Audition rotations - how to do well?

[quickfeet]

What are some things you look for in M4s interested in your program who rotate there? In other words, what are the things you like to see in students who rotate other than their ERAS factoids (exam scores/class rank/etc.)

I.e. good presentation skills, coming up with good assessments/plan, wide skill-set (suturing, do pelvic exams, interpret basic imaging, etc.)

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[Tenk]

I like students who have the following characteristics:

1) Give short but sweet presentations that are immediately followed by their plan and disposition (if you are an all star). Every word you speak should tell me something useful. If you've gone beyond 20-30 seconds I have already lost interest. It's not that I don't care, it's just that I'm busy.

2) ALWAYS, ALWAYS, ALWAYS look at vital signs. I can't tell you how many times students have missed temperatures of 102, pulses of 140, oxygen sats of 85%, etc. You might think this is a no brainer but even attendings will d/c people with blood pressures of 210 and then realize they missed them initially. Make it a habit.

3) Be pro-active but also be very respectful. I've seen a lot of attendings/residents get ticked off at students who think they are Rosen and Tintinali combined.

4) Don't piss off my staff. They are my second family.

5) Don't ever lie. If you don't know something just say you don't know, didn't ask but you will find out/look it up.

In terms of what you said about skill-sets, I honestly could care less. I'd be more impressed with someone who sucks at suturing but is really willing to learn and listens to what I say over someone who thinks they are good and doesn't want to listen to me.

Hope that helps!

 

[5739]

I like students who have the following characteristics:

1) Give short but sweet presentations that are immediately followed by their plan and disposition (if you are an all star). Every word you speak should tell me something useful. If you've gone beyond 20-30 seconds I have already lost interest. It's not that I don't care, it's just that I'm busy.

I'm an intern at a competitive program who honored all my aways. I still don't meet this standard. I think this is unreasonable.

 

[deleted547339]

search function is your friend.

 

[Tenk]

I'm an intern at a competitive program who honored all my aways. I still don't meet this standard. I think this is unreasonable.

I've met third years who do. Like I said, all star.

It's a goal that you should strive for, not a standard of practice for med students.

 

[Cinematographer]

Based on one-to-one feedback offered residents and attendings:

1. Presentation: Tailor your presentation so that it supports your top differential diagnosis and excludes life-threatening etiologies for any given chief complain. For example, if you believe someone has low back pain secondary to musculoskeletal strain and not disc herniation or cauda equina syndrome, then say something along the lines of "ROS negative for radiation of pain down the legs or symptoms of radiculopathy; denies any numbness, tingling, or weakness of lower extremities; denies any urinary retention or incontinence... etc."

Overall, most of my presentations were under 2 minutes during my first EM rotation and they ranged between 30-60 seconds on my last AI depending on the chief complaint.

2. Have a broad differential diagnosis that includes life-threatening causes, even if they are unlikely. Some attendings may only want to hear what you think is the most likely diagnosis while others you to list the life-threatening causes that need to be excluded/considered while the patient is in the ED.

3. Be ready to explain why you want to get any given lab/imaging study on a patient; just getting a CBC/BMP because it's "routine lab work, cheap, fast" is not sufficient. What are you actually looking for in those labs that can help support your initial assessment or potentially change your management plan?

4. What will your disposition be once those labs/imaging studies you ordered are back? Does this patient need to be admitted? If so, which service should we consult? If you send them home, whom should they follow up with and what symptoms should they come back to the ED for?

5. Reassess/check up on your patients. Is their pain/nausea/vomiting/whatever improving or worsening? Have their vital signs changed? Are they OK to go home or is it looking like they will need to be admitted for observation?

6. Know some of the scoring scales and admission criteria for common complaints such as chest pain, dyspnea, pneumonia, cellulitis, head injury. This is where your phone comes in pretty handy (e.g., I use MedCalc for NEXUS C-Spine rule, PECARN algorithm, PERC, Wells Score, Centor Score, HEART score, Ottawa Ankle/Knee Rules, Ranson's Score, RIFLE Classification). This will make you sound smart/like you know stuff, or maybe sound pretentious depending on the attending listening.

7. Have basic knowledge of pain management options (PO and IV) commonly used in the ED and their respective indications/contraindications. I swear every attending at some point asked me "so... what do you want to give for pain?"

8. Be proactive about doing basic procedures (sutures, I&Ds, LPs, splints, wound dressings, etc.) or at least show interest in learning how to do them.

9. Do the same common sense stuff that applies to other specialities, and life in general really: Be on time; don't be an a-hole to nurses, techs. Interact and get to know the residents; ask how you can help them.

