What should I do during my shadowing experience???

[Keberson]

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Hello all. I am an MS1 and have started going to the ER after I was invited by an EP here at my school. I am really pumped about EM and as of now it is my first choice specialty. The EP that I am hanging out with is really nice but she is very quiet. She is very busy as the attending in the ER and does not seem to have time to teach. I don't want to bug her by dragging behind her at all times but I want to learn. She is definatly willing to help because she invites me to come so there is not a problem there.

So my questions are:
what should I do to interact more with the doctor? I know I need to be more aggressive but what is the line between healthy aggression and "really annoying student"

thanks alot guys

 

[beyond all hope]

I'm an PG-3 and I have med students/EMT students shadow me all of the time, as well as 4th year students who see patients.

The problem as a resident or an attending is that we'd like to teach but we don't have much time. The best way you can shadow is just follow me around. I know it seems demeaning but that's the best way to understand the experience is to be a part of it.

We won't be annoyed/dismayed if you wander off for awhile. Go where things seem interesting. It's your time and you should make the most of it. Go to see codes, tag along other residents, even hang out with nurses and PCAs to talk.

If you hang around long enough you'll get some teaching. I'll make time. I let even the 1rst and 2nd years do simple procedures, interview patients, etc. You can interject questions from time to time but don't feel bad if the attending cuts you short or doesn't answer. It's not personal, it's not arrogance, it's just haste.

 

[SoCuteMD]

This isn't specifically ED-related, but I spent most of my volunteer time in undergrad at a free clinic. In the beginning it was...eh. By the time I'd been there a year, all the docs knew me and if we all had time would send me into a room, have my interview a patient, present the case to them in the hallway, and then take me in to see the patient again. I learned a lot, but it took a while to learn the ropes and get to the point where I was able to do that. Stick with it.

 

[EM_Rebuilder]

I am currently a third year and I too began to shadow in our ED during the first part of my first year. I made it down there once to twice a month. At first I did often seem in the way, but the more I went, the more I got to know more doctors and the more I got to do. Soon I felt very welcomed!

By the end of my first year I had done chest compressions many times, started several IVs/Foleys, intubated patients, interviewed patients, put in a chest tube, I&Ds, sutured up soooo many lacs....

I did not get down there as much 2nd year because of the increased school load but still managed to go occasionally.

Needless to say, procedure wise, third year has been great. I have done several complicated facial lacs during my surgery/trauma rotation; all of which the attending/residents were very impressed with. I have done several paracentesis, IVs, etc. My weakest link by far is still central lines; everytime I ask to do one the resident still needs a few more signed off on. Hopefully I can get at least 1 or 2 before my EM away rotations come up.

Needless to say, stay with it and you will be noticed. Do not go so often that your school work suffers but go just enough to tame that desire to be in the ED... and pick up some skills that will make you shine later!!!

 

[Radiohead]

By the end of my first year I had done chest compressions many times, started several IVs/Foleys, intubated patients, interviewed patients, put in a chest tube, I&Ds, sutured up soooo many lacs....

My jaw almost dropped when I read that you intubated patient(s) in the ED as a 1st year medical student??!!! I don't know, but is anyone else calling BS on that one?? A chest tube? Where are you doing your shadowing? Even as a 4th year student, those procedures were few and far between. Not to mention that they were highly coveted, which means that they usually got eaten up by the intern if the 2nd year resident wasn't already at the head of the bed. Maybe you were in the room for an intubation/chest tube, but to be performing them as a 1st year, are you kidding me. If not, I need to transfer schools.

 

[leviathan]

My jaw almost dropped when I read that you intubated patient(s) in the ED as a 1st year medical student??!!! I don't know, but is anyone else calling BS on that one?? A chest tube? Where are you doing your shadowing? Even as a 4th year student, those procedures were few and far between. Not to mention that they were highly coveted, which means that they usually got eaten up by the intern if the 2nd year resident wasn't already at the head of the bed. Maybe you were in the room for an intubation/chest tube, but to be performing them as a 1st year, are you kidding me. If not, I need to transfer schools.

That does seem a little fishy, especially as a 1st year when you have very little knowledge of anatomy to be intubating or needle decompressing a chest. How would you know where to landmark, what structures to be careful to avoid (eg. the intercostal neurovascular bundles), etc.? Not calling you a liar, but just concerned about the safety of this if it is true.

 

[bartleby]

Come out and ask the attending what his/her preference is in regard to shadowers. Do they want you literally be their shadow or would they like you to step back a bit? Please do ask questions, by all means, but try to time things right (don't ask questions in the middle of a code or when the attending is about to answer a phone call) and make them count (ask questions which are relevant to patient care. Don't ask about the Krebs cycle.) In general, the busier the ED gets, the lower the profile you should try to keep. Take any opportunity to be helpful...if Mr Jones needs a urinal or a cup 'o joe, offer to get it. It will save the person you are shadowing time and make them appreciate your presence.

