Students who are not fit for EM

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I was pretty excited to rotate through EM last month, only to get slammed on my first day eval when a senior said, "you are okay.. sometimes you know who should be an EM doc and who shouldn't. you'd be a great doctor, but not a natural EM doctor."

I've gotten almost all A's on my rotations, all my attendings and patients loved me, and I like to think myself of a little above avg on medical knowledge. During my month on EM, i saw pts, developed plans, followed up on them, volunteered for procedures, was first to see lab results, and didn't leave until my last patient checked out.

What ran through my mind is, who are you, senior resident, to tell others who is made for a specialty or not? My bad, didn't know there had to be a prototype student. Sorry about the venting, but I just feel like a kid who was told by a punk that he wasn't "cool enough" to hang out with a group.

So my question is, what characteristics make a student "not fit" for the ED?

Damn that's rough, sorry that happened to you.. What about looking him in the eye and just saying "challenge accepted".

Chances it could have been some kind of test to see what you're made of?

IMO the resident was a little inappropriate if this was a *written* eval. Working with someone one shift is not usually sufficient to form a concrete judgement regarding their strengths, unless something really bad happened, which it sounds like wasn't the case. If this was a verbal eval, no harm done. He may just be one of those people who says whatever they're thinking whether it's backed up or not.

The other thing you do to help prove you *are* suited to EM is having thick skin, letting that little comment roll of your back, and working hard to be a good student during the rest of your rotation.

So first off- dude, sorry that sucks. It sucks for a couple reasons- the first being, it comes across as a snarky comment. It could be that this resident is just a jerk.

Lets pretend he's not just trying to be an a*$hole. Despite his intentions, a comment like that offers you no action specific information: no insight about what specific aspects of your performance could be improved and no specific information about how to get better. So, basically, a comment like that really not helpful at all.

Consider the following scenarios:
(1) you did something way stupid (see "worst thing you've seen a med student do" thread) and he doesn't think that you should disgrace the field of EM by joining it. Well, then you need the feedback about why you were such a bafoon.
(2) the resident thought you were way interested in pursuing an EM career but found something about your performance to be subpar or off-putting. If so, then how does the comment he wrote in your evaluation help you improve? It doesn't. The purpose of evals isnt to document that you are awesome or that you suck (although there is some of that)- the purpose is to provide you feedback upon which you can improve so you can become a good EM doc if that's what you want.
(3) Consider that he thought you were really great but not a good fit for EM- then the feedback needs to be "great job, would do great in x specialty, but if interested in EM, consider developing the following specific characteristics in order to strengthen your performance in the ED: ..."

Taking the time to have a face to face conversation with you of course, would be best so he could actually understand your goals (become EM doc vs. get through EM rotation) and therefore actually help you.

I couldn't predict what the resident was thinking, but based on what you said he wrote on your eval, its obvious that the person hasn't had much education about or spent much time on learning to give useful feedback. It doesn't mean he's a terrible dude, its just that he doesn't understand one of the main reasons he's giving you feedback: to get you to be better. Specific examples is really the best way to get you there- you're not a mind reader. (e.g., good job treating pain, now work on knowing appropriate doses; you do a great job at coming up with extensive/complicated differentials, but if interested in EM, be sure to think about immediate life threats first)

If you are interested in EM, it might be beneficial to make an appointment to meet with your EM preceptor to request specific feedback (this would also show enthusiasm). Good luck!

Originally Posted by discharged

I was pretty excited to rotate through EM last month, only to get slammed on my first day eval when a senior said, "you are okay.. sometimes you know who should be an EM doc and who shouldn't. you'd be a great doctor, but not a natural EM doctor."

I've gotten almost all A's on my rotations, all my attendings and patients loved me, and I like to think myself of a little above avg on medical knowledge. During my month on EM, i saw pts, developed plans, followed up on them, volunteered for procedures, was first to see lab results, and didn't leave until my last patient checked out.

