How to be a super STUD?

It is better to be complete than to try to multitask or be "fast".

Have a complete presentation (read a book like secrets) and have a plan for what you want to do with your patients and know why you want to do it.

dont blow patients off when you present (..he's fine, she's a drug seeker, etc)or act jaded, even if you think they've got nothin. This is one thing that students do that irritates me, even if they are right.

I am a lot more impressed by students who work hard, show enthusiasm, and arent afraid to show what they dont know, assuming they will go read about it.

I'm not trying to be rude or naive but is trying to calculate ways to be seen as a stud really what it is all about? I personally couldn't go through any of this, if that's what mattered to me, or where I focused my energy.

Also, it's not crucial to honor EM, especially if your school is "stingy" with honors, as that will be reflected in your SLOR. Plus you can do away rotations and get a second or third chance to prove your merit... or, um, ability to read the attending's mind.

Look at an EKG book and maybe a radiology book before the rotation. Med students always get pimped on that stuff. But make it all look effortless...

Do not bog down your attending and resident. Pick up only 1 chart at a time and wait to present it at an opportune time. In the interim don't see another patient. Having 2 or more in the hole waiting for the resident/attending to see is just bad.

Speed is not the issue & quantity of patients you see is not the issue. Being complete from begginning to end is the issue. Having your resident clean up after your by having to make decisions about them while you are off at lunch or seeing another patient is just BAD. Call family for information. Call nursing homes for information. Talk to EMS thoroughly before they leave.

Communicate effectively and breifly with your presentations. Know the patients history well, including prior tests etc. Having a Emergency medicine ddx in your head (stuff like PE, Dissection, Ischemic gut) rather than some esoteric DDX that doesnt matter is more satisfying to hear and shows you are really thinking like an ER doc. Have a plan of what you think needs to be done including labs, meds, fluids, nursing orders, pain meds, etc.

Never act like you know it all. Don't try to be a know it all. Being the smartest student is not as important as how you interact with others & the effort you show by being thorough. When in doubt, back off difficult and complex cases. Stick with bread and butter types. If unsure, ask a attending if it's okay to see. Simple cases you see with an attending go a lot better and you'll get less frustrated.

Try to be involved with time consuming things such as suturing, helping nurses, putting in IVs, assiting in procedures, as this will gain the thanks of nursing and the docs alike.

and don't reverse-pimp anyone -- ie asking a string of crazy questions of a resident (or attending but i figured that was obvious) trying to make yourself look smart. my god that's annoying. ask relevant questions, do a little reading, and if something still isn't clear, ask. but formulating some long question about an obscure article you read (that you don't know the other person read) or distracting someone from work for 20 min is another version of being over-enthusiastic.

just have a clue, too. asking someone the OTC dose of ibuprofen (and pronouncing it wrong) doesn't send a good message. i had a podiatry student do this.

Actually the more important things for me when a student is on a shift with me is do they have good rapport with the nurses.

Too often I see medical students act very pompous and rude to my nurses. They are MY nurses and are on OUR team. They know probably as much, if not more, than most M3s and M4s in regards to Emergency Medicine. You should atleast introduce yourself to them (but try not to be their best friend), ask them fi they need any help putting in the NGT or Foley, etc.

Also, KFF's advice about not assuming they are FOS or a drug seeker or whatever is great advice. That's a big pet peeve of mine, and until you have several years under your belt, you shouldn't jump to those conclusions. I even yell at my interns that say those things....

Q

Dr.McNinja said:

Not true. Nowhere on the SLOR does it say "Student's school only gives pass/fail".

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The EM SLOR includes a section that tells what percentage of students get each grade, so that a program can tell if 5% get honors, or 30%. As far as the other rotations, most schools include a histogram in the dean's letter that also gives the proportions of students getting each grade ...

there is also a book out there titled "Pimp Protector", might look into it.

First off, honors on an EM rotation is not critical for matching. It varies so widely from department to department that a program director would need an amazing decoder with all the EDs in the country to determine what it truly means and how to score the information. So don't worry too much about it. It gets noticed and helps but it is not critical. It is mainly an indicator that you have a great shot at matching with the program that gives you the honors.

Personally, I think asking about how to get honors is the same as asking how to do a great job on an ED rotation. It's a great question. Honors is a fringe benefit and an incentive, but the goal is what clinical training is all about.