 

[EM_Rebuilder]

That does seem a little fishy, especially as a 1st year when you have very little knowledge of anatomy to be intubating or needle decompressing a chest. How would you know where to landmark, what structures to be careful to avoid (eg. the intercostal neurovascular bundles), etc.? Not calling you a liar, but just concerned about the safety of this if it is true.

I am at Texas Tech University SOM in Lubbock, TX. We are a small state school (120+ total students and we split up for 3rd and 4th year to El Paso, Lubbock, and Amarillo, TX leaving about 40 at each campus). The residency programs here in Lubbock for the most part are smaller and overall our students are known to have done many more procedures than the typical medical student. The residents meet their 'quotas' early each year and most are more than happy to share anything. I should also mention that Lubbock, TX is the only Level I trauma center for something like 300+ miles and we have no EM residents. Students with a desire in surgery love it here; they are always first assist if they are in Amarillo (no surgery residents) and there is so much going on in Lubbock with so few residents that you are always at least scrubbed into to every case on your service and often first assist. I have friends who want to do surgery that have done much of the more simple surgeries. If you want to be an OB/GYN, go to El Paso; my friend in that rotation now just delievered 22 SVDs last week. Our school does not have any huge fame associated with it but I am confident we turn out very good future doctors.

I was always supervised for the bigger things. On the chest tube, landmarking the neurovascular bundles was the question I was asked before I was handed the knife.

I had to wait until third year to see an emergency thoracotomy where I got to do the cardiac massage..

 

[jojo14]

When I shadowed as an MS1, often I would ask the doc shortly after we came out of a patient's room what they thought was "going on" with the patient if it wasn't super obvious. That's the time when they are thinking about it too, and usually they were happy to think out loud about the differential, what labs they wanted, etc for a few minutes. Also, when they pulled up an xray or a ct and started looking at it, I'd ask what they were looking for and say something like how I really didn't know anything about reading films and they were again happy to take a minute or two to teach. Don't do it with every patient, because that would be annoying, but the attending you are following might not remember what it is like to be a first year and what you don't know. I also tried to ask the other attendings that were working that shift if they could grab me for any cool exam findings or good teaching patients (if they remembered! Usually they did).

The longer I stuck around, the more of a relationship I developed with everyone and I got to do stuff like suture, ABGs, and oh, joy rectal exams. Also ask your attending (and the patient of course) if it's okay to listen to the heart and lungs when she does, that way you can practice. Not very exciting, but you gotta start somewhere!

 

[Keberson]

Thanks guys. I really appreciate all of the advice. I am afraid to admit that I do get intimidated by doctors (even though supposedly I will be one someday). I hate to interfere with their work. I am going to the ER tonight and tomarrow night so hopefully good will come of it and I will learn a thing or two.

 

[Keberson]

oh one more thing...
The doctor I am shadowing has given me various times that they work and basically said, "come in and hang out" very casually. They work only nights and i usually have class at 8am. Is it rude to leave before the shift is over (say 4am or 5am so i can get home and get some sleep/get ready)? Also...is it rude to just "show up" at any of these times that they specified (basically they said, I work tues,thur, and fri...such and such time, come on in).

okay..i know its getting ******ed with all my questions but I just want opinions.

 

[nvshelat]

When I shadowed, I would hang around with the attending while she was seeing patients, but I found that residents are a better lot to hang around with. So I asked the attending if she would mind if I shadowed residents while she was doing paperwork on pts. In turn, that resident would introduce me to another resident, and so on. I feel this is the best way to maximize your time shadowing.

 

[EM_Rebuilder]

oh one more thing...
The doctor I am shadowing has given me various times that they work and basically said, "come in and hang out" very casually. They work only nights and i usually have class at 8am. Is it rude to leave before the shift is over (say 4am or 5am so i can get home and get some sleep/get ready)? Also...is it rude to just "show up" at any of these times that they specified (basically they said, I work tues,thur, and fri...such and such time, come on in).

okay..i know its getting ******ed with all my questions but I just want opinions.

My shadowing was usually friday or saturday night, 5 or 6ish pm to 1-3am (when things started to slow up). I would not stay all night when you have class the next AM. Remember that class is your first goal right now. I never stayed 'full shifts' until I did a preceptorship between 1st and 2nd year... even then they would urge us to get out of there at 3 or 4am since typically not much goes on until 7am when the shift changes. It could vary from place to place. Another reason why I like EM is that everyone I have met seems laid back. Their opinon is why spend all your time there; go home and relax or worst case study for your classes. I think third year and certainly fouth year away rotations are about being there as much as humanly possible. Remember that being in the ED even just 6 hours a week as a first year would impress most attendings since obviously they never see first or second years.. (Feedback please if my statements are poor suggestions!)