What ran through my mind is, who are you, senior resident, to tell others who is made for a specialty or not? My bad, didn't know there had to be a prototype student. Sorry about the venting, but I just feel like a kid who was told by a punk that he wasn't "cool enough" to hang out with a group.

So my question is, what characteristics make a student "not fit" for the ED?

If it makes you feel any better I was told by an FP that I just didn't get it and that I wouldn't make a good physician. I still got my number one choice for EM residency. Sometimes I think it's that person with the problem (after I evaluate and overevaluate and over think things and can't find the problem). If it's only one comment, don't feel bad. Those people just sometimes have issues. Maybe that EM program is not meant for you but you would be better served at another. I found that to be the case for me. Some environments I flourish, and others I have problems acclimating. It happens sometimes. Just move on and prove it is meant for you by doing what you are doing. Especially if they didn't back it with reasons. Some I see as better IM types, but that's because they are more thorough and spend more time with patients and want to know what happens after they leave the ED. I also found half the issue was me because I don't usually want to know unless it was an interesting case. Just hold your head high and battle through.

Edit: I did ask the FP's coworker what the guy could have meant. They had told me to ignore it because the FP attending was having a rough time at home because his kid was found to have cancer. You never know what the real issue is.

.

thanks for the support guys. i mean, you work your butt off, what else can you do. some people will just disapprove of you regardless of what the case is. so is life..

i won't be applying to that residency for sure. God be with whoever does!

.

Originally Posted by myhandsarecold

lol, I'd be devastated if a Plastic Surgeon said that about me, but an EM guy, meh

Don't feed the troll.

OP, I wouldn't worry about it, some random senior is not the gatekeeper of EM and you can't please everyone. Just keep on working hard and look for programs that you think are a better fit (i.e. not full of judgmental douchebag seniors)

Originally Posted by OccupyTheED

Don't feed the troll.

OP, I wouldn't worry about it, some random senior is not the gatekeeper of EM and you can't please everyone. Just keep on working hard and look for programs that you think are a better fit (i.e. not full of judgmental douchebag seniors)

I agree with this. Also the other poster is in the same area and possibly med. school as my ex and hell looking at the pic it could be my ex lol. She(myhandsarecold) goes to different threads and pisses folks off intentionally.

Originally Posted by myhandsarecold

lol, I'd be devastated if a Plastic Surgeon said that about me, but an EM guy, meh

I have yet to see you add a single meaningful thing to any thread. Please stop.

Originally Posted by discharged

So my question is, what characteristics make a student "not fit" for the ED?

Shy
Thin skin
Poor multitasking
Easily stressed
Easily grossed out
Easily frustrated
Easily flustered
Dick to nurses
Can't talk quickly or clearly.
Uncomfortable with uncertainty
Ego damn large

Please note that I'm just answering your question, I don't know you, haven't worked with you, I'm just speaking in generalities.

If you love EM, prove him wrong and go for it, but do take some time to reflect. For a resident to make such a bold claim outloud to your face, you gotta have some clue why, no?

The only thing I can think of that repeatedly aggravates me with students is that they take foreeeevver to do an H&P, only to come back with no useful data. Ex: 55 y/old M with chest pain, and I hear all about his mother's fight with gyn cancer, but don't know if he's hypertensive/diabetic/smoker/etc.

Originally Posted by Redrox

Shy
Thin skin
Poor multitasking
Easily stressed
Easily grossed out
Easily frustrated
Easily flustered
Dick to nurses
Can't talk quickly or clearly.
Uncomfortable with uncertainty
Ego damn large

Please note that I'm just answering your question, I don't know you, haven't worked with you, I'm just speaking in generalities.

If you love EM, prove him wrong and go for it, but do take some time to reflect. For a resident to make such a bold claim outloud to your face, you gotta have some clue why, no?

