The CORD EM Blog

Disclosure:  I am also an editor for the CORD EM blog, writing and editing posts by members of the CORD Student Advising Task Force (SATF).  

The Council of Emergency Medicine Residency Directors (CORD EM) recently started their own blog. This new Free Open Access Medical Education (FOAMed) resource is growing to include a variety of resources for those involved in emergency medicine (EM) education. One of the content areas (and the reason this is being mentioned here) is from the CORD EM Student Advising Task Force (SATF).

On the first Thursday of each month the SATF will publish a post with information crucial to students applying to EM, and all those that advise them.  Their first two posts should be of great interest:

• HireVue - The Pre-Interview Interview, where the video interviews that all EM applicants are being asked to conduct are explained.  This pilot program is being rolled out by the American Association of Medical Colleges (AAMC) just in EM this year.  
• Student Advising: A Comprehensive Guide and FAQ, where the most up-to-date versions of the CORD SATF Emergency Medicine Applying Guide and Applicant FAQ were shared. These resources contain the most current applicant advising recommendations available, based on Clerkship Director and Program Director consensus and the best available evidence.  

Future posts will highlight more invaluable resources for students including advising recommendations for applicants in Special Circumstances and highlighting of the most useful resources for students.  

CDEM Curriculum - EM Stud and SATF Resources

The Clerkship Directors in Emergency Medicine (CDEM) is the National Organization representing Undergraduate Medical Education in Emergency Medicine.  CDEM is comprised of medical student educators who are committed to enhancing medical student education.  They have recently revamped their web presence with the fantastic new CDEMCurriculum.com site.  Any student interested in EM should spend some time poring over this site as it is the single best resource available.  In this post we highlight the tip of that content iceberg. 

Curricula
Among the resources available are the Student Curricula that give the site its name.  Included are focussed reviews of the major adult and pediatric complaints with an emphasis on what the student needs to know.  A student familiar with all of this material would have a knowledge base that any supervisor would find impressive.  

EM Stud Podcast
There are an amazing number of podcasts out there, but don't you wish there was a podcast for the student interested in EM?  Well it turns out that the EM Stud podcast is what you are looking for.  Started independently by Dr. Nate Lewis (@ERDrN8), it is now the official CDEM podcast for students.  His co-host, Dr. J. Scott Wieters (@EMedCoach), recently recorded an incredibly insightful Match Analysis with Dr. Mike Van Meter.  Just packed with great insights that impact your application.  Previous episodes cover a variety of topics including the dreaded VSAS and How to Run Third Year Like a Boss, among many others. 

Student Advising Resources
The CDEM site also hosts the Advising Resources created by the Council of Residency Directors in EM (CORD-EM) Medical Student Advising Task Force.  This group of Program Directors, Clerkship Directors, Residents and Students collaborate to improve the quality of available student advising and increase the transparency in the EM application process.  Currently available resources you can download from the CDEM site include a comprehensive Guide to Applying to EM, a concise set of Frequently Asked Questions, a Student Planner, and a collection of the best Advising Resources currently available.  

This should keep you busy for a while.  Enjoy!

Adam Kellogg is an Associate Residency Director, former Medical Student Clerkship Director, and the immediate-past Chair of the aforementioned CORD-EM Student Advising Task Force. He wishes that the EM Stud podcast existed when he was a medical student.  Or any podcast for that matter.    

Application Resources from the CORD SATF

The CORD EM Student Advising Task Force has produced a set of application resources for medical students and those who advise them.  These were created with the input of all the groups who care about quality medical student advising (CORD, CDEM, EMRA, AAEM/RSA).  

You can find these resources on the CDEM Curriculum website, along with a whole bunch of other great resources: 
http://cdemcurriculum.com/2016/04/06/student-advising-task-force/ 

Included are a comprehensive guide to the application process, a more concise FAQ, a list of the best resources currently available, and a planner to help guide you through the process.  

Enjoy!

Adam Kellogg is an Associate Residency Director and a previous Emergency Medicine Clerkship Director.  He was Chair of the CORD EM Student Advising Task Force until very recently. Full disclosure - he served as an editor for these resources. 

