prep for subi help!!! need some good resources

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lilmisty

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Hey guys,

I'm trying to "function at the intern level" for my subinternship and I'm curious as to what I can use to prepare/study. I want to do well on this rotation, and its graded harshly (or so I have heard).

What resources/books can help me function at an intern level??? Maybe a set of flashcards online somewhere? Or a good book/resource?

Thanks guys. I wish you all the best.

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Road Map: EM is a great book for starters, gives you an EM perspective.
EM Secrets is easy to read too, although it might be too long and too "condensed"for a MS4 to read during one rotation
 
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Road Map: EM is a great book for starters, gives you an EM perspective.
EM Secrets is easy to read too, although it might be too long and too "condensed"for a MS4 to read during one rotation

Did anyone actually read EM secrets before EM rotations? That book is huge.
 
May I recomend:

1. If you are looking for a quick online reference that is free, try the CDEM site from SAEM. It has an outline for approaches to different common complaints and lists a life threat ddx and workup. Then there are pages for individual diagnoses. Decent amount of info, but bite sized, and not overwhelming at all. Here is the site: http://cdemcurriculum.com/m4/
2. Learn to get out of the room in 10 min or less. Period. You have to learn how to take succinct yet pertinant history/physicals. If the patient is there for abdominal pain, people will care if you asked a past surgical history, but don't care if they have a family history of DM. If the patient is there for URI symptoms, their PSH of an appendectomy 20 years ago probably isn't important.
3. Just like in #2, learn to pare down your presentations to essential details. You have a minute or less to get your point accross before the attending stops listening. We don't want an entire H+P presentation, just pertinant positives/negatives.
4. Always have your own ddx and plan and state them, even if you are unsure. Anyone can go in the room and take a history, scribes are trained to do this with no medical background whatsoever. We need to see that you can assimilate that information and come up with some sort of plan. Don't afraid to be wrong.
5. Check on your labs/studies. If an attending has 15 active patients and you have 2, there should be no way that attending is seeing results before you are.
6. Most students are pretty good at checking for results, but abysmal at rechecking the patient. This will absolutely make you standout. If you pick up on one patient that is getting worse during your month because you were diligent and checked on them, you will look like a superstar.
7. Listen to the rules. If a place tells you to do something a certain way because "thats how we do it here", do it how they want you to. Noone wants to match someone who can't play by the rules.
8. Keep your schedule requests low if possible. I know this is tough in interview season. But the chief residents who make the student schedules also will have some say when it comes to the match. Don't make their life miserable by constantly trying to change things or have unreasonable number of requests.
9. Be nice... to everyone. But don't come across as fake. We've had students carrying and emptying bedpans and trying to do all kinds of scut in order to impress us. Stuff they weren't asked to do and that has no relevance to what they are applying to do (being an EM doc). So treat everyone nicely and with respect, but don't start mopping the floor in order to try and impress someone.

I hope that helps. That's all off the top of my head. I'm sure there's more advice in there somewhere, if I think of anything, I'll be sure to add it!
 
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If you haven't already, get an EMRA membership. They send you a box full of EM pocket books and cards that are very useful to carry on you during your shifts. Said box included a pocketbook called "Basics of Emergency Medicine" which gives you a DDx and workup for the top chief complaints you will see in the ED. I would always refer to it after picking up a new patient and before actually interviewing then, just to get an idea of what questions to ask. It's really small and <20 pages. The EMRA Antibiotic Guide that is included with your membership is also great.

Disclaimer: I do not work for EMRA, but they should pay me for this free ad.
 
I used to be a pocket book/card carrier, then you realize you don't have enough pockets. Everyone has a cell phone these days. I can't say enough about palmEM. Its a paid app (I think $20) thats a one time fee and updates free then for life. It has a ped's resuscitation "broslow" tape, tons of quick med reference charts in it, and an enormous amount of quick info regarding procedures and disease processes that is sorted by system.

Its like Pepid, but more succinct, and its always with you on your phone. You don't have to be connected to the internet to use it either, in case you are in an ED with poor reception. I've been using that app for years, and I can't remember the last time I used another reference to quickly look something up on the fly unless its something really obscure.

I have no financial disclaimer re: palmEM. Just a longtime user and I always recommend it to all my residents every year.
 
Rosh Review.


Disclaimer: I may or may not suffer from extreme bias since my residency program receives financial benefits from Qbank sales.
 
Google "3-min EM patient presentation". It an older article that is free access at this point. Read it through before every shift.


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This is indeed helpful, but realistically speaking I think 3 minutes is a long time for the avg. EM attending's attention span. Most of my presentations ended up being <1.5 min, otherwise it seem like they could probably fall asleep.
 
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Two things that I did that I felt paid off: EM Basic Podcasts (every single one 3+ times), as well as Rosh Review question bank.
 
If you're burning up the Rosh Review qbank before an ED student rotation I honestly think you're doing it wrong. It's meant for board review, in excess of what a sub-i would ever be expected to know, and you lose the prognostic capability of their % chance of passing estimate when you do them for real. Read EM secrets or baby Tintinalli or just listen to EM basic. Be nice, energetic and interested. Say "no, I haven't, but I'd love to learn" for every single little thing someone asks if you have done/know how to do. I feel like reading some Carnegie would honestly take you farther than Roberts & Hedges as a sub-i.


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This is indeed helpful, but realistically speaking I think 3 minutes is a long time for the avg. EM attending's attention span. Most of my presentations ended up being <1.5 min, otherwise it seem like they could probably fall asleep.
I would agree, but I think that first one or two out of the gate can be the 3 min version. Make the attending comfortable, give a good differential with appropriate plan.


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I would agree, but I think that first one or two out of the gate can be the 3 min version. Make the attending comfortable, give a good differential with appropriate plan.


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Yep... I struggle to listen more than a minute. There is alot going on around us at all times with constant interruptions. The more succinct the better IMO.
 
If you're burning up the Rosh Review qbank before an ED student rotation I honestly think you're doing it wrong. It's meant for board review, in excess of what a sub-i would ever be expected to know, and you lose the prognostic capability of their % chance of passing estimate when you do them for real. Read EM secrets or baby Tintinalli or just listen to EM basic. Be nice, energetic and interested. Say "no, I haven't, but I'd love to learn" for every single little thing someone asks if you have done/know how to do. I feel like reading some Carnegie would honestly take you farther than Roberts & Hedges as a sub-i.


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You know there's also a med student EM Qbank...

Interns can do it too! ;)
 
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