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Good/Bad idea to do EM elective early 3rd year?

Discussion in 'Clinical Rotations' started by kdhmed, 02.17.12.

  1. kdhmed

    kdhmed

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    I'm interested in EM for the long run. To make sure it really is what I want to do I'd like use it as my elective (3rd month). Prior to this I will have had Advanced Clinical Skills and Family Medicine. We've gotten a pretty solid EM education, so book-wise I feel confident. What I'm getting at is, should I do the EM rotation early on to make sure I don't hate it or should I wait (it would be early 4th year) until I've gained more clinical experience? Ideas?
  2. turkeyjerky

    turkeyjerky

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    How exactly have you gotten a "pretty solid EM education" prior to doing any clinicals? That doesn't make sense to me, and I doubt that it's actually true.

    Does your school have an EM residency? If so, I would not take your EM rotation that early. I think it's actually very hard to excel in an EM rotation. Take your cores first so you have a good knowledge base and then rotate thru the ED at the end of third year/beginning of 4th year.
  3. sylvanthus

    sylvanthus EM/IM/CC PGY-2

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  4. mtwop

    mtwop

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    I'm considering doing the same thing. I'm trying to decide between surgery (general or ortho) or EM. Do you guys still think it would be a good idea to NOT to take an EM rotation to decide on a specialty choice? I wouldn't be able to take general surgery (early) and ortho during my third year, so it would be nice to rule EM in/out. Thanks again for the advice
  5. Day man

    Day man

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    if you're between surgery and an IM specialty, take something that has surgery in it early. you need to figure out if you like the OR or not, and if so, how much. From there you can rule in/out surgery (I have a ton of friends who thought they wanted to do surgery and realized anesthesia would make them very happy). As far as subspecialties, it will depend on the types of problems/patients you like to deal with (general and ortho are two totally different beasts).

    Lots of threads lately on EM vs Surg/Ortho. For me (going into ortho), I just don't really understand it. To me EM is FM on steroids (and I'm at a level 1 trauma/very poor city hospital so take that for what it's worth), with some procedures here and there. Surgery is...surgery. I was torn between various surgical sub-spec vs anesthesia vs IM-sub-spec going into 3rd year, for frame of reference.

    My advice is to take OB early, you get alot of OR time (at least at our program) and the grade doesn't really matter as much as surgery (if you're going into surgery you want to honor that). Taking EM early seems like a bad idea...you have to have a foundation from the cores of 3rd year, our school doesn't even allow it to be scheduled until late 3rd/4th year. Hope that helps.
  6. mtwop

    mtwop

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    Thanks for the advice. Taking OB early makes a lot of sense. My problem is that I've already spent a lot of time in the OR with both general (especially trauma) and ortho. I think my main issue is that I'm torn between liking the OR (not loving it) slightly more than emergency medicine, but I prefer the lifestyle of EM. Some people tell me to go with what I like best, while others tell me to only go into surgery if that's the only thing I can see myself enjoying. Not to sure what to make of it. Thoughts?
  7. kdhmed

    kdhmed

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    No clinical experience yet. All I was saying is I feel I have a decent background from our 2nd year course. The thing is, if I go through a year of rotations without having spent a month in EM yet, will it be too late to decide on EM as a specialty come beginning of fourth year?
  8. Rendar5

    Rendar5

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    Early 3rd years do very poorly as med students when it comes to EM, disproportionate to other rotations. They don't gain a broad enough medicine/surgery base until later in the year. Do EM later.
  9. jcu

    jcu should have been dr. who

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    No .
  10. cofcemt

    cofcemt CofCEMT

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    I'm going to disagree. EM folks will know it's early in 3rd year, so won't be expecting too much. 3rd yr rotations are all about learning if you like a specialty, showing that you can learn, are a hard worker, and I'd you can get along with the people in that field; less so about being a competent student. Doing it earlier buys you a little incompetence, later on in the year, they are going to be frustrated that you can't keep up.

    Most MS3s struggle in EM because you have to think completely differently (ie. rule out bad stuff, care less about everything else). At least this is what I'm seeing as an MS4 now.