Interview Advice from ALiEM

Over at the invaluable Academic Life in Emergency Medicine (ALiEM) blog, Christina Shenvi, MD PhD, has written a tremendous post full of great tips on the "Dos and Don'ts of Residency Interviewing".  I strongly recommend you check it out.  

How to excel during interview season is a topic we have tackled here in the past as well.  Have a look at this guide to scheduling your interviews.  Included are tips on how many interviews to do, managing all the travel, the value of the night before, and how to gracefully handle canceling interviews you no longer need.

We also have a separate guide to the interview day itself.  Included are tips on making a great first impression, having good questions, and a reminder to make sure that you interview the program too - that you get what you need out of the day.  

And a few other interview resources bouncing around the #FOAMed universe:

• Nikita Joshi (@njoshi8), also from ALiEM, posted some great tips for the residency interview process.
• The ALiEM series of Match Advice video discussions are excellent.  They are discussions by Program Directors from across the country and include one on Interviewing Strategies.
• The EM Stud podcast by Dr. N8 (@emstudpodcast) has covered The 7 P's of RSI (Really Stellar Interviewing) and done a 2 part Q&A on Interviewing (part 1 and part 2).

EM Presentations 2.0

The not-so-secret "secret" of doing well on your Emergency Medicine (EM) rotations is to be able to give patient presentations the way that your supervisors want to hear them.

We have covered this in the past in a post on "The Secret to Honors", and that advice has not changed. The best way to make a good impression is with organized and focussed presentations that include a worst-first differential diagnosis and a plan appropriate to an acute care setting.  There is even a bit of literature to back-up this approach. The 3-Minute EM presentation article has been a staple of EM clerkships for years.

Some ingenious folks at the Emergency Medicine Residency Association (EMRA) and Clerkship Directors in Emergency Medicine (CDEM) have improved upon this resource with this video on Patient Presentations.  The 10 minutes invested will undoubtedly pay off on your EM rotation.

Enjoy!

Adam Kellogg is an Associate Residency Director. When he was a Clerkship Director he gave every student a copy of the 3 Minute EM Presentation.  Some of them even read it.  

The EMStud Podcast

I recently became aware of a new resource that every medical student interested in Emergency Medicine should check out: the EMStud podcast.

Started this fall by Dr. N8 (@emstudpodcast), they are hitting on key topics of importance to students applying to EM. They have covered The 7 P's of RSI (Really Stellar Interviewing), had a 2 part Q&A on Interviewing (part 1 and part 2), and most recently got the rank list discussion started with 100 Days to Match Day.

These short (well under 20 minutes!) podcasts hit the key points that students need to know. He also provides links to longer form advice for those seeking more. EMStud is a welcome addition to the growing collection of resources for students interested in EM.

Enjoy!

Learning Resource: FOAMcast

The world of FOAMed (Free Open Access Medical Education) is over-flowing with resources discussing cutting edge, controversial, and high risk topics.  This is why we use it.

However, much of the popular and best FOAMed content is not ideal in the early stages of assimilating the broad knowledge base required for Emergency Medicine.  You should try walking with EMbasic, before you go running with EMCrit and Smart EM.

A new addition to the list of resources for EM learners at all stages is the FOAMcast podcast by Lauren Westafer (@LWestafer) and Jeremy Faust (@jeremyfaust).  These short, easily digestible podcasts summarize a recent piece of hot new FOAM and pair it with a review of core content material that every emergency provider should know.

Recent episodes have covered Anaphylaxis, Neonatal Jaundice, and First Trimester Bleeding.

Have a listen.  You won't be disappointed!

FOAMCAST

Why FOAM it alone?

Learning Resource: Closing the Gap

For fourth year students interested in Emergency Medicine this is the time when most are finally getting to do EM rotations. There are a lot of objectives packed into these four week blocks. You need to figure out if this is really the kind of medicine you want to practice. You need to "audition", showing your aptitude and fit for EM, and secure letters of recommendation evaluation. You also want to start improving your clinical skills and getting some procedural experiences under your belt.  The latter is where todays post come in.

