Why Emergency Medicine?

Kara Barker is a third year medical student who is embarking on the year-long journey to match to an EM residency. This is how she made that decision.    

Prior to starting medical school, my experience with Emergency Medicine (EM) was limited to an ER visit with my nephew following an unfortunate run-in with a homemade arrow and a few late night TV episodes of Bizarre ER. During medical school one of my instructors - a retired EM doc - piqued my interest in this field with her wild stories about her time “on the front line of medicine”.  When I had to pick my third year elective rotation, I decided to see for myself what all the excitement was about. After just one day in the Emergency Department I was done searching for my future specialty.  I was done trying to figure out what I want to be when I grow up. I was hooked.  

There were several aspects of this experience that helped me end my search for a specialty:  

Variety.  We saw a tremendous variety of patients each and every shift.  We treated babies, elderly and everyone in between. We treated psychiatric patients, pregnant women, the critically ill, prison inmates, college students, the addicted, veterans, and many more.  We had the opportunity to meet and help people from every walk of life. There was never a dull moment.

Multifaceted Challenge.  Every shift offered interesting and diverse challenges.  The EM physicians had to possess the tools to address the most critical issues in all other specialties. These tools included both medical knowledge and the skills needed to perform a multitude of procedures. During my first twelve hour shift we reduced a shoulder, placed a central line, treated an anaphylactic reaction, evaluated a suicidal patient, treated a miscarriage, placed a chest tube, and sutured multiple lacerations.

And the challenge did not end with just having medical knowledge and procedural skills.  The EM physicians also had to have exceptional interpersonal skills – they had to be mind-reader, therapist and trusted confidant all wrapped in one.  In a matter of minutes, they had to be able to enter a room, read the patient and their situation and then establish that patient’s trust to solicit critical information in order to initiate appropriate care.    

Teamwork.  Every day, the EM physicians worked closely with a large group of individuals including Emergency Nurses, Physicians Assistants, Medical Assistants, Interpreters, and many other members of the healthcare system. The team I was fortunate enough to briefly be a part of worked together like a well-oiled machine. The staff looked out for one another, anticipated each other’s needs, and collectively worked hard to deliver the best patient care possible.  The losses were mourned together and the successes and triumphs were celebrated together.  There were tense moments, there was a lot of laughter and, importantly, there was never a lonely moment.

Impact.  On many days we were with patients during some of their most vulnerable moments.  This meant that we had the opportunity to make a huge impact on their lives - whether by initiating a lifesaving treatment, easing someone’s pain, or simply taking the time to sooth a worried family member.  I was inspired every day by what a privilege and responsibility this area of medicine carries with it.  

In my opinion, EM physicians have one of the most interesting and challenging jobs out there.  As a third year medical student, I feel fortunate to have found a specialty that inspires me.  Now, I look forward to moving on to the next step in my journey – ending up in the emergency department . . . as one of these inspiring healthcare providers.

I hope reading this helps you decide if EM is right for you.

- Kara

A Fourth Years Perspective: What a third year student needs to know right now

Elizabeth Karr is a 4th year medical student in the 2015 EM Match.  This post is a 4th years perspective on what a 3rd year needs to know.

As I started Fourth Year, I was told that this year would be the hardest yet, and this advice has proven true.  You start out going on your audition rotations, wanting to put your best foot forward and impress the people you are working with.  However, you are also still learning the craft of Emergency Medicine (EM), formulating your differential, perfecting the three minute presentation, and learning the basics of emergency medicine. Then interviews start and you are traveling all the time, which is exhausting in and of itself, and on the interviews you are selling yourself.  You have to answer the same questions 50 thousand times, and yet you still want to sound like you are not giving a rehearsed statement.

Fourth Year Rotations

What I now know at the end of it all: just take a breath, relax, and be yourself.  Audition at sites whose residency programs truly interest you.  Choose a program that you want to learn more about or a program you have heard is a great learning experience for students--not necessarily just your number one or two pick.  If you have a number one choice, it may be better to do that as your second rotation. This will allow for your first rotation to polish your EM skills for your second rotation. The knowledge and skills you acquire will help you to shine at your top program. Also, if you are doing an away rotation in another specialty at a site you are interested in, contact the program director or student coordinator and see if you can do a shift in their emergency room and get an inside perspective on the program.

It is recommended you do your first audition rotation early in fourth year, because these are the rotations in which you will obtain your Standardized Letters of Evaluation (SLOE’s). SLOE’s are letters of recommendation that are often written by an Emergency Medicine residency, not just by individual physicians.  If you look at the following link, it will make sense as to why this is so: http://med.fau.edu/pdfs/SLOE_Standard_Letter_of_Evaluation.pdf  Ideally, you want to have at least two SLOE’s by the time applications are due in September. When you submit these, along with any other letters of recommendation, it gives programs a way to see how you compare, side-by-side, to other emergency medicine applicants. Programs also want to see that you are improving from one evaluation to another.

