 months. This rotation often allows time for additional study and exam preparation.

• Focus Areas:

  • Airway management, including difficult airway assessment

  • Use of various laryngoscopes and airway devices

  • Techniques for rapid sequence and delayed sequence intubations

  • Pain management strategies

  • Execution of common anesthetic blocks

ON-CALL RESOURCES

• WikEM - The Global Emergency Medicine Wiki

THOROUGH STUDY RESOURCES

• Tintinalli's Emergency Medicine: A Comprehensive Study Guide - Section 4 (28, 29A and B, 30, 31, 32), Section 5

• Airway Assessment - LITFL

• Introduction to Intubation

• Effectively using Airway Adjuncts

• EMCrit RSI Checklist

TOPIC RELATED RESOURCES

• Failed Airway Algorithm

• Airway Decontamination

• The Psychologically Difficult Airway

• Mechanical Ventilation – Basics

• Ventilation – Grand Round

GUIDANCE

• Duration: 3 months, focusing on managing pediatric emergencies.

• Focus Areas:

  • Pediatric history taking and examination

  • Management of common pediatric diseases

  • Pediatric Advanced Life Support (PALS)

  • Neonatal Resuscitation

  • Medication dosing based on weight and age

  • Differences in disease management between adults and children

ON-CALL RESOURCES

• WikEM - The Global Emergency Medicine Wiki

• EM Cases Digest: Volume 2 - Pediatric Emergencies - Emergency Medicine Cases

• Dont Forget The Bubbles

• The Harriet Lane Handbook

  • This book is actually written for paediatric residents, but it is a good resource for paediatric dosing and sizes of NG tubes, Foley catheters, and CVCs.

• Pediatric Advanced Life Support Manual (PALS) Cards

THOROUGH STUDY RESOURCES

• MRCEM Success

• Neonatal Resuscitation

• Pediatric Cardiovascular Examination

• Pediatric Respiratory System Examination

• Pediatric Abdomen Examination

• Pediatric Neurological Examination

TOPIC RELATED RESOURCES

• Pediatric Infection – The EM Boot Camp Course

• Pediatrics – National EM Board Review Course

• Pediatric EM Pearls

• Pediatric Illnesses You Should Not Miss | EM & Acute Care Course

• Febrile Infant

GUIDANCE

• Duration: 3 months, potentially divided between CCU and ICU depending on the training institute.

• Focus Areas:

  • Management of ventilated patients, including complication assessment

  • Sterile techniques for CVC and arterial line placement

  • Understanding and managing different ventilation modes

  • Use of POCUS for various diagnostic purposes

  • Decision-making for weaning from ventilation and tracheostomy indications

ON-CALL RESOURCES

• PoCUS 101

THOROUGH STUDY RESOURCES

• Tintinalli's Emergency Medicine: A Comprehensive Study Guide - Section 4

• The ICU Book by Paul Marino

• ABCDE Assessment - Resuscitation Council UK

• Daily Assessment of the ICU Patient

• How to Present a case in the Medical ICU

• Sedation, Analgesia and Paralysis in the ICU

• Mechanical Ventilation – Basics

• Ventilation – Grand Round

• Critical Care Board Review – Part 1, Part 2

• Resuscitation of the Critically Ill Patient

TOPIC RELATED RESOURCES

• Management of End-of-Life Issues in the ED

• Aortic Dissection

• Common Errors in Shock

• Electrolyte Disorders

• Antimicrobial Therapy EM Approach