Scared About EM Rotation

[theWUbear]

Hi all,

I am a 4th year who starts my first/home EM rotation Monday. EM has been the goal/dream since starting medical school.

I know that I must show dedication and hard work in my clerkship, and I am not worried about that. I am going to give it 100%. However, I consider myself to be mediocre in terms of medical knowledge and inexperienced in working up patients and management of patients when compared to my US MD classmates who are pursuing EM - and therefore I am scared about struggling comparatively when managing my patients this month, and that of course being reflected in my SLOE.

I have been told to seek podcasts in general for preparation for the clerkship by a resident. I took Friday night and Sat morning off to unwind after finishing my surgery clerkship. Should I just listen to EMBasic podcasts on many typical presentations over the next day or so? What other materials should I use so that I can hit the ground running well? Greatly appreciate any advice.

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[RustedFox]

Hi all,

I am a 4th year who starts my first/home EM rotation Monday. EM has been the goal/dream since starting medical school.

I know that I must show dedication and hard work in my clerkship, and I am not worried about that. I am going to give it 100%. However, I consider myself to be mediocre in terms of medical knowledge and inexperienced in working up patients and management of patients when compared to my US MD classmates who are pursuing EM - and therefore I am scared about struggling comparatively when managing my patients this month, and that of course being reflected in my SLOE.

I have been told to seek podcasts in general for preparation for the clerkship by a resident. I took Friday night and Sat morning off to unwind after finishing my surgery clerkship. Should I just listen to EMBasic podcasts on many typical presentations over the next day or so? What other materials should I use so that I can hit the ground running well? Greatly appreciate any advice.

Not being a whiny beeyatch will help.


Lolz. I was nervous, too. Download WikEM, use it. Stick to the playbook. Good luck.

 

[TooMuchResearch]

Yes, the first 20ish em basic episodes with general approaches to chief complaints will be your best bet. The wikem app is helpful, too.

Helpful and enthusiastic (but not too enthusiastic) is always appreciated.

 

[theseeker4]

Hi all,

I am a 4th year who starts my first/home EM rotation Monday. EM has been the goal/dream since starting medical school.

I know that I must show dedication and hard work in my clerkship, and I am not worried about that. I am going to give it 100%. However, I consider myself to be mediocre in terms of medical knowledge and inexperienced in working up patients and management of patients when compared to my US MD classmates who are pursuing EM - and therefore I am scared about struggling comparatively when managing my patients this month, and that of course being reflected in my SLOE.

I have been told to seek podcasts in general for preparation for the clerkship by a resident. I took Friday night and Sat morning off to unwind after finishing my surgery clerkship. Should I just listen to EMBasic podcasts on many typical presentations over the next day or so? What other materials should I use so that I can hit the ground running well? Greatly appreciate any advice.

If you are efficient in your evaluation of patients, meaning you can go and do a focused H and P without spending 45 minutes with every patient, take a couple minutes and brush up on what the initial tests/treatments for the patient you are about to see would be. If you have a chest pain patient for example, when you come back to staff the patient with the attending, have at least some answers to the questions used to evaluate for likelihood of a PE, know you need a chest x-ray, EKG, aspirin, continuous monitoring, etc. Know to ask about recent vomiting, bloody vomitus, etc. History of heart conditions, history of blood clots/cancer, etc.

You will impress the attendings you work with if you first, can see a patient and get the pertinent information from them quickly, and second, you have a differential diagnosis that at least covers the major potential threats to the patient's life, and initial workup/treatment for those serious conditions.

One last thing, remember that these aren't standardized patients. If there is a patient that is seriously, acutely ill, make sure you notify the residents/attendings of that fact. Sometimes a patient will slip through triage, and someone who should be in resus sits getting more and more hypoxic in the module. You don't want to be that med student who spent 20 minutes trying to evaluate an acutely ill patient instead of recognizing the danger immediately and notifying a resident or attending.

 

[engineeredout]

If you're working with me, you don't need to be the most intelligent, have the full work up down for every patient, rattle off wells score or sgarbossa criteria from memory etc... A few things matter when I'm working with a student:

1. Reevaluate your patients without having to be asked. I want to hear from you "hey I relistened to bed 2 and she still sounds wheezy after the first neb". It shouldn't be me constantly asking "did you reevaluate bed 2?"

2. Don't lie. If I ask you if mrs. Jones had any recent travel history and you didn't specifically ask her, your response should be "I didn't ask but I'll find out". Don't say "No" because she didn't specifically say it and you didn't ask. I don't care all that much if you didn't ask the first time around. I'll care if I catch you in a lie.

3. When you show up for your shift, introduce yourself to the resident and the attending working. Do not just stand in the corner silent waiting for someone to talk to you. And whatever you do, do not go see patients without introducing yourself to us. I didn't think I needed to say that, but it has come up.


Basic interest with basic common sense will take you a long way.

 

[KinesiologyNerd]

You know far more than you think you know.

 

[Angry Birds]

Lolz. I was nervous, too. Download WikEM, use it. Stick to the playbook. Good luck.

Better than WikiEM would be PEPID EM Suite. I don't know how much it costs for a student, but if it is $150 or so, then it's well worth it, in my humble opinion. (That's the cost of an expensive textbook, except this one will allow you to kick some serious a** during your rotation.)

Right after seeing a patient, sneak a quick peek on Pepid, and within 30 seconds you will get a more focused plan than any other student. This is what I did during my EM clerkship and I did well because of it. (Then, I used a pocket handbook, the Oxford handbook of EM... It's great, but I think PEPID is the best.)

 

[gman33]

There is a lot to learn. Too much really.

I recommend learning the most common chief complaints really well.