These characteristics are actually rampant in EM residents if you ask me. I've seen at least a dozen people who clearly think of themselves as EM docs start to decompensate when faced with 2 sick patients. I mean full on decompensation saying stuff like "this is just too much to thandle."

To the OP: EM is full of people who aren't suited to it but were led to the field by perceptions about excitement, high pay, and controllable hours.

I told a student this year she should do something else, not quite in that flat of terms but she was down to 2 fields and I suggested strongly that she may like the other one. Saw her a few weeks ago and she ended up going into something like Rad Onc. I worked with her several times and yes, that is enough to see that she wasn't a good fit.

Your being sure EM is for you is in no way a guarantee. I would take a long hard look at that list above and ask yourself if it really applies to you. If the answer is no, it doesn't mean you will be barred from the gates of Emergency Medicine but I think it does mean you will be barred from greatness.

--

Originally Posted by danzman

I have yet to see you add a single meaningful thing to any thread. Please stop.

Agree.

Originally Posted by discharged

I don't mean to boast, but I've been recruited in fp, critical care, child psych, and rads. I have thought long and hard because honestly, I want to be happy. EM seemed to be the best fit for my personality.

I believe I have thicker skin than plenty of residents. I grew up in an undeveloped country, came over to a poor city in America as a child. Because of that, unlike many residents and students, I don't take **** from attendings/residents/students/staff who disrespect others. We are all a team, and we all can benefit from learning. But if you want to talk **** for the sole purpose of putting someone down, I will bite back. I don't sit there and cry, shut my mouth, and let people rape me. I look out for my teammates, even though I know I probably wont get the same in return when **** hits the fan.

I get bored easily. I like doing different things. I love my nurses. Without them, we wouldn't get things done at the efficiency we would. Just take a look at NYC residencies..

Most of all, patients love me. I've been to hell and back, and know how to connect with patients. And they respect that.

I'm not some spoiled brat who chose EM bc of the lifestyle, money, or whatever the case is. EM seems to be who I am.

So, if some senior/future attending is gonna play judge and tell me I'm not fit, I can sit there and point out reasons why I think he's not fit. Sure, there are stereotypes of who the EM doc should be. But wake up. Respectfully speaking, 50% of the attendings don't even fit those stereotypes. He doesn't even fit it himself. Ohh if it weren't for the sake of getting a LOR from the place, I wouldn't have held my tongue..

Sorry. I'm just fed up with all these games! And I'm not even halfway done with where I want to get..

You say you have thick skin, yet you seem really hung up on a comment by 1 resident. Move on and prove him wrong if you feel he's got the wrong opinion of you.

I've noticed that while many people in EM (physicians, RN's, Paramedics) tend to be good people it always attracts this odd type of person who has a malignant personality.

You could take almost all the characteristics from the list above (anger, insecure, ego) and it describes this type perfectly. What is interesting is that they also tend to be the most vocal and territorial about who or should not be involved with EM.

This is what I have noticed working as a medic for several years. To be clear - physicians tended to exhibit this behavior the least - while RN's and paramedics the most. I think there is an inverse relationship between this type of personality and level of education.

Originally Posted by discharged

I don't mean to boast, but I've been recruited in fp, critical care, child psych, and rads. I have thought long and hard because honestly, I want to be happy. EM seemed to be the best fit for my personality.

I believe I have thicker skin than plenty of residents. I grew up in an undeveloped country, came over to a poor city in America as a child. Because of that, unlike many residents and students, I don't take **** from attendings/residents/students/staff who disrespect others. We are all a team, and we all can benefit from learning. But if you want to talk **** for the sole purpose of putting someone down, I will bite back. I don't sit there and cry, shut my mouth, and let people rape me. I look out for my teammates, even though I know I probably wont get the same in return when **** hits the fan.

I get bored easily. I like doing different things. I love my nurses. Without them, we wouldn't get things done at the efficiency we would. Just take a look at NYC residencies..