These SLOE’s will be obtained from your audition rotations, or possibly from a home rotation if your school has an EM program. As you start your first audition rotation, everyone is aware that it is your first rotation.  You are not expected to know everything and have all the answers, or even earn the grade of honors. It is expected you are interested in the field of EM, you learn from your experiences day in and day out, and you show growth over the month-long rotation.  It is appreciated if you show initiative; want to see patients, work on your differentials, volunteer to perform procedures even if you have never done it before.  Most of all, just enjoy the experience.  Don’t be set on trying to impress everyone, and be ready to admit when you didn’t ask your patients something, or if you don’t know the treatment for disease-X.  You are not expected as a fourth year student to have all the answers.

As for the number of EM rotations you need to do, you have to do at least two in order to get two SLOEs.  I have classmates that did five rotations, and others that only did two.  It is up to you.  I actually ended up doing a very late rotation in January, as that was the only time the program could accommodate me.  That program director told me he really likes to see interested students doing rotations late in the season, because you stick out so much more in their mind when it comes to ranking for residency.  With that said, programs are not likely to forget you if you rotate early in fourth year and are a good candidate for the program.  January was also the end of interview season, and by that time, I was exhausted and yet still had to be on my A-game as I was rotating at a place which I was also interviewing at. However, a late rotation was a good reminder of how much I enjoy emergency medicine and why I was spending all the time and money going on interviews. If you are doing a late rotation, make sure you weigh the pros and cons.

Also, in third year or early in fourth year you should try to connect with a mentor: an advisor, faculty member, program director in whom you can share your application with and discuss any lingering questions.  Most people in EM want to see you succeed and match into the program of your choosing.  It is great to have someone to ask questions, look over your personal statement, advise to the number of programs to apply to, and give you an unbiased opinion on your competitiveness in the EM match.

Look for Elizabeth's next post, the Interview Season, coming soon...

Stop Second Guessing Yourself

We have covered your rank list in great detail, but with the Rank List certification deadline approaching (February 25 at 9 pm), many of you are starting to second guess your top programs. This is normal. Everybody does this. You hear from friends, advisors, and deans, and they all have different opinions on where you should go. Remember to focus on what YOU want, above all else.

Think about the top 3-4 programs on your list. Picture them in your mind and see which one causes the biggest smile to split across your face. That is your number one. Stop perseverating - that is YOUR number one. 

When deciding the order of the next few programs, continue to follow your heart. The Match is student weighted, so you get preference. The order you rank the programs matters. You want your list to reflect your true desire to train at the program. Put the spreadsheet down, stop talking to everyone, and focus on how you feel overall about each program. Above that, these are the common pitfalls to avoid:

Squirrel - Being distracted by shiny objects 

Many of the superficial attributes of a program are not going to determine if you are satisfied with your experience training there:

Programs with big names in EM, and those your parents recognize are usually tremendous programs, but that only matters if they were a tremendous fit for you. Don’t elevate a program based solely on reputation or how much you anticipate others will be impressed.

Helicopters, aerospace medicine and hyperbarics are cool, but that won’t be where you spend the majority of your time. Choose to elevate a program based on elements that actually make up a large part of your experience training there.

Location is really important for most people. Though being in a location that others think is cool, but you don’t see yourself in, shouldn’t count as an asset. This is not a vacation, you will live there - make sure it is someplace you want to be, more than visit.

Glossing over glaring negatives

There are only a few things in a program that will have an enormous impact on your training experience:

Program Director - If you didn’t click with the PD- think hard before ranking this program highly. This is not a person you can avoid.

Residents - If they weren’t really happy, or you don’t see yourself as a part of their group, this is not the program for you.

Curriculum - ensure the educational approach, the design of the rotations, and the responsibilities on shifts match up with your needs.

Being Flattered by attention

Be careful to not allow a program’s perceived response to you influence your ranking. Many programs purposefully withhold telling students how well they were liked, while others may overestimate where you are on their rank list. This is a time to trust yourself and be wary of being influenced.

In the end you need to trust your gut, rank your programs in the order you want to be there. Keep in mind more than half of you will get your top choice, and 80% will get in your top 3. You have the control. Use it wisely.

For more on making your rank list see these posts from Academic Life in Emergency Medicine's EM match advise: Making Your Rank List and Top 10 Tips When Making Your Rank List, as well as our post on Going with your gut that includes a more detailed explanation of the Match Algorithm in case you do not believe the whole "student weighted" thing.

Lucienne Lutfy-Clayton is a former Clerkship Director and Associate Residency Director. She believes in shaping destiny, and that things work out as they were meant to. "Life is what you make it, so you might as well trust yourself."