Honoring EM AI/Sub-I

[TheOther]

For those of you who got honors on AIs/sub-Is, how did you prepare for them? What do you think helped you most and if you could go back, what would you have done better?

Thanks!

Edit: I know there's info out there on EMRA, ALiEM, and on this forum, but I'm looking for any current personal accounts.

---

Members don't see this ad.

 

[BoardingDoc]

For those of you who got honors on AIs/sub-Is, how did you prepare for them? What do you think helped you most and if you could go back, what would you have done better?

Thanks!

Edit: I know there's info out there on EMRA, ALiEM, and on this forum, but I'm looking for any current personal accounts.

1: Be punctual
2: Be friendly
3: Be interested
4: If there is an exam, study hard for it to meet whatever grading cutoff they use.

It's literally the exact same thing you need to do for every other rotation in medical school.

 

[doggydog]

1: Be punctual
2: Be friendly
3: Be interested
4: If there is an exam, study hard for it to meet whatever grading cutoff they use.

It's literally the exact same thing you need to do for every other rotation in medical school.

Going through rotations this year, it takes a considerable amount of luck too. Doing those 4 things is good enough for a HP on my rotations/where my friends have rotated.

 

[TheOther]

1: Be punctual
2: Be friendly
3: Be interested
4: If there is an exam, study hard for it to meet whatever grading cutoff they use.

It's literally the exact same thing you need to do for every other rotation in medical school.

Is that it? Not asking in a minimizing way, but genuinely surprised. I just figured a lot more is expected of a sub-i student than on a regular rotation..

 

[racerwad]

Is that it? Not asking in a minimizing way, but genuinely surprised. I just figured a lot more is expected of a sub-i student than on a regular rotation..

When it comes to expectations, NO ONE CARES. You'd be surprised how difficult it is for some students just to do the above. No one cares about your skills or knowledge, because it will never be "adequate" - that is the whole point of residency. You should know the basics about medicine, in general, and how that knowledge is (and isn't) pertinent to EM. You should know where to find out answers to questions and you should know whatever weak spots you might have.

There are great vodcasts on ALiEM and the EM Basic podcasts are great for 4th years and interns.

Just relax, act like you give a F, and have fun. Honestly, students (myself included) work so hard on looking like they are working hard, that they don't look like they are enjoying their time in the ED. If you genuinely can have fun in the ED, that probably will leave the most positive impression.

 

[TheOther]

When it comes to expectations, NO ONE CARES. You'd be surprised how difficult it is for some students just to do the above. No one cares about your skills or knowledge, because it will never be "adequate" - that is the whole point of residency. You should know the basics about medicine, in general, and how that knowledge is (and isn't) pertinent to EM. You should know where to find out answers to questions and you should know whatever weak spots you might have.

There are great vodcasts on ALiEM and the EM Basic podcasts are great for 4th years and interns.

Just relax, act like you give a F, and have fun. Honestly, students (myself included) work so hard on looking like they are working hard, that they don't look like they are enjoying their time in the ED. If you genuinely can have fun in the ED, that probably will leave the most positive impression.

Awesome. This is great to hear, thanks for the honest insight. I really appreciate it and it definitely lifts some of my worries/concerns.

 

[racerwad]

Awesome. This is great to hear, thanks for the honest insight. I really appreciate it and it definitely lifts some of my worries/concerns.

I was in your shoes and I get your concerns. Honestly, now being on the other side and talking with our program leadership, clinical acumen is never what makes or breaks someone (unless they are truly terrible and recognizing sick/not sick). We we review candidates, it really comes down to fit with the program and whether or not we liked working with them. Sometimes, some folks with a unique niche skill or experience actually brings something more to the program than "just being a new intern" (a PhD in something the program is actively looking for, experience as a mountaineer in a program w/ a strong wilderness med component, etc) but this also is very rare and it isn't going to be held against you if you aren't one of the very small handful of folks that fit that description.

 

[EM2Be2017]

I believe the number one aspect is to be friendly and respectful to everyone. This includes nurses, techs, janitorial staff, etc. Next to that be always on the lookout for anything to help with and make sure you finish any task you take on and keep the resident/attending in the loop.

Assume you are the only provider for your patient. I was told that the "next step" in our development it to start building solid A&P's. This doesn't mean you will know exactly what to do everytime, but you should always going directly to your plan after presenting the H&P without being prompted. List your top differentials and what tests you want and why. Include what meds you think are appropriate such as fluids, pain meds, etc.

The biggest problem is that the personality of the programs can be extremely different. In one of my aways I really connected with the attendings and they would listen to my complete presentation without interruption and allow me to show them my thought process. The attendings at the other program would commonly interrupt me in the first 30 seconds and ask for my plan. So you have to tailor it to who you are working with. And unfortunately the grading is subjective and, in my personal opinion, will depend on how well you fit within the culture and personality of the program.