Most of all, patients love me. I've been to hell and back, and know how to connect with patients. And they respect that.

I'm not some spoiled brat who chose EM bc of the lifestyle, money, or whatever the case is. EM seems to be who I am.

So, if some senior/future attending is gonna play judge and tell me I'm not fit, I can sit there and point out reasons why I think he's not fit. Sure, there are stereotypes of who the EM doc should be. But wake up. Respectfully speaking, 50% of the attendings don't even fit those stereotypes. He doesn't even fit it himself. Ohh if it weren't for the sake of getting a LOR from the place, I wouldn't have held my tongue..

Sorry. I'm just fed up with all these games! And I'm not even halfway done with where I want to get..

just ignore his comment and move on.
if it's what you want, do it. who gives a $h** what one a**hole says on the wards.

Just ignore that resident and go into the specialty that you want.

At my medical school, the emergency medicine residency program director told me that he didn't think I would be a good fit for emergency medicine during my rotation.

I subsequently successfully completed residency, passed the boards, and have a very comfortable and well paying job as an attending. As far as I can tell, I seem to be doing a pretty good job as an emergency doc.

The only thing that his comments accomplished was that I ranked them last on my rank list, and I now refuse to donate any money to them.

Originally Posted by Tacet

Just ignore that resident and go into the specialty that you want.

At my medical school, the emergency medicine residency program director told me that he didn't think I wouldn't be a good fit for emergency medicine during my rotation.

I subsequently successfully completed residency, passed the boards, and have a very comfortable and well paying job as an attending. As far as I can tell, I seem to be doing a pretty good job as an emergency doc.

The only thing that his comments accomplished was that I ranked them last on my rank list, and I now refuse to donate any money to them.

Sounds like he was right? [sorry for the grammar nazism]

Originally Posted by discharged

I don't mean to boast, but I've been recruited in fp, critical care, child psych, and rads. I have thought long and hard because honestly, I want to be happy. EM seemed to be the best fit for my personality.

I believe I have thicker skin than plenty of residents. I grew up in an undeveloped country, came over to a poor city in America as a child. Because of that, unlike many residents and students, I don't take **** from attendings/residents/students/staff who disrespect others. We are all a team, and we all can benefit from learning. But if you want to talk **** for the sole purpose of putting someone down, I will bite back. I don't sit there and cry, shut my mouth, and let people rape me. I look out for my teammates, even though I know I probably wont get the same in return when **** hits the fan.

I get bored easily. I like doing different things. I love my nurses. Without them, we wouldn't get things done at the efficiency we would. Just take a look at NYC residencies..

Most of all, patients love me. I've been to hell and back, and know how to connect with patients. And they respect that.

I'm not some spoiled brat who chose EM bc of the lifestyle, money, or whatever the case is. EM seems to be who I am.

So, if some senior/future attending is gonna play judge and tell me I'm not fit, I can sit there and point out reasons why I think he's not fit. Sure, there are stereotypes of who the EM doc should be. But wake up. Respectfully speaking, 50% of the attendings don't even fit those stereotypes. He doesn't even fit it himself. Ohh if it weren't for the sake of getting a LOR from the place, I wouldn't have held my tongue..

Sorry. I'm just fed up with all these games! And I'm not even halfway done with where I want to get..

Dude I'm not trying to get into some kind of pissing contest with you. This is an anonymous internet forum. You posted about a resident saying you weren't a good fit for EM. Some of us have merely pointed out that you can at least consider what that person said. If you really think it's BS and this is someone whose opinion you don't value, fine, go for it. I think that the vast majority of senior residents would not take saying something like that lightly.

This post really makes it sound like you got into some sort of confrontation with the resident in question...

In terms of your ability to tell a successful senior resident or board certified attending with a faculty position that they are not fit for EM, well that's just really not something a medical student would have any decent perspective on.