The scope of EM practice includes numerous procedures, including high stakes ones like pericardiocentesis, cricothyrotomy, and resuscitative thoracotomies. While you will learn to do these eventually, at this stage it will be higher yield to focus on the procedures that are more readily available, like wound management. You should get opportunities to do wound repair during your rotations and your future residency will expect you to arrive with some degree of experience with basic wound closure techniques.

The world of FOAMed (Free Open Access Medical Education) is overflowing with great resources for procedural education. The "Closing the Gap" site, lacerationrepair.com, is a particularly nice resource that consists of a set of videos and annotations covering the majority of wound repair techniques you need to know. Start with simple interrupted sutures, check out the corner stitch, and work your way through the advanced techniques, like layered closure.

Enjoy!

R.E.B.E.L. EM and the Importance of Airway

In this brave new world of FOAMed one of the big challenges is vetting which sources of information are worth following. The work of Salim Rezaie (@SRRezaie) on his R.E.B.E.L. EM blog, should be a a must read for anyone trying to keep up in EM. He is a prolific contributor to #FOAMed with recent posts exploring the need for an insulin bolus in DKA and what actually matters in post-LP headaches.  But the one that prompted this long over-do "shout out" was a review of preoxygenation and apneic oxygenation that you should go read right now.

Your communication skills are probably those most critical to your overall success in medicine, but you can argue that airway skills come in a close second. If you train at an ACGME-approved residency program in the U.S. you will be required to perform 35 intubations to meet requirements.  Ask any Emergency Physician and they will tell you that 35 is just the beginning. Real competence likely happens somewhere around "triple digits". 

You have to start somewhere, and early in the development of your airway skills you are going to need some extra time to figure out where you are and what you are looking at.  These techniques for maintaining excessive oxygenation during the peri-intubation period are good for the patient and great for your chances of completing the intubation. The FOAMed world is full of wonderful Airway resources, and R.E.B.E.L. EM is a good place to start.  

Also see this primer on intubation from The Short Coat by Lauren Westafer (@LWestafer) and this lecture by Rich Levitan posted on the EMCrit blog by Scott Weingart (@emcrit).

Learning Resource: Didactics Online

I recently met a student who created a website full of useful educational resources for medical students and others early in their EM careers.  Brandon Parker (@DidacticsOnline) is a soon-to-be EM resident and his site, Didactics Online covers a variety of topics.

The most recent post is on GI Bleeding.  Included on the page are a pdf of slides that are concise and focussed on what you need to know.  Short, sweet, and to the point.

The post before that is on Monitoring the Critically Ill Patient and has both a pdf of the slides as well as the accompanying podcast.

This site is different from a site like Flipped EM Classroom, which is trying to be a repository of all topics in EM.  Instead, Brandon has put together some very accessible dives into a few different topics, many of which are relevant to EM.

Some of the EM oriented topics are:

How to present a patient
Stroke and TIA
Migraines
Dizziness and Vertigo
ARDS
COPD

Have a look.

Learning Resource: The Flipped EM Classroom

Many educators feel that the future of didactic instruction is the "flipped classroom" model.  Students review materials at home before coming to class, sometimes watching on-line lectures/videos.  In the classroom they do their "homework", working through problems and concepts while the teacher(s) circulate and help the learners.  Many Emergency Medicine Residency Programs are adopting, or at least experimenting, with these concepts.

One benefit to all is that a lot of on-line resources are being produced.  A great example is that work of The Flipped EM Classroom.   The foundation for the content covered is the Clerkship Directors in Emergency Medicine (CDEM) Curriculum for medical students, so it makes a strong foundation of knowledge.  Think of this like a souped-up, FOAMed, multi-media version of the "First Aid for the EM Clerkship"-type books.

There are small, easily-digested, modules on "Approach to..." a variety of common ED complaints like:  Abdominal Pain, Poisoning, Trauma, etc.

There are also Disease Specific reviews grouped by organ system.  For example, in the Cardiovascular group there are Abdominal Aortic Aneurysm, Acute Heart Failure, Pulmonary Embolism, and more.

