Acing your EM Clerkship

Acing your EM Clerkship

Here are five things you can do to shine during your rotation

1. You are on stage all month: present yourself well at every opportunity. Residents, nurses, and secretaries notice how you act, and will make their thoughts known. Be polite, be agreeable, be willing to bend as needed. Be WHERE you are expected WHEN you are expected: be eager from minute one, until you leave. 
2. Yes, but... At some point you will be asked to do something you have never done before. Accept the challenge but explain your limitations. This way your supervisor knows where you are starting from. When asked if you would like to suture a child's face answer "yes, but this will be my first experience suturing a child’s face. Can you walk me through it."
3. Anticipate the next step: Students who interpret are noticed. If you sent a urine to check for infection, decide what antibiotic you want to use if it is positive. Be flexible, plans will change, patient's status will worsen, exams will change- don't be too invested in any one direction, flow with the needs of those around you.
4. Presentations present you: Be concise, succinct, and focused. Take a moment after seeing the patient to put your thoughts together and practice your presentation. Focus on the complaint and the differential, and let them guide your presentation of the history, exam, differential, and plan. The following is a great article on EM presentations: The 3-minute emergency medicine medical student presentation: a variation on a theme. Davenport C, Honigman B, Druck J.Acad Emerg Med. 2008 Jul;15(7):683-7.
5. Demand timely, useful feedback: at the end of the shift residents and attendings are rushing to finish. Rather than asking how you did at the end, give your supervisor an area to concentrate on right from the start. As you begin a shift let them know the area you want to work on. "Today I'd really like to work on my presentations, can you help me with that." Now your supervisor has a focus, and you've enlisted them to be your ally.

Applying Pages

Several new resource pages have been added to this blog that should be of help to those applying for the 2014 match.  All the "pages" can be found in the right hand column.

An Intro to the Application should get you started with some basic over-view of what you need to know now.

The pages below then elaborate on the five main components of your application:

The ERAS Application
The Personal Statement
The Dean's Letter and Transcript
The Boards
Letters of Recommendation

 Now is a great time to find out what you are going to need to do.

Spring To Do List for Fourth Years

To Do List:

1. OWN OCCUPATION Disability insurance-  As you finish up medical school you have an opportunity to get disability insurance that will cover you within your specialty of choice EM, at a steep discount. ON OC covers you if you can no longer practice in your specialty. This is imperative as many policies will stop covering if you can practice in another area of medicine. 
2. COBRA Health insurance - this is health insurance through your medical school to cover any gap from your coverage during school and your coverage at your residency hospital. Check your paperwork for coverage dates and ensure you are covered. Accidents happen, please think ahead and protect yourself.
3. PAPERWORK- Whether electronic or in paper the stack is huge. Your residency and hospital have a lot for you to fill in. While it may seem pointless and often redundant, you have an obligation to get them done and done quickly. You will be working with your residency coordinator for three to four years- don’t make her life harder by needing nagging to meet your obligation.
4. CAPSTONE- if your school doesn’t have a capstone course to get you in gear for residency then make your own. See our section on designing your own  https://www.blogger.com/blogger.g?blogID=5950597211152538922#editor/target=post;postID=5649412330569209983;onPublishedMenu=allposts;onClosedMenu=allposts;postNum=5;src=postname
5. TAKE SOME TIME - you have an opportunity to use your time this spring to explore, travel and renew yourself. Residency will be exhilarating but the hardest work of your life. Don’t waste the time you have, enjoy it.

Away Rotations - Keeping Bridges Unburned

After working so hard, and stressing so much, over securing the Away Rotations that are going to make your application for EM perfect, it can be really hard to let those rotations go.  What is the harm in hanging onto that spot until the last minute, just in case?

Please do not do this.  Once you know you will not be completing a rotation, politely withdraw.  Three groups are hurt if you wait to the last minute to vacate that spot:

1.  You - that program that you were recently interested in enough to rotate at will now treat you like persona-non-grata.  Drop them at the last minute and you should not bother wasting money on an application.  The repercussions could be even broader than burning bridges at one program.  All the Clerkship Directors know each other.  

2.  The Clerkship and Program left with an empty spot - they are trying to get as many students an opportunity to rotate as they possibly can.  Canceling at the last minute just makes their job harder.  Clerkship Directors, as a rule, are really nice people.  Generous with their time and very much invested in helping students navigate the path to an EM Residency.  They are a difficult group to make angry.  Leaving them with a last minute unfilled spot in the rotation they pour so much of their personal and professional time into, is a very reliable way to make them angry.   