Your difficult upbringing doesn't make you specially prepared for Emergency Medicine, sorry but it doesn't. One of the best residents in my program is Ivy League gentry. Born with a silver spoon but figured out how to work like a dog. Leave that sh** at the door when you come to work.

Originally Posted by discharged

I don't mean to boast, but I've been recruited in fp, critical care, child psych, and rads. I have thought long and hard because honestly, I want to be happy. EM seemed to be the best fit for my personality.

I believe I have thicker skin than plenty of residents. I grew up in an undeveloped country, came over to a poor city in America as a child. Because of that, unlike many residents and students, I don't take **** from attendings/residents/students/staff who disrespect others. We are all a team, and we all can benefit from learning. But if you want to talk **** for the sole purpose of putting someone down, I will bite back. I don't sit there and cry, shut my mouth, and let people rape me. I look out for my teammates, even though I know I probably wont get the same in return when **** hits the fan.

I get bored easily. I like doing different things. I love my nurses. Without them, we wouldn't get things done at the efficiency we would. Just take a look at NYC residencies..

Most of all, patients love me. I've been to hell and back, and know how to connect with patients. And they respect that.

I'm not some spoiled brat who chose EM bc of the lifestyle, money, or whatever the case is. EM seems to be who I am.

So, if some senior/future attending is gonna play judge and tell me I'm not fit, I can sit there and point out reasons why I think he's not fit. Sure, there are stereotypes of who the EM doc should be. But wake up. Respectfully speaking, 50% of the attendings don't even fit those stereotypes. He doesn't even fit it himself. Ohh if it weren't for the sake of getting a LOR from the place, I wouldn't have held my tongue..

Sorry. I'm just fed up with all these games! And I'm not even halfway done with where I want to get..

And I wonder why he said you weren't a good fit...if you don't fix that little attitudeI doubt you match EM. You come off as a know it all and I can promise you most Attendings will chew you out and spit you out when they have an overflowing ED and other students that are willing/more capable to learn without the attitude.

Originally Posted by Makati2008

And I wonder why he said you weren't a good fit...if you don't fix that little attitudeI doubt you match EM. You come off as a know it all and I can promise you most Attendings will chew you out and spit you out when they have an overflowing ED and other students that are willing/more capable to learn without the attitude.

"discharged" would last about two days with my group before being "discharged" permanently. That attitude won't buy you any friends, and the nurses certainly won't take to it.

Originally Posted by GeneralVeers

"discharged" would last about two days with my group before being "discharged" permanently. That attitude won't buy you any friends, and the nurses certainly won't take to it.

i think the take home point is suck it up, put a smile on your face and work hard (even when encountering an upper-level who's a jerk).

we all gotta play the game.

agreed. my last remark was more fumes than anything and i apologize for the impression i gave, or if there was any offense.

and i also agree that it's all a part of the game. what else can you do. again, thanks for the support and encouragement guys.

When you get negative criticism, there are a couple of things you can do.

One is to just say, BS, and ignore it. Sometimes it is just that.

Other times, there may be some truth to it which can be hard to accept.
If you can gain anything from the insight, use it to your advantage.

I got some negative feedback on one of my rotations.
At first I thought it was just bs, but after giving it some thought, I saw how some of the things I did could be perceived by others and changed my ways.

It was nothing major, but the feedback was still useful.

gman, you nailed it.

Even if it hurts, one ought to reflect upon the negative criticism.

Also, if you think it's rough now, wait til you start practicing.

Patient complaints and satisfaction scores are here to stay for now. For those of you w/ terrible ED directors and/or administrators, I feel for ya. In the wrong hands, those 2 things are vindictive tools.

.

Originally Posted by myhandsarecold

relax guy, i'm just trying to make the OP feel better. if the OP is really the rockstar that she claims to be, then I wouldnt take that kind of crap from a resident who belongs to a specialty populated by average med students at best. I doubt that resident was any better than the OP when that resident was at the OP's level.