For third years soon to start EM rotations: this is the knowledge base and approach that your supervisors are going to be looking for.  Get a jump on understanding this information from an EM perspective.

For fourth years going into EM.  Your program is going to be expecting you to have this foundation of knowledge when you show up.  If you don't, you will get feedback like, "knowledge base is behind that of peers".  Any you don't want that.

Enjoy!

Effective Interviews - Part 2: What's Hot?

In part 1 of "Effective Interviews" we covered the basics of how to get the most out of your interview days.  In part 2 we are going to raise your interview game with a discussion of what topics are "hot" in Emergency Medicine in the fall of 2013.

While on the interview trail you are discovering the "hot topics" to talk about from your fellow applicants.  This is the default topic.  The one you go to when you are out of other questions or because everyone says you should ask about it.  For a long time this was Trauma, as in: "What is your Trauma experience like?"  For a few years now Ultrasound has usurped this spot.  This year, another shift is likely upon us: "What role does Social Media have in your education program?".  The most mainstream of EM publications, the Annals of Emergency Medicine, just published an article about Twitter.

Twitter is a great window into what is being discussed and debated in EM.  All you have to do is follow a few of the disseminators of #FOAMed (@emlitofnote, @njoshi8, @emcrit, @CriticalCareNow, @srrezaie, @precordialthump, @LWestafer, just to name a few) and you will quickly be caught up on the discussion.

But if none of the preceding paragraph made any sense to you, here are some of the big topics under discussion in 2013:

• Social Media in Education - you should probably have an opinion or stance on this.  Many of your interviewers will.   Though you shoudl be ready for otherwise wonderful and enthusiastic educators to be very skeptical of the whole concept.  They may also be more interested in your understanding of professionalism as it relates to Facebook/Twitter/Snapchat/etc.
• Thrombolysis for Acute Ischemic Stroke - this is being debated vigorously in EM with ACEP releasing a policy statement that has led to much consternation from many practicing Emergency Physicians.  This has recently been discussed really well on the ERCast podcast.  The LITFL blog also did a good discussion to review as well.
• Video vs. Direct Laryngoscopy - This is being hotly debated in EM right now with very knowledgable people on both sides of the "Is direct laryngoscopy dead?" debate.  As someone about to begin your training, knowing the programs philosophy on airway management is going to be really important to your education.  What do they do?  What do they teach?  This is way more important to your eventual career than how they get Trauma experience (A comes before T, after all).

Other topics of recent discussion also include:

Transexamic Acid (TXA) in Bleeding Trauma Patients - Review by Napolitano et al.

Novel anti-coagulants and newly approved treatments - Dabigatran, Rivaroxaban, Prothrombin Complex Concentrates

And just this past week, the value of Therapeutic Hypothermia (aka Targeted Temperature Management [TTM]) in Cardiac Arrest came under renewed scrutiny.

So much to know.  Maybe you should get that Twitter handle after all...

Link: ALiEM Interview Tips

Nikita Joshi (@njoshi8) over at the incomparable Academic Life in Emergency Medicine site recently posted some great tips for the residency interview process.

This is a great list of recommendations.  I would add particular emphasis to "Being interested".  You should have questions ready to go for anyone you talk to.  The benefits are both for you and the program.  You get as much information as possible and impress upon the program how interested you are.  An applicant without any questions is presumed disinterested.  Even if the Residency Director answered every question you had during the "sales pitch", you should still ask about the things that matter to you.  You may even get different answers from a different source.

Another point that deserves a little more emphasis is "Remember that you are interviewing the program as well".  Once you have cleared the hurdle of getting an interview they want to like you.  You have met their academic standards and something about your application drew their attention. No one will sour on you for asking insightful questions.  Ask about the factors that matter most to you, from an educational perspective.  Both sides benefit from you making sure that this is going to be a good fit.

What in the world is FOAM... and where can I get some???

The new education trend sweeping Emergency Medicine is FOAM (Free Open Access Medical-education), also known as #FOAMed.