 

[TheOther]

I was in your shoes and I get your concerns. Honestly, now being on the other side and talking with our program leadership, clinical acumen is never what makes or breaks someone (unless they are truly terrible and recognizing sick/not sick). We we review candidates, it really comes down to fit with the program and whether or not we liked working with them. Sometimes, some folks with a unique niche skill or experience actually brings something more to the program than "just being a new intern" (a PhD in something the program is actively looking for, experience as a mountaineer in a program w/ a strong wilderness med component, etc) but this also is very rare and it isn't going to be held against you if you aren't one of the very small handful of folks that fit that description.

Ah got it. Yeah, I constantly read about being "stellar" on aways and I figured that translated to being a rockstar clinically. So I wondered if there was some magical book I needed -- especially since many places don't even allow students to rotate until their 4th year, basically on their sub-i. Again, I appreciate the insight! Thanks for taking the time to lay it out for me!

I believe the number one aspect is to be friendly and respectful to everyone. This includes nurses, techs, janitorial staff, etc. Next to that be always on the lookout for anything to help with and make sure you finish any task you take on and keep the resident/attending in the loop.

Assume you are the only provider for your patient. I was told that the "next step" in our development it to start building solid A&P's. This doesn't mean you will know exactly what to do everytime, but you should always going directly to your plan after presenting the H&P without being prompted. List your top differentials and what tests you want and why. Include what meds you think are appropriate such as fluids, pain meds, etc.

The biggest problem is that the personality of the programs can be extremely different. In one of my aways I really connected with the attendings and they would listen to my complete presentation without interruption and allow me to show them my thought process. The attendings at the other program would commonly interrupt me in the first 30 seconds and ask for my plan. So you have to tailor it to who you are working with. And unfortunately the grading is subjective and, in my personal opinion, will depend on how well you fit within the culture and personality of the program.

Noted! Thanks for this.

 

[jslo85]

Everything everyone said above basically.

After being on the other side, it becomes pretty stark what really matters and what doesn't. The decision amongst candidates is hard when you look at it strictly on paper but pretty apparent when you get to see them inside the department. I will however add these things which are in no particular order that I feel are important personally.

1. the 2AM or 4AM litmus test. Are you someone that I would want to have working with me at around 4 AM when feces are hitting the fan? AKA. Can I see myself working with (and wanting to work with) you for the next four years?
2. Are you teachable? Which then leads to, can you put two in two together with some gentle prodding and be able to connect the dots in the future. If you've listened to some podcast or some journal, bring it up when we're not slammed and it could be something fun for us as residents to learn about too or try if the attending is down for it. We like to try new things too
3. Do you follow up with your patients? - I feel like auditioning students lose sight of this or do not feel that this is important. Often they feel that it is the best showcase of their "skill" to see as many patients as possible, wait impatiently behind while resident/attending is furiously charting away to do their brief presentation and run off to the next room. Please pick up 2-4 patients (max 4) and follow up with them. Ie. if we gave zofran/pain medicine/gi cocktail/headache cocktail or whatever, follow up with them quickly after and reassess to see if they're feeling better and let me/whoever know. Also follow labs and imaging. We do run the board often but if you know an abnormal lab value or results of imaging is back and there is something that needs to be done ie. dispo/replete lytes/call consultant, let us know.
4. Make our lives easier. We're a team, whether you envision it that way or not as a student. The attending, me (resident), intern and you. Our mission of the day is to treat the patients in the department so if you can make our lives easier, you can bet we will be remembering you. This goes from pelvics to lac repairs to listening to the EMS give their report on the latest pt that they rolled in to following up on patients that you picked up on their labs and reassessment after treatment to bringing the sad mom a tissue to getting that patient the warm blanket they always wanted to helping to log roll a patient off a backboard to getting the bedside US for the cardiac arrest coming in etc etc. You may think these things are trivial. I don't.

Icing on the cake: know your dispo or what you think needs to be done and tell me why. This is something I think needs to be fleshed out during residency but have an idea of is this guy going home or is he staying. Back yourself up with TIMI/HEART score/PERC/PECARN/new orleans CT or whatever 13135971357 other score.

 

[TheOther]

Everything everyone said above basically.

After being on the other side, it becomes pretty stark what really matters and what doesn't. The decision amongst candidates is hard when you look at it strictly on paper but pretty apparent when you get to see them inside the department. I will however add these things which are in no particular order that I feel are important personally.