Oh, so it shouldn't be a problem because the lowly EM doc said it, go play in traffic

Originally Posted by myhandsarecold

relax guy, i'm just trying to make the OP feel better. if the OP is really the rockstar that she claims to be, then I wouldnt take that kind of crap from a resident who belongs to a specialty populated by average med students at best. I doubt that resident was any better than the OP when that resident was at the OP's level.

Enjoy residency my friend, it isn't going to be fun for you.

Originally Posted by myhandsarecold

relax guy, i'm just trying to make the OP feel better. if the OP is really the rockstar that she claims to be, then I wouldnt take that kind of crap from a resident who belongs to a specialty populated by average med students at best. I doubt that resident was any better than the OP when that resident was at the OP's level.

lmao. Man i hope i dont have to work with anyone like you

Originally Posted by myhandsarecold

relax guy, i'm just trying to make the OP feel better. if the OP is really the rockstar that she claims to be, then I wouldnt take that kind of crap from a resident who belongs to a specialty populated by average med students at best. I doubt that resident was any better than the OP when that resident was at the OP's level.

I am about to report her to the mods for trolling. she goes between the physician and midlevel forums stirring trouble.I have even emailed her to be civil and of course no response.

I would assume she is a loner type of med student because otherwise she couldn't possibly be that ......when dealing with others in the medical community.

Originally Posted by Makati2008

I am about to report her to the mods for trolling. she goes between the physician and midlevel forums stirring trouble.I have even emailed her to be civil and of course no response.

I would assume she is a loner type of med student because otherwise she couldn't possibly be that ......when dealing with others in the medical community.

Yeah I have seen her post a lot of asinine, trollish things too.

Originally Posted by discharged

I was pretty excited to rotate through EM last month, only to get slammed on my first day eval when a senior said, "you are okay.. sometimes you know who should be an EM doc and who shouldn't. you'd be a great doctor, but not a natural EM doctor."

You're blowing this way out of proportion. He didn't say you couldn't be an EP; he said he didn't think you were a natural fit. If that's true, it might mean you have to work harder than your co-residents to develop the skillset that comes easier to some other people. But if you want to be an EP, and you're willing to put in the work to overcome your weaknesses, then so what? Make up your mind that you will learn how to do the job, and do it.

What ran through my mind is, who are you, senior resident, to tell others who is made for a specialty or not? My bad, didn't know there had to be a prototype student. Sorry about the venting, but I just feel like a kid who was told by a punk that he wasn't "cool enough" to hang out with a group.

People just spout off sometimes. He probably didn't spend a lot of time thinking about how this was going to come off to you.

So my question is, what characteristics make a student "not fit" for the ED?

I don't think there's any absolute contraindication for being an EP. Like I said before, some people adapt to the job more easily than others, but if you go down Redrox's list, there are people in EM who fit every single category they listed.

Originally Posted by docvino

i think the take home point is suck it up, put a smile on your face and work hard (even when encountering an upper-level who's a jerk).

we all gotta play the game.

This. People are stressed, and they're goign to take it out on you sometimes. You have to let it roll off your back and not take it personally.

Originally Posted by myhandsarecold

relax guy, i'm just trying to make the OP feel better. if the OP is really the rockstar that she claims to be, then I wouldnt take that kind of crap from a resident who belongs to a specialty populated by average med students at best. I doubt that resident was any better than the OP when that resident was at the OP's level.

and yet you continue to spend your time in an EM forum....



I agree with gman but the feedback needs to have actual suggestions for improvement. Granted, customer service surveys have ridiculous crap on them that you have to decipher.

thanks for the encouragement guys

Ask them what they mean, specifically. If they were just frustrated they'll feel bad and apologize. If they stick with their assertion you can then evaluate if it's an honest area of weakness or an interpersonal conflict with the resident. If the latter you can reflect on where things went wrong and how to avoid the issue in the future. Maintaining a working relationship with asshats without being eaten up by it is a valuable skill.