    If I were the OP and you are just considering this as one of a few specialties, I would go ahead and take it early. You can impress them in 4th yr if you decide to do EM. Your SLOR comments would come exclusively from your sub-I as a MS4 anyways, which is the most important part for residency app in EM (4th yr grade in EM, away grade in EM, SLORs).
  11. ArcGurren

    ArcGurren only one will survive

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    I have a friend who is in a similar position to you and he's going for EM - mostly because he feels that if he doesn't consistently enjoy being in the OR the entire time, it's not a good sign. So I agree to only go into surgery if that's the only thing you see yourself doing - I've met way too many residents at different programs (including purportedly "good" programs) who are burnt out and regretting they went into the field because they only "liked it more than medicine".
  12. b-real

    b-real What, me worry?

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    Another thing you may want to consider is getting an excellent SLOR. If you take EM early 3rd year, you probably don't know enough clinical medicine to shine on the rotation. When it comes to EM residencies, the SLOR is heavily factored into interview/match decisions, along with the standard USMLE/other clinical grades.
  13. cofcemt

    cofcemt CofCEMT

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    While it is true you wont know enough clinical medicine, they are less likely to count that against you early on (before Dec/Jan) in 3rd yr. I don't think any EM rotation would use comments from a 3rd yr rotation to utilize for the SLOR other than if you were a hard worker. They would/should only use the info from your rotation 4th yr, unless you were to really ioss someone off 3rd yr.
  14. drno31

    drno31

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    I have to disagree with most of the posters. I did an EM elective early on in 3rd year, only after completing IM core. If you really like EM, prepare by having a good knowledge base on the most emergent conditions (ACS, PE, etc) and have developed effective, basic physical exam skills you can excel! Plus, if you're interested in pursuing it as a career, it's helpful to know earlier rather than later that you love or don't love it.
  15. boone95

    boone95

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    I, also, did an EM month in my 3rd rotation of 3rd year, and it was great for a few reasons.
    1. I was ahead of the game when I did my first audition rotation.
    2. It solidified my decision to go into EM... if you decide in 4th year that you don't like EM all of a sudden, you're in a tight spot.
    3. Although it was early in my training, I still learned a lot from it... as a 4th year rotation, you'll know more and be more 'helpful,' but there's still plenty to be learned as an MS 3.

    If I had to do it over again, I would still do an early EM month.
  16. turkeyjerky

    turkeyjerky

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    They absolutely will count that against you. Remember, most EM residents and attendings are not used to dealing w/ students fresh off of step 1. I also found that they were much more likely to grade you on clinical competence vs IM people grading based on bs like enthusiasm.

    And if you're rotating at a residency affiliated ED, you will be expected to have a SLOR from that rotation. That grade and your overall suckiness as a nascent third year (you will suck, everyone does) will go on your permanent record.
  17. Rendar5

    Rendar5

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    If you decided to do EM early, you will need to do extra rotations again later on for LoR's, because it is very hard to be solid early on. I'll say it again, I see rotators throughout the year, and students continue to fail to impress early on in their 3rd year and come back with clueless faces on any area of medicine they haven't dealt with before.

    It's fine and I'll teach them, and give them appropriate evals for the point in the year they're at, but they would not have a glowing LoR if they asked for one.
  18. copes

    copes

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    You guys are scaring me. This is EM not plastic surgery.
  19. DocEspana

    DocEspana my troubles will have trouble with me

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    Im also going to be part of the counter-movement here. I had EM as my third rotation (after Peds and Ob/Gyn) and it was an amazing experience. It was a required rotation for us in our 3rd year. I've seen more than enough students screw it up by not coming in and knowing some basics of ACS, EKG reading, and radiology. Those students complain a lot about it. But most students did what I did: I did some bare bones studying before the rotation and was working on the same level as the residents by midway through my second week. I say that in that I would go and see the pt on my own, present to the attending the H&P I gathered and my A&P, and they would either tell me what treatment to administer or aid me in some of the more invasive procedures.

    I'm not some EM wiz either, just did my due diligence (as plenty of other students had) and got an amazing experience out of it. I'm still strongly considering EM and at the end of my rotation the primary educational preceptor told me that next time I rotate in EM I should ask for the SLOR (not required for 3rd year students at my hospital) and I should get an amazing objective evaluation because I come in with significant experience unlike other 4th years coming in blind.

