Stanford Emergency Medicine: What Every Doctor Needs to Know

Stanford Emergency Medicine: What Every Doctor Needs to Know

Instructors: S.V. Mahadevan, MD; Matthew Strehlow, MD, Rebecca Walker, MD, MPH
Department/SchoolDepartment of Emergency Medicine
CourseSURG 210 – “Managing Emergencies: What Every Doctor Needs to Know”
Audience:

(1) Makerere University School of Medicine (focus on Medical School Years 4 & 5) Kampala, Uganda
(2) Stanford School of Medicine (focus on preclinical Years 1 & 2)

HISTORY AND RATIONALE FOR THE COURSE:

Launched in April 2014, Managing Emergencies was offered simultaneously at Makerere University in Kampala, Uganda and the Stanford School of Medicine. As an international institution with a history of collaboration, Makerere was a natural choice to pilot the course. Dr. Mahadevan and Dr. Strehlow decided to offer the course to Stanford medical students as well to compare the benefits for international and local audiences.

Due to Makerere’s academic calendar, ten weeks of material were compressed into an intensive five-week learning experience. The course modules were presented in video lectures and inquiry-driven case discussions. Video lectures ranging from 10-15 minutes in length covered topics such as fever, burns, and trauma, and skills such as how to manage undifferentiated patients. The instructors invited experts to deliver some lectures and lead the case discussions to provide a variety of expertise and presentation styles.

Individual providers have used the course in 28 different countries.  Organized groups of medical students have taken the course in Kampala,  Uganda, in the Spring 2014, and in Phnom Penh, Cambodia in the Spring of 2015.  Also a group of physicians Spring/Summer of 2015, physicians in Mongolia have been taking the course through Mongolian National University, Medical School Ulaanbaatar, Mongolia. The course has also been offered at Stanford University Medical School for the last 2 years.

GOALS:

Students in this course aimed to learn:

• A systematic approach to evaluating and managing undifferentiated patients
• Key differential diagnoses for common presenting complaints
• How to efficiently interpret key diagnostic tests and studies such as ECGs and chest radiographs
• Essential procedural skills
• Differing medical conditions and approaches in the US and Ugandan healthcare systems

Approach:

Launched in April 2014, Managing Emergencies was offered simultaneously at Makerere University in Kampala, Uganda and the Stanford School of Medicine. As an international institution with a history of collaboration, Makerere was a natural choice to pilot the course. Dr. Mahadevan and Dr. Strehlow decided to offer the course to Stanford medical students as well to compare the benefits for international and local audiences.

Due to Makerere’s academic calendar, ten weeks of material were compressed into an intensive five-week learning experience. The course modules were presented in video lectures and inquiry-driven case discussions. Video lectures ranging from 10-15 minutes in length covered topics such as fever, burns, and trauma, and skills such as how to manage undifferentiated patients. The instructors invited experts to deliver some lectures and lead the case discussions to provide a variety of expertise and presentation styles.

Regardless of where physicians practice they are expected to be calm, cool, and collected when confronted with undifferentiated, critically ill patients. Medical education in most countries however, focuses on approaching patients in a methodical, time intensive manner. Although this approach can be effective for certain patients and settings it can prove disastrous during those moments when time is of the essence. The specialty of Emergency Medicine (EM) centers on rapidly sorting, assessing, and stabilizing undifferentiated patients regardless of the etiology of their condition. Designed by educational leaders in the field of EM, Surgery 210 taught current and future healthcare providers the necessary skills to recognize and manage patients with life-threatening emergencies.
 

Lectures and video case studies were available online and students could review course material on their own schedule. Accompanying case question assignments were due weekly and expert analysis of the cases were available after the question due dates. A 4-hour live procedure training day was held toward the latter half of the course. 

In-Class Strategies:

This class was designed to culminate in an emergency medicine procedural skills training session, which took place on one day after the completion of the modules. Students learned about basic triage; basic life support; airway management; wound care; and emergent trauma care. Participants left proficient in skills including but not limited to airway support, endotracheal intubation, tube thoracostomy, splinting, suturing, focused assessment of the cervical spine, and CPR.   

Online or out-of-class STRATEGIES:

Before the final skills session, students completed 20 modules. Participants would (1) watch video lectures; (2) subsequently view relevant cases (short clips of an emergency scenario from the medical drama TV series ER); (3) answer online case discussion questions related to these cases; and (4) collaborate and debate with classmates in online discussion boards about the tricky cases, as there is not always one correct answer in the management of an emergency medicine patient.

Lessons Learned:

(1)   Online education at Makerere was very well-received, with an enrollment of almost 100 students who completed the entire course. The emergency medicine approach to medical diagnosis was relatively new for students, and they expressed confidence about their future aptitude in the emergency room. As for the class, we face selected logistical hurdles in offering the online videos, and realize now how critical it is to have reliable internet and computer capability.