Chest pain, abdominal pain, sob, ha, back pain.

I think the chapters in rosens on these topics are excellent.

Remember that early in your training, think about worst first.

Don't start thinking that a cp or belly pain is gerd and the patient can go home.

Start with the premise that everyone is really sick and figure out a way to prove they are not.
Someday this will change, but not now.

As others have said, be on top of your patients.
If you start presenting a cp case to me and there is no EKG, that's an epic fail.


Find a reident who seems helpful and have that person show you the ropes.

If you made it this far, you can succeed.
Learning the right mindset is a big part of the next step.

 

[EndersRebutal]

Not going to lie I was nervous before my first away, but as soon as I started seeing patients I was fine. If you do things right you will be too busy to be nervous. Don't forget to ask for feedback both on the fly (patient load willing) and especially at the end of the shift. That way you can show improvement in subsequent shifts.

 

[KinesiologyNerd]

Oh also. Even if you have no idea, give them an assessment and plan. They like that.

 

[gman33]

Here's the presentation I want.

I have a male with cp who needs to be admitted for a rule out and here's why.

50 yo with cad htn hld. 2 days of intermittent cp. no sob. Normal vs. neg trop. No EKG changes from baseline EKG.

If you tell me this and it's all true. Honors

 

[gman33]

An additional thought.

If the presentation starts with,
I have a guy, he's umm, wait I'm not sure how old (look at chart) umm, 55 years old with a pmh of x,y,z....

I already stopped listening and will have moved on to other work. Maybe even have walked away.

I used to go for the technique of walking to the room while getting a presentation with the instructions that they had to be done by the time we got there.

 

[shoal]

Here's the presentation I want.

I have a male with cp who needs to be admitted for a rule out and here's why.

50 yo with cad htn hld. 2 days of intermittent cp. no sob. Normal vs. neg trop. No EKG changes from baseline EKG.

If you tell me this and it's all true. Honors

not that i work in an academic setting, but i wouldnt expect this from a medical student. if i heard it, i'd be hard pressed to believe them, and would be quite concerned.

im all about getting to the point but as a medical student? i would like a little more presentation than that. i want to hear your thought process, why not pe, why not dissection, ptx etc. brevity is king, as your seasoned, but brevity from minimally trained and minimally education students or residents make me very concerned somethings going to get missed.

Sent from my VS986 using Tapatalk

 

[tkim]

I already stopped listening and will have moved on to other work. Maybe even have walked away.

I used to go for the technique of walking to the room while getting a presentation with the instructions that they had to be done by the time we got there.

Little hard-core for the med stud doing a rotation, ja?

 

[Cinematographer]

I used to go for the technique of walking to the room while getting a presentation with the instructions that they had to be done by the time we got there.

This sounds awful

 

[Hercules]

Better than WikiEM would be PEPID EM Suite. I don't know how much it costs for a student, but if it is $150 or so, then it's well worth it, in my humble opinion. (That's the cost of an expensive textbook, except this one will allow you to kick some serious a** during your rotation.)

Right after seeing a patient, sneak a quick peek on Pepid, and within 30 seconds you will get a more focused plan than any other student. This is what I did during my EM clerkship and I did well because of it. (Then, I used a pocket handbook, the Oxford handbook of EM... It's great, but I think PEPID is the best.)

I thought it was awesome as a med student/resident and still use it now as an attending. High value as a med student though in terms of having a plan.


Sent from my iPhone using SDN mobile

 

[gman33]

We would also talk a lot about the differential and how to eval patients.

One of the trickiest parts of teaching in EM is that sometimes there is no time to do it.
ER overrun with sick patients, you just don't have time for a 10 minute presentation.

At times, you have to tell the student, resident, etc, that you have 1 minute to get your story across and after that we are going to see the patient.

 

[KinesiologyNerd]

We would also talk a lot about the differential and how to eval patients.

One of the trickiest parts of teaching in EM is that sometimes there is no time to do it.
ER overrun with sick patients, you just don't have time for a 10 minute presentation.

At times, you have to tell the student, resident, etc, that you have 1 minute to get your story across and after that we are going to see the patient.

I would say I really hope M4s aren't giving you 10 minute presentations in the ED, but I believe it haha. I find attendings typically want a more detailed 3-5 min spiel that you show some growth and an ability to leave out the unimportant details. URIs and simple lacs get the jets, though.

 

[doggydog]

Honestly, I'm not sure I could give a 10 minute presentation if I tried.

 

[tkim]

We would also talk a lot about the differential and how to eval patients.

One of the trickiest parts of teaching in EM is that sometimes there is no time to do it.
ER overrun with sick patients, you just don't have time for a 10 minute presentation.

At times, you have to tell the student, resident, etc, that you have 1 minute to get your story across and after that we are going to see the patient.

Great backpedal.

 

[theWUbear]

Thank you all; I very much appreciate all of the insight. My first shift was uneventful - in a good way. I used Pocket Emergency Medicine and Dr. Levine (Chritiana Care)'s antibiotic guide for planning (is PEPID a level up from this? $150 won't deter me from a resource for the specialty I am entering into, happy to have the additional resource).

My presentations need to be tighter - being my first shift, I reported everything in the Hx, like I was on medicine. I'll do more presenting the phrases "no social risk factors, family history noncontributory" etc.

I was complemented on my differentials by using your suggestions to inform the attending I've thought about serious differentials and this is why they are not what is happening.

Over the course of the month I am going to study daily so that I can work on my dispositions - learn the equivalent of HEART scoring and other tools for guiding diagnostics and dispo for the gamut of presentations as I read my textbooks and listen to EMBasic and EMRAP