EM training milestones

[discongruent]

Hello everyone,

I'm not sure if this has been answered before, and I apologize if there is a sticky with this already.
I'm posting this question mainly to first year EM attendings and graduating PGY-3 EM residents.
How prepared did you feel for starting your first job after your residency training?

For those who felt their residency prepared them extremely well, if you were to break it down into categories, what order would you place each in terms of importance to your current level of comfort/being able to tackle pretty much all that comes through the door. Those being:

1. Volume and time spent while in the ED
2. Number of acute of patient encounters
3. Number of procedures (thora/CT/intubations/LPs)
4. Trauma
5. Off-service rotations (OB/Peds)
6. Didactics/self-study
7. Other/not mentioned above

And the opposite, for those who felt they didn't get the best training in hindsight, what did you feel was the major shortcoming and wish you had been exposed/done more of while in residency?

I'm about to start my PGY-1 in EM. I am aware I will not be exposed to the full breadth and volume of emergency medicine in short 3 years, but want to ensure that I'm meeting all the right milestones in those 3 years and see the shortcomings if they do arise. Greatly appreciated

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[winkleweizen]

Volume and being able to handle the natural department surges is probably the biggest and most important. Most everyone comes out of residency being able to take care of sick patients and do all the procedures, imo.

 

[Daiphon]

1, 2, & 6 are most important, IMHO.

3 will naturally happen, just be aggressive. 4 becomes rote/cookbook. 6 is +/- depending upon your setup.

In regards to 1 & 2, as long as you're maximizing your ED time, it oughtn't be a problem. Push yourself - if you ever feel like "man, this is too easy" then unless your department is dead, there's always another patient to see. You should learn where your tipping point of losing control is, and stay as close as you can to it in order to expand it.

6 will naturally follow, and as you read up on the things that caused you to go to sphincter 11, the edge won't be so scary nor close.

Good luck!

Semper Brunneis Pallium

 

[canigetawhatwhat]

Once you intubate your first pseudoseizure, you have finished residency

 

[shoal]

You should get at least 6 thorocotomies otherwise you'll be woefully unprepared. I've done 12 since graduation....



Seriously tho chill. Work hard study hard you'll be ready to start on your own. There will be plenty you still don't know and that's what residency was for. Knowing how to deal with the unknown.


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[medic4lyfe]

Once you intubate your first pseudoseizure, you have finished residency

Thought that was ACEP policy...

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[Janders]

(1) Chill, your program was designed to churn out functional ED docs. listen to their advice and do your rotations

(2) I think a higher yield question would be "Are there any small things you DIDN'T learn enough in residence you suggest I seek out?" assuming most residencies will get you the foundational education and experience you need to thrive in an ER.

I'll give some answera my own #2 question--
Seek our neurology and make sure you are comfortable with it, as in the real world there isn't a neurologist waiting to consult on some random dizziness patient.
Seek out education on the financial side of the gig (contracts, personal finance, investing). Just read white coat investor and be done with it.

 

[deleted547339]

Once you intubate your first pseudoseizure, you have finished residency

Intentionally or unintentionally? I intubated a pseudoseizure as an intern because I didn't know any better. I intubated a pseudoseizure as a senior because....because, well, I was over it.

 

[deleted109597]

Intentionally or unintentionally? I intubated a pseudoseizure as an intern because I didn't know any better. I intubated a pseudoseizure as a senior because....because, well, I was over it.

IOs are more satisfying. Nobody can fake seize through that.

 

[engineeredout]

IOs are more satisfying. Nobody can fake seize through that.

THIS

 

[canigetawhatwhat]

Intentionally or unintentionally? I intubated a pseudoseizure as an intern because I didn't know any better. I intubated a pseudoseizure as a senior because....because, well, I was over it.

Unintentional but intentional. I dont believe in punitive medicine despite the most obnoxious individuals but I strongly believe in controlling a situation that has ANY possibility of danger to staff or self.

2 times.

1. Medical icu rotation. Lady gets a rapid response from the stepdown unit and she is excited delirium, hypotensive (from co-sepsis) and is in and out of "unresponsive". Tubed her. Chart review later saw pseudoseizures with exact same presentation minus the hypotension. Completely unintentional.

2. S/p narcan. "Seizing". Tries to spit, bite, when you get near. Hep C + too. Not a safe situation. Tubed. I have an extremely low threshold in these situations.

Like you said, sometimes you just get over it and need to get a plastic consult to ensure safety for all parties.

"Patient unable to follow commands and is in excited deirium state from unknown condition and is high risk for danger to staff and self and needed immediate intervention to prevent worsening deilirium and other metabolic derangements."

Done. Boom.

 

[WilcoWorld]

IOs are more satisfying. Nobody can fake seize through that.

I prefer an ammonia ampule placed within a face mask. 100% effective for the restoration of purposeful movement, in my experience.

 

[deleted109597]

I prefer an ammonia ampule placed within a face mask. 100% effective for the restoration of purposeful movement, in my experience.

Nasal cannula. Ammonia amp. Toomey syringe. It's a thing of beauty.

 

[deleted547339]

Nasal cannula. Ammonia amp. Toomey syringe. It's a thing of beauty.

This.

 

[canigetawhatwhat]

Nasal cannula. Ammonia amp. Toomey syringe. It's a thing of beauty.

Ah yes. The go to.

 

[Akail]

What is this? Sounds like something I want to know..

Nasal cannula. Ammonia amp. Toomey syringe. It's a thing of beauty.

 

[deleted547339]

What is this? Sounds like something I want to know..

It's way better than ammonia under a NRB.

 

[Daiphon]

What is this? Sounds like something I want to know..

Put NC on "seizing" patient.

Put ammonia popper in toomey & replace plunger.

Attach toomey to NC.

Plunge.

Hilarity ensues.

-d

Semper Brunneis Pallium

 

[RustedFox]

Put NC on "seizing" patient.

Put ammonia popper in toomey & replace plunger.

Attach toomey to NC.

Plunge.

Hilarity ensues.

-d

Semper Brunneis Pallium

Yesssss.

 

[Akail]

Put NC on "seizing" patient.

Put ammonia popper in toomey & replace plunger.

Attach toomey to NC.

Plunge.

Hilarity ensues.

-d

Semper Brunneis Pallium

OHHHHHHHHHHHHHHHHHHHHHHHHHHHH. I WANT TO DO THIS RIGHT NOW!