[This guest post is a guide to succeeding on EM rotations by Dr. Duncan Grossman, a first year resident at Maimonedes Medical Center in Brooklyn, NY. Originally created for his fellow EM bound students at the University of New England, the guide has been adapted for all and is a great perspective on how to succeed on EM rotations.
- Adam]
This guide reviews what to expect on your sub-internships and how you can look like a rockstar. I'll also include a list of resources -- some of which you *must* use, some of which will be up to you.
CHAPTER ONE -- WHAT TO EXPECT
Typically your first day will consist of some sort of orientation. You'll meet your clerkship director and other rotators, do some paperwork, maybe meet a resident or two. You'll get a tour of the ED and they'll set some sort of outline about what to expect for your four weeks. They'll mention SLOEs this day too, probably -- since you're rotating during prime SLOE months, they kind of already know you want one.
You'll work a variety of shifts. These may include nights, fast-track, shifts on the ambulance, or any combination.
Remember, you're at a residency program, so there are weekly lectures for the residents that you'll attend. In addition, you may have specific med-student lectures. During these they may do skills labs (central lines, splinting, lumbar punctures), SIM labs, and they may have you do a presentation. Don't stress about presentations -- no one is looking to eviscerate you, just to see that you put some effort in and learned something.
Some places have a test on the last day. Some don't.
Most places will offer you a guaranteed interview at the end. Some will not.
CHAPTER TWO -- ON SHIFT
Consider listening to a podcast or quickly reviewing a topic on your way in, just to get in the mindset.
The hardest part of these rotations (in my opinion) is that you'll likely be paired up with a new attending for every shift. That means you need to establish rapport and trust at the beginning every single time. Don't get lazy with your appearance or enthusiasm -- remember, you are always auditioning.
At the beginning of the shift, introduce yourself to the attending, residents, and even to some of the nurses & techs (these people can be a gold mine of knowledge and may grab you for cool stuff). You might say something like, "Hey there, I know you're busy, but I just wanted to introduce myself: my name is Duncan and I'm your med student for today for the 7a-7p shift."
(Pro-tip: I try to say the hours of my shift at the beginning because sometimes your attending will be working different hours, so instead of awkwardly saying no when they ask you to see a patient at 6:59pm, you set the expectation.)
If it's not crazy busy, I always try to ask, "What are your expectations of me for this shift?" This does three things. 1 -- It shows you are enthusiastic and you care. 2 -- It sets what you should be doing. 3 -- It allows your attending/resident to realize what they want out of you, so you're all on the same page.
See patients (obvs). There's a fine line between being proactive and being annoying, so ask if there's anyone to see and if your preceptor says not yet, then just chill out. Read, go walk someone to x-ray, familiarize yourself with the equipment carts -- always be doing something, even if it's small. Some places will steer you toward patients, some will tell you to sign up for them... It just depends.
Seeing patients is the fun part -- we'll address some pearls later in the email.
Once you've seen them, you need to present. We'll cover *how* to present later, but when you're ready, you should say, "Dr. Johnson, I saw the patient in room 3 and I'm ready to present whenever you're free." Sometimes you'll present immediately. Sometimes an hour later. Sometimes you'll never present it. That's just the ED for you.
Volunteer to do procedures (suturing, IVs, splinting) for all the patients, but especially your own.
**Fun Tip** I scribbled down super interesting patients and little knowledge nuggets in the back of my notebook and kept a running list through the whole rotation. It may be as simple as "Lovers Fx = b/l calcaneal fx" or a chief complaint like "central retinal artery occlusion." It could also be something for you to look up later, like, "Pics of ultrasound fetal pole."
CHAPTER THREE -- END OF SHIFT
You'll likely turn in an evaluation sheet to your preceptor at the end of your shift. (Consider doing it 30min before the end so you're not giving it to them while they're running out the door.) They know they have to do it, so you don't have to make a huge production out of it. A simple, "Dr. Johnson, can I leave my evaluation at your computer?" will suffice.
But you're NOT DONE THERE -- this is your time to shine, peeps. This is when you ask, "What can I do to be better on my next shift? What can I improve on?" This is gold on your evaluation. Be humble, don't be defensive about critical feedback, and thank them sincerely. Then thank everyone around you.
Pat yourself on the back, take a breath, and chill out.
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RESOURCES
Just like studying for boards and school, when looking at this insane list of resources, find what works for you.
With that said, there are a couple of mandatory (in my opinion) resources that you need to have under your belt. I listed those under "Mandatory." Then just pick a couple from the other lists.
MANDATORY:
1) Patient Presentations -- Document
2) Patient Presentations -- Video
3) Clinical rules -- App (Download onto your phone!)
4) Chief complaint driven guide to differentials -- *BEFORE YOU BUY* you may get this for free with an EMRA membership, which you should def get. If it's not free, I'd still recommend buying it -- it's a great resource to start organizing your thoughts with regard to chief complaints.
PODCASTS:
1) EM Basic Podcast -- 30 min episodes -- Super dry but really covers the nuts and bolts of stuff you need to know for routine emergency medicine. Listen to him on 2x speed. He also has "show notes" which are a GOLD MINE of information, and I'm actually making flashcards out of them before internship.
2) EM Clerkship Podcast -- 6 min episodes -- Really short but awesome overviews of chief complaints, ddx's, procedures, etc. Good to cover a lot of info in a little time.
3) EM:RAP -- Variable time -- I just started listening to this but everyone raves about it. Free with your EMRA membership. Their "C3" lectures will cover Core Clinical Content. All the rest is gravy. They have their own app.
4) EMCrit -- 30-60min -- So these are pretty advanced and honestly, I don't think they're going to be particularly high-yield for your rotations. But I have friends who love it.
5) The Emergency Medical Minute -- 5min -- This is just a whole bunch of recordings of residents lecturing their co-residents on tiny topics. Kind of like the clerkship podcast above but less formal and tackling less core content.
6) Core EM Podcast -- 20min -- Great podcast covering core content. Two hosts.
7) PEM Playbook -- 60min -- Pure gold for pediatric emergency medicine. Listen to this if you have a couple peds EM shifts thrown in or if you're doing a PEM rotation.
BOOKS:
1) Tintinalli's Manual -- Small version of the biggest name in EM textbooks. Carried this with me in my backpack and would bring it to shift, looking up diagnoses and treatments of patients I had. Highly recommend.
2) Tintinalli's Just The Facts -- I think it's physically bigger, but more succint?
3) Rapid Interpretation of EKGs -- If you have NO IDEA where to start with EKGs, make sure you read through this.
4) ECGs for the Emergency Physician -- A whole book of EKGs to quiz yourself.
5) Antibiotic Guide -- Should be free with EMRA. Used it a couple times, def not mandatory. They have an app, too.
APPS:
1) MD Calc, as listed above. Learn how to use PERC, Canadian Head CT, PECARN, Wells (PE and DVT), San Francisco Syncope.
2) Epocrates for drugs
3) Medscape -- good for drugs and diseases but is occasionally incorrect
4) WikEM -- a wikipedia page specifically for emergency medicine. Really great resource -- you can plug in chief complaints and it'll give you an EM specific wiki page.
5) PalmEM -- recommended to me but I couldn't justify $20 for an app. Looks cool.
VIDEOS: (My favorite, personally!)
1) EM:RAP -- Just found this. Def gonna watch these.
2) EM in 5 -- This is my absolute favorite. Biased because it's done by the clerkship director at my soon-to-be-residency, but I think this is my absolute favorite resource.
3) Emergency Medicine Cases -- These guys have a podcast too
Good luck out there!
-Duncan
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