3.  The other students in the applicant pool - somebody else would have really liked that rotation opportunity that it may now be too late to fill.  Emergency Medicine is a team sport and cut-throat, self-serving behavior has no place in it.  If you even occasionally suffer from these "qualities", now is the time to remove them from your character.  

While I cannot guarantee that Groups 2 and 3 matter to you, I am pretty sure that Group 1 does.

No rationale person, including Clerkship Directors, will be angry if a student withdraws more than a month before their start date.  They may not even notice, and they certainly will not put you on a list of students whose careers they must crush.  No one has that kind of time.

Withdraw at the last minute, or no show, and that Clerkship Director may decide to make the time.  

Tricks of the Trade: Rotations

Tricks of the Trade

Rotations

When you get the rotation you wanted you have preparation to get done:

Read the paperwork from the program carefully, and complete it in a timely manner. There is no second chance for a first impression. You don't want to arrive, and not be able to rotate because of paperwork. Health requirements vary at different institutions. Check with the undergraduate medical education office or health services, at the hospital you are going to. They should relay what you need in detail. This is the time to jump through the hoop and get it done.

How many is too many?

There are no perfect number of clerkship applications. Get help from your advisor to review your application to determine your competitiveness. Look at where you want to go, and how competitive a market it is for clerkship. For most student 4 applications will suffice. If you are a weaker applicant or looking at a more competitive market- consider 6. If you get a clerkship and still have applications outstanding that you will decline, call and let them know you appreciate their time but have accepted another opportunity. This is better than waiting and declining the spot. This proactive stance will win you points with the clerkship director and the coordinator. If at all possible do not accept a rotation and then back out of it. This sends the message you are not interested and inconsiderate- not a good impression.

To Research or not to Research?

Research is less likely to enhance your application than great letters and rotations, but can be another opportunity to get experience, get to know an EM attending, and be on the front lines. Discuss with the attendings at your home institution or contact the Research Director at a program you are interested in. They can help connect you with ongoing projects that you can assist in. Many EM attendings have great ideas and simply need man-power to make them reality. If you get involved, list the project on your ERAS application. Be prepared, this will be a topic of interest in your interviews.


Who is successful?

Students who succeed in EM are proactive, flexible, and enthusiastic. Be a "tigger1." Show up to every shift with a smile, ready to do and be anything needed. Have a positive outlook, and energize those around you. Put your hands on patients, and FOLLOW THROUGH. Know the labs, update your supervisor on how each intervention has worked, and ask to make consultant and admission calls. When you don't know something, look it up. Find articles, case reports, or guidelines and show your supervisors. Be honest, if you didn't ask, or didn't do it, say so. I trust a student who say, "I didn't...."

1. Amal Mattu. Becoming the Leader That Others Follow: ACEP Teaching Fellowship, March 9, 2013.

What can we learn from the 2013 NRMP match experience?

If you go to the NRMP website you can read their preliminary report on the 2013 match.  This is usually followed by a more detailed analysis of each specialty and program, but I think there is some useful information here.

For 2013 there were 165 EM Residency Programs offering1,744 training spots.  Only 3 of these spots went unfilled in the match.  Scrambling to an EM spot is not a reasonable back-up plan.

1,428 of those 1,744 spots (~82%) went to U.S. Seniors.  There were another 212 of these U.S. Seniors who applied for EM, but did not successfully match.  So 87% of senior medical students at Allopathic schools successfully matched to EM.  Most U.S. Seniors will not need a back-up plan.

313 non-U.S. Seniors (i.e.  everybody else in the applicant pool) also matched to EM out of a non-U.S. Senior applicant pool of 790.  So if you were a DO applicant, a re-applicant, or a foreign trained student, you had a ~40% chance of matching.  Knowing you face these odds should factor into your strategy.  

The number of EM spots has been growing.  1,744 this year.  1,668 in 2012.  1,607 in 2011.  Whether this yearly growth will continue is debatable given the current discussions about cutting funding for resident training.   

EM is growing in size and continues to ascend in popularity among medical students.  What these numbers tell you is that most U.S. allopathic seniors will match so long as they make reasonable application decisions.  Applying to dozens of programs is not reasonable.  It just makes more money for the ERAS service.  Better to be realistic in choosing the programs you apply to.  Your individual advisor should be able to give you a good idea of what programs you should specifically target.

Non-U.S. Seniors can absolutely match in EM, but they need to be even more realistic in their choice of programs to apply to.  Again, it is not about the number you apply to but choosing ones that will be interested in you as an applicant.

Do not be dissuaded by these numbers.  They are just another part of your application strategy that needs to be managed.