(2)   Online education at Stanford was very well-received in the context of students’ busy schedules, and the material was praised as being accessible and easy-to-digest at your own pace. However, in order to achieve more substantial enrollment, students suggested that the course had requirements, including required modules and discussion questions to complete weekly.

Plans for Next Iteration of Course: 

Instructors plan to offer this course at Makerere in the future, and hope to role out SURG 210 to new countries in Sub-Saharan Africa, Southeast Asia, and possibly South America. While in-person education has some advantages, online education costs very little to scale up and can ultimately make a much greater impact in resource-strapped settings.

Instructors also hope to offer this course every year at Stanford, alongside students’ preclinical expectations to shadow and perform procedures in the Emergency Room. Stanford students have expressed feeling tentative while headed into their ER shifts, and say it would be very helpful to better understand the 20+ most common chief complaints before being asked to help provide emergent medical care. 

About the Teaching Team:

S.V. Mahadevan, MD

Dr. S.V. Mahadevan created Stanford Emergency Medicine International (SEMI) and has written, traveled, and taught widely about emergency medicine systems, presenting over 500 invited lectures worldwide and authoring over 100 journal articles, book chapters, and multimedia publications. He was instrumental in setting up India's first international paramedic training institute (2007), India’s first prehospital research center (2009), Nepal's first Emergency Medical Services (EMS) system (2010), India's first guidelines for prehospital care (2011) and Cambodia's first emergency medicine strengthening program (2012). He is lead editor of the textbook, An Introduction to Clinical Emergency Medicine, which was awarded the 2006 American Medical Writer’s Association Award: Physician’s Category as the top medical textbook in the United States for all specialties.

Matthew Strehlow, MD

Dr. Matthew Strehlow is an Clinical Associate Professor of Emergency Medicine and serves as Senior Technical Advisor on the USAID funded Quality Health Services project in Cambodia.  Over the past decade he has been actively involved in pre-service and in-service education at Stanford and across the globe including India, Malaysia, Indonesia, Cambodia, Uganda, Egypt and Ethiopia. Through his role as the Co-Director of Stanford Emergency Medicine International and Stanford’s International Emergency Medicine Fellowship, he strives to increase awareness regarding the global burden of emergency health conditions.

Rebecca Walker MD,MPH

Dr. Rebecca Walker is an Assistant Professor of Emergency Medicine at Stanford University School of Medicine. She has a background in International Studies/Global Public Health Leadership at the University of North Carolina, and completed a fellowship in International Emergency Medicine and Global Health at Stanford. Dr. Walker’s academic focus is on the development of international emergency care systems. She has worked in systems development for health provider education and prehospital emergency systems in the Solomon Islands, Cambodia, Ethiopia, Nepal, India, and Peru. She lectures nationally and internationally on the delivery of emergency care and social determinants contributing to inequities in health outcomes. At Stanford, she directs the scholarship of physician leaders from abroad through Stanford’s International Visiting Scholar Program and co-directs the International Emergency Medicine Fellowship.

Teaching Assistants: Michael Yokell (SMS4); Jordan Apfeld (SMS2)

Resources:

Two textbooks were recommended and made available online as additional, more-detailed resources for students to consult. The first textbook is a comprehensive resource for clinical emergency medicine written by Dr. Mahadevan, one the SURG 210 course directors. The second book appropriately includes information about providing emergency medicine in a setting without comprehensive resources. Chapters were placed on the course website for each of the 20 modules, as well as interesting papers on the topics of the week.

1.     An Introduction to Clinical Emergency Medicine, 2nd edition; S.V. Mahadevan, G.M. Garmel; Cambridge University Press, May 2012

Building on the strengths of its award-winning predecessor, An Introduction to Clinical Emergency Medicine is a must-have resource for individuals training and practicing in this challenging specialty. Guided by the patient's chief complaint, this text presents a concise, methodical approach to patient evaluation, management and problem solving in the Emergency Department.

2.     AFEM Handbook of Acute and Emergency Care; L.A. Wallis, T.A. Reynolds; Oxford University Press, South Africa, Oct 2013

The Handbook takes the reader through the approach to the patient in a moderately resourced setting (e.g. where an X-ray machine and oxygen is available), or in a setting with full resources (e.g. CT scanner, cardiac catheterization lab). This unique stratified approach is tailored to the specificities of the African context.


Stanford Emergency Medicine Goes Online in Uganda, Teaching Commons

OIA and VPTL Announce Winners of Faculty Seed Grants for Online International Learning, Office of International Affairs News

Novel Online Course for Emergency Medicine in Africa and the U.S., Office of International Affairs News

Stanford Seed Grants for Online Learning Highlight International Collaboration, Stanford Report

Faculty Seed Grants, Office of the Vice Provost for Teaching and Learning

Stanford Emergency Medicine International (SEMI)