Offering medical knowledge free to the world is a break from the pay-to-learn model that has existed in medicine (buy a textbook, subscribe to a newsletter, pay for CD's, etc. etc.).  But information wants to be free and educators are finally embracing that it is more satisfying to expose a larger audience to what you have to teach.

Everything a student of Emergency Medicine could want to know is now out there for free. The challenge has become:  how do you find what you want to know.

As a student just getting started in this specialty you are faced with a daunting mountain of resources.  And many of these sites, blogs, and twitter feeds are not targeted to the early EM learner.  So where should you begin?

Well, two of the best sites for students recently posted some great content on getting the most out of this  wonderful new world:
Academic Life in Emergency Medicine 
iTeachEM

Enjoy!

Should I do combined EM/IM residency?

If you ask most people who trained in just Emergency Medicine they will tell you that EM/IM training is not necessary.  They may even look at you funny for voluntarily doing more ward medicine months.

As an advisor, my best "pro" for dual training was that it left open the option for Board Certification in Medical Critical Care.  With that pathway now open to those who train solely in EM prior to Critical Care Fellowship, I have had to reevaluate who I recommend EM/IM too.

But instead of listening to me, take a look at what Dr. Matt Astin had to say about his own experience over at Academic Life in Emergency Medicine.  

Stuff for Students: EM Basic

EM Basic is a podcast and blog by Dr. Steve Caroll.  The sub-heading on his home page reads: "Your Boot Camp Guide to Emergency Medicine".  That about sums it up.

Listening to this podcast will give you a solid foundation in clinical Emergency Medicine.  He started with approaches to common clinical complaints like chest pain, abdominal pain, etc., and progressed to reviewing essential evidence and discussing elements of EM practice like trauma resuscitation, procedural sedation, and much more.

You can find EM Basic on iTunes or download the files from his website.

Enjoy!

Stuff for Students: ALiEM and Patwari Academy videos

Academic Life in Emergency Medicine (ALiEM) is a wonderful blog started by Dr. Michelle Lin for Emergency Medicine enthusiasts.  There is now a stable of authors providing useful content for anyone interested in EM.

Particularly helpful for students and early residents are the Patwari Academy videos they post every Sunday.  These are short videos, Kahn Academy style, of an expert breaking down an EM topic on a "whiteboard".  Here is a link to the most recent on Salter Harris Fracture classification.  Other recent topics include Early Goal Directed Therapy, Approach to Altered Mental Status, and a series on Chest Trauma.

To get caught up you can go to the ALiEM blog and go back through the posts, OR search the blog for all "patwari" posts.

Enjoy!

Stuff for Students: SAEM Website

SAEM is the Society for Academic Emergency Medicine.  A natural part of their mission is to provide resources for medical students, especially those with an interest in a career in academics.  They recently revised their website to make it more functional.  There are still a few bugs and misplaced links, but there is also a ton of resources for students.

Follow the "Membership" tab to the "Medical Students" page and have a look around.  What follows are a few of the most useful resources.  You do not need to be a member to use any of these, but membership does confer additional benefits, though at a not insubstantial price.

Full disclosure:  I am a member of an SAEM committee whose mission is to find ways to better serve  medical student's and resident's.  I do not think this creates any conflicts of interest.

The most invaluable resource SAEM provides are their Directories, including their Clerkship Directory and their Residency Directory.  These are interactive maps of the U.S. with links to information on most of the EM rotations and all of the Allopathic EM residencies.  This is a great place to start researching the programs you may want to apply to.  The information here is very helpful.  A word of warning: not all of the details are right (I found several errors on my home institutions page).  A residencies actual website, usually linked to in the profile, should be considered a more definitive source of information.

Another incredibly useful service provided is the E-Advisor program.  This is a great way to get advising on a different region of the country from where you go to school.  This is also a great way to connect with an adviser if you do not have a local EM program.

One more to highlight is their collection of Student Resources.  Included are a variety of documents answering common questions and providing advice on numerous issues facing students applying to EM.

There is a lot more as well including award and grant opportunities, and information on the Annual SAEM meeting (next week in Atlanta).  Enjoy!