10. Fluids... IV fluids for everyone... Or something like that.

11. Mention stuff like PE, ruptured triple A, dissection, SAH, CES as part of your DDx whenever possible. They love that ****.

12. Have fun!

**Bolded items are things that ≥3 attendings/residents at different programs emphasized as important and a quality. For reference, I completed three EM rotations, two of them being sub-internship/acting-internship rotations.

 

[sonofva]

As above, based on what I was told on my always:

Always be master of your patient. You're not there to "move the meat", you're there to learn. So know everything about your patient. Always know when the labs/tests are back before the attending for your patient (be proactive). Be humble. If you're going to use a rule out criteria or other rule (pecarn, perc, etc), know what the value of that rule is (i.e. - PERC negative means <2% prob of pe). Don't just say "perc negative", for example, without knowing the significance of that just to sound smart.

 

[sonofva]

Also listen to all the big chief complaints on "EM Basic" podcast by Steve Carroll before your rotatuon

 

[EM/CC_23]

I agree with most of the above from my sub-i's this year. One thing to add that is super important, but I think sometimes overlooked:

While of course you want to be nice and helpful and friendly/social, you want to always be aware of your position as a med student/outsider. Always call attendings by last name (Dr. So-and-so)--unless told otherwise, even if residents are calling them by first name (calling residents by first name is usually fine). Never invite yourself to a resident-only social event after shift. Don't constantly ask residents/attendings how you can help; only ask when you are finished with your work and they seem swamped. At end of shift, offer 1x to help with wrapping things up; if they say to "go home," say "alright thanks, have a good one" and then immediately bounce (don't repeatedly ask: "are you sure..?). Smile and laugh at their jokes and subtlety be a part of their conversations, but don't obnoxiously put in your 2 cents every 5 seconds, constantly tell your own crude jokes, or do things like pat residents and attendings on the back. Don't try to loudly socialize with other students during shift--be focused and professional. Don't bring gifts to residents/attendings at any point during rotation. If you are going to buy a soda, you can offer to grab one for your resident too, but don't insist on paying for it.

Above all, remember: you are auditioning to show how bright/skilled/hard-working you are, but also to show you are a normal/tolerable person that they want as part of their program for at least 3yrs.

PS. If individuals will be evaluating/grading your performance for that shift, best to ask for verbal feedback near end of shift, rather than just giving them a grade card. I have found most attendings will not write things behind your back that they arent willing say to your face (though some bad attendings/residents will anyways), and a good proportion will be nicer to your face than to a confidential written eval--so this works in your favor.

 

[sonofva]

X

 

[cbrons]

1) Give short but sweet presentations that are immediately followed by their plan and disposition (if you are an all star). Every word you speak should tell me something useful. If you've gone beyond 20-30 seconds I have already lost interest. It's not that I don't care, it's just that I'm busy.

20 secs?

 

[Apollyon]

20 secs?

Considering that you couldn't even type out "20 seconds", that should be more than an adequate amount of time.

 

[hoot504]

I agree with most of the above from my sub-i's this year. One thing to add that is super important, but I think sometimes overlooked:

While of course you want to be nice and helpful and friendly/social, you want to always be aware of your position as a med student/outsider. Always call attendings by last name (Dr. So-and-so)--unless told otherwise, even if residents are calling them by first name (calling residents by first name is usually fine). Never invite yourself to a resident-only social event after shift. Don't constantly ask residents/attendings how you can help; only ask when you are finished with your work and they seem swamped. At end of shift, offer 1x to help with wrapping things up; if they say to "go home," say "alright thanks, have a good one" and then immediately bounce (don't repeatedly ask: "are you sure..?). Smile and laugh at their jokes and subtlety be a part of their conversations, but don't obnoxiously put in your 2 cents every 5 seconds, constantly tell your own crude jokes, or do things like pat residents and attendings on the back. Don't try to loudly socialize with other students during shift--be focused and professional. Don't bring gifts to residents/attendings at any point during rotation. If you are going to buy a soda, you can offer to grab one for your resident too, but don't insist on paying for it.

Above all, remember: you are auditioning to show how bright/skilled/hard-working you are, but also to show you are a normal/tolerable person that they want as part of their program for at least 3yrs.

PS. If individuals will be evaluating/grading your performance for that shift, best to ask for verbal feedback near end of shift, rather than just giving them a grade card. I have found most attendings will not write things behind your back that they arent willing say to your face (though some bad attendings/residents will anyways), and a good proportion will be nicer to your face than to a confidential written eval--so this works in your favor.

Totally spot on. /end thread