1. the 2AM or 4AM litmus test. Are you someone that I would want to have working with me at around 4 AM when feces are hitting the fan? AKA. Can I see myself working with (and wanting to work with) you for the next four years?
2. Are you teachable? Which then leads to, can you put two in two together with some gentle prodding and be able to connect the dots in the future. If you've listened to some podcast or some journal, bring it up when we're not slammed and it could be something fun for us as residents to learn about too or try if the attending is down for it. We like to try new things too
3. Do you follow up with your patients? - I feel like auditioning students lose sight of this or do not feel that this is important. Often they feel that it is the best showcase of their "skill" to see as many patients as possible, wait impatiently behind while resident/attending is furiously charting away to do their brief presentation and run off to the next room. Please pick up 2-4 patients (max 4) and follow up with them. Ie. if we gave zofran/pain medicine/gi cocktail/headache cocktail or whatever, follow up with them quickly after and reassess to see if they're feeling better and let me/whoever know. Also follow labs and imaging. We do run the board often but if you know an abnormal lab value or results of imaging is back and there is something that needs to be done ie. dispo/replete lytes/call consultant, let us know.
4. Make our lives easier. We're a team, whether you envision it that way or not as a student. The attending, me (resident), intern and you. Our mission of the day is to treat the patients in the department so if you can make our lives easier, you can bet we will be remembering you. This goes from pelvics to lac repairs to listening to the EMS give their report on the latest pt that they rolled in to following up on patients that you picked up on their labs and reassessment after treatment to bringing the sad mom a tissue to getting that patient the warm blanket they always wanted to helping to log roll a patient off a backboard to getting the bedside US for the cardiac arrest coming in etc etc. You may think these things are trivial. I don't.

Icing on the cake: know your dispo or what you think needs to be done and tell me why. This is something I think needs to be fleshed out during residency but have an idea of is this guy going home or is he staying. Back yourself up with TIMI/HEART score/PERC/PECARN/new orleans CT or whatever 13135971357 other score.

I appreciate you taking the time to write this up! It's reassuring to hear that a lot of the things that'll help an auditioning student stand out is not necessarily tied in to clinical acumen, but a real interest in the specialty, an eagerness to learn/help, and a respectful attitude. Also reassuring to hear that what seems pretty common sense to me isn't so common haha.

 

[ThreadStalker]

This is a great discussion. Thanks for all the input here!

On a related note, what do you all think about the timing of an away during fourth year? Due to my school's scheduling our fourth year starts a few months earlier than most and I've noticed that some programs offer away slots in May and June. Students at most schools are still completing M3 rotations then, so I suspect it would be easier to arrange one of these. On the flip side, I don't know if it's wise to do an away before I even rotate at my home program or complete a sub-I.

Based on this thread, it doesn't seem like I would be judged much on my clinical knowledge (thank the good lord almighty). I can do the basics (being on time, interested, friendly, etc.), and we have a required M3 EM rotation so I have some exposure. Are there other advantages that students gain from doing home rotations first? Is it better to do away's closer to interview season so you're more likely to be remembered? Any reason(s) that you personally would not do an away for your first M4 rotation?

Thanks!

 

[mega_colon]

I did aways first and it's gone fine. Work hard on your 3rd year rotation so you can easily transition into the role of a sub i and you'll be fine.

 

[EM2Be2017]

The big exception that I can think of is if you are doing a Sub-I at a program you really want to go to. Then I would really recommend doing another EM rotation first.

 

[racerwad]

This is a great discussion. Thanks for all the input here!

On a related note, what do you all think about the timing of an away during fourth year? Due to my school's scheduling our fourth year starts a few months earlier than most and I've noticed that some programs offer away slots in May and June. Students at most schools are still completing M3 rotations then, so I suspect it would be easier to arrange one of these. On the flip side, I don't know if it's wise to do an away before I even rotate at my home program or complete a sub-I.

Based on this thread, it doesn't seem like I would be judged much on my clinical knowledge (thank the good lord almighty). I can do the basics (being on time, interested, friendly, etc.), and we have a required M3 EM rotation so I have some exposure. Are there other advantages that students gain from doing home rotations first? Is it better to do away's closer to interview season so you're more likely to be remembered? Any reason(s) that you personally would not do an away for your first M4 rotation?

Thanks!

I would do exactly as you are planning. It will help secure an early SLOE and confirm (one way or another, lol) that EM is the right choice. There is very little advantage to doing a home vs away first - at some point, something has to come first and it is unlikely that the two programs will be so similar in EMR, physical plant, staff, etc, that a single month will give you a huge advantage. You will have to relearn a bunch of stuff at any new place and no one evaluates you on how well you know their EMR or where supplies are hidden.

Timing doesn't matter too much - honestly, if you can get a couple of auditions out of the way this early, you are at a huge advantage.

 

[ThreadStalker]

Awesome. Thanks for the replies!

 

[engineeredout]

Reevaluate your patients without me having to tell you.

Have a differential and a plan for each patient. Even if it's wrong, you need to prove you're thinking.

Don't be annoying.