    Thats my $0.02
  20. Rendar5

    Rendar5

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    True, it's not as competitive a specialty. I'm just saying that if you're going into EM, do rotations later for SLOR's, or do them early and do them again early 4th year for the SLOR. Just don't do it early 3rd year and expect to get great SLOR's if you haven't had many other rotations.
  21. MeatTornado

    MeatTornado

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    i did EM as my very first rotation 3rd year and i had no clue what i was doing nor did it help me decide whether or not i wanted to do EM (it was/is on the short list). there's no time to teach you the basics in the ER so if you haven't done medicine and surgery you'll be pretty lost. however, noone will hold that against you and they will grade you accordingly as long as you are enthusiastic about seeing patients and doing procedures.

    that being said i would suggest you do it during 3rd year to potentially rule it out because there is very little time in 4th yr before apps are due and you might be forced to jump right into an EM subI if you are still considering more than 1 specialty.

    this is wrong in many ways. residents/attendings in most specialties recognize that you will be deficient in many areas at the beginning of 3rd year (except maybe surgery and ob) and if something is an option for 3rd year then the residents/attendings in that specialty have seen students fresh off of step 1. you don't get your SLOR after your 3rd year rotation, you will get it after your 4th year sub-I. You can suck as an early 3rd year but still get HP and H on your evals by being enthusiastic and personable. even if u end up with a pass it's not the end of the world.
  22. 45408

    45408 aw buddy

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    What is a SLOR and why does EM use it?
  23. coldweatherblue

    coldweatherblue

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    council of residency director's "standard letter of recommendation".

    It's a LOR with standardized numerical rankings for evaluating student performance.

    EP's are most comfortable ticking off small cardinal numbers; prose can be just a little too much.. :smuggrin:
  24. turkeyjerky

    turkeyjerky

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    What kind of ED did you rotate through? This is going to be vastly different depending on whether or not it's an EM residency site. If it's a community site, then yeah, go for it. You might be assigned to a single attending for the whole month, and he'll get to know you and like you and grade you accordingly. Your grade won't even really matter all that much anyway in that case. But if it's a residency program, then you'll work w/ a different attending or senior resident each shift, and they'll be busy supervising other students, interns and residents as well. You're not gonna get much face time w/ them and they may or may not care to ask you what year you are and what you're interested in.

    And you're gonna want to get a SLOR b/c if you don't, you'll get asked about it during residency interviews and it'll look bad. And you'll have lost your chance to get a slor or do a real rotation at that program b/c they're not gonna let you rotate twice.


    Look, ideally you'd have a great experience and be matched up w/ a great preceptor and get a great grade and lor, but I think it's a mistake to plan out rotations hoping for the ideal. You have to remember that your job during med school is to get a job (residency position).

    Plus, by taking EM early on you're wasting a great educational opportunity since you won't know wtf is going on half the time.
  25. mtwop

    mtwop

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    Would you guys just recommend doing some more shadowing in the ED to rule it in/out? I don't really feel like I get a sense for what a specialty is truly like until I'm the one actually putting in the work
  26. cofcemt

    cofcemt CofCEMT

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    Not sure where you rotated, but either the attendings/residents are not personable or they just are overworked. I have almost always (>90%) had time to talk with the attending/resident I was working with, even if we were getting slammed. Heck, yesterday I saw 10 patients in 9 hours as an MS4 and still had time to chat. And, almost always you will be reporting directly to an attending or a chief resident (both of whom write evals at my school) as a medical student.

    I'm pretty sure the OP is talking about doing a 3rd yr rotation at his home institution and then he would still do another 4th yr rotation to get a SLOR. No reason to get 2 SLORs from the same program, just doesn't make sense, nor should it raise red flags in the application process.

    Hell, 1/2 the time I was on my ENT and CT surg (don't ask, had to rotate through both...) rotations I didn't know what was going on, how is that any different? But, it sure let me know based on personalities and what I witnessed, that I did NOT want to enter those fields. And, talking to most MS3's that have taken a rotation in EM at my med school, almost all have agreed that they thoroughly enjoyed their rotation, learned a lot, and were never just cast aside.

    @mtwop - If you are going to shadow more, I would look to shadow during the day as well as overnight. Not only on overnights will you get more trauma (usually), but you will really see the ED at work. Also, around 3-4am, it usually slows down and you can have a bit more chatting time with attendings/residents.
    Last edited: 02.21.12
  27. cabinbuilder

    cabinbuilder

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    Most schools don't let you rotate through ER until 4th year. 3rd year rotation likely won't be an option anyway.
  28. b-real

    b-real What, me worry?

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    This is true. Many, if not most, schools do not have electives built in to the 3rd year curriculum. My school only allows 4th years to do a proper EM elective.

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