EM Rotations - Preparation and Expectations

Updated July 2022

Preparation is one of the keys to success in EM.  Only on TV can you walk in and just "wing it".  This also applies to your EM rotations.  To be successful it is important to be as prepared as possible, including knowing what your supervisors expectations will be.

Preparation

You will have a much easier time with the clinical medicine if you have already completed Medicine and Surgery clerkships.  The more core clerkships you have done the better your general knowledge base will be.  You have the potential to encounter anything in the ED so broader experience is helpful.

Start working on your knowledge base with a focus on the dangerous complaints.  There are study guide books specific to the EM rotation that have the level of detail you need at this stage.  The Clerkship Directors in EM (CDEM) have put together an incredible website with curricula for students in EM.

Another option is to listen to one or more of the podcasts that covers the foundation knowledge of EM.  Three particularly good ones are:

• EM Basic 
• early FOAMcast
• EM Cases

And become familiar with a reference you can use while working clinically, like UpToDate or WikEM (something beyond just "googling it").  

The minimal equipment to bring with you are a stethoscope, a light of some kind, and a medication reference (this can be an app - but you need to be familiar with it enough to find information in a timely fashion).  Also recommended are trauma shears, a reflex hammer, and a sense of humor.  Bring spare scrubs in case they are not available and your white coat in case they want you to wear it.

Expectations

The minimum expected of you is to work hard, be enthusiastic, and arrive on time (early).  These are all deal-breakers - necessary, but not sufficient, to make the impression you want.

In order to really impress your supervisors and evaluators you need to start the transition from data gatherer to clinician.  You want to go from being a Reporter, to an Interpreter and Manager.  Reporters collect data for others to evaluate.  Interpreters assess the available information and come up with a plan.  Managers execute a plan.  You want to show the ability to be a Manager.

You will be evaluated largely on the strength of your presentations.  Therefore you should present in an organized and focused manner.  Your presentations should address the chief complaint.  You should have a differential diagnosis as part of your assessment and you need to have a management plan.  This is easier said than done, but a good place to start is with this article.  Read it.  Believe it.  Live it.  

And now the same concepts have been converted to video form by EMRA.

For more on being ready for your clerkships:

• Check out the "Emergency Medicine Clerkship Primer" by the Clerkship Directors in Emergency Medicine (CDEM).  
• There is an episode of the CDEM EM Stud podcast specifically on Away Rotations.