Usually the decision to award honors is based on a constellation of factors that allow the student to stand out from his/her peers. So you need to be noticed yet not irritate the people who will evaluate you. The advice I got when I asked the same sort of question was useless by perfectly true: "Don't do too little but don't do too much!". Let me try and flesh out that concept:

1. Fund of knowledge
The evaluations used to determine honors will ask how well does the student formulate a differential diagnosis, understand the underlying pathophysiology, and respond to the Q&A sessions most people use to teach at the bedside and the classroom. One quick easy way to prepare for this before the rotation is to read EM secrets. A good painless way to review the core content and not a bad prep for a student rotation.

2. Work ethic
All of what has been mentioned in earlier posts is golden. You should work as hard as possible and help out as much as possible without getting scattered or doing sloppy work. Helping the nurses with IVs or giving patients a warm blanket, not only scores points but is good care and builds practice habits that will serve you for your entire career. Work hard at your presentations. Think about the case carefully before reviewing it with the senior or the attending. When you present, you want to show that you understand the priorities and management options. You do not want to recite every random fact about the case. You don't want to forget something when it is indicated, yet you want to do a focused exam when the chief complaint calls for a minimal approach. For example, not doing the rectal in a potential GI bleed will cause eyes to roll but so will doing a rectal in a patient with an ankle sprain. Although this is an extreme examples, the concept plays out in every case. Always pick up the next chart in the rack when you are ready for another case, particularly in patients who may not be particularly exciting. Cherry picking charts does get noticed.

3. Interpersonal skills
The best strategy is to be yourself while being very sensitive to who you are working with. Learn to listen to what the supervising resident or attending are saying and figure out what their priorities are, then adapt to them. You don't want to brown nose but you don't want to be invisible either. Your basic theme should be "I'm just here to help the team". Remember that the attendings and residents are quietly deciding if they want to work shifts with you on a daily basis for the next 3 years. Never, never, never, loose your temper, no matter what the reason. When you make an error, admit it and pride yourself on intellectual honest and the willingness to take contructive criticism. You are a student and thus it is expected that you are there to learn. Save venting for your evaluation form.

4. If there are any extracurricular activities, go for it: presentation at a conference, assisting in a research project, drinks or food after the shifts. Every little bit helps.

Dr.McNinja said:

Yes, but if the school that gives the SLOR gives out honors and high pass, but the form from your school only lets them give you a pass, then you are stuck with a pass on a form that says "we give 10% honors, and 20% high pass" and the like.

No histogram on our MSPE either.

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😱

There needs to be some changes made at your school, at the very least the student affairs office in order to improve how they handle the residency application process for the students. Maybe you guys need to get a big group of students to meet with the dean of the med school and demand changes because it doesn't sound like they do everything possible to support their students 100% through this process. They seem to bend over backwards for us here.

****Also wanted to thank Haemr Head for their opinions on SDN. If the screen name is of any indication, it's great having you around here and I hope you become a regular contributor!

Thanks for the welcome although two of us could claim that screen name. I just beat the other guy to it. 🙂

I really believe that this forum is the voice of the future of our specialty. I'm here to listen more than spout off (at least when I can restrain myself). If I can put my experience to use and shed some light, I'm delighted to to participate.

Dr.McNinja said:

Yes, but if the school that gives the SLOR gives out honors and high pass, but the form from your school only lets them give you a pass, then you are stuck with a pass on a form that says "we give 10% honors, and 20% high pass" and the like.

No histogram on our MSPE either.

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Dr. Mcninja, I don't know what school your from, but it sounds like my school. For all of our electives we only have two grades, "pass/fail". So, no matter how hard you work and how much you stand out you can get no more than a "pass" and then have to explain to your future interviewers the situation every time. What can I say, my school really doesn't care about it's students (or at least it doesn't care enough to do anything about it).

dmitrinyr said:

Dr. Mcninja, I don't know what school your from, but it sounds like my school. For all of our electives we only have two grades, "pass/fail". So, no matter how hard you work and how much you stand out you can get no more than a "pass" and then have to explain to your future interviewers the situation every time. What can I say, my school really doesn't care about it's students (or at least it doesn't care enough to do anything about it).

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st george's doesn't give out honors? that just sounds ridiculous. I can understand it in basic science yrs but rotations?

what about ross? do they give out honors/high pass etc?

Dr.McNinja said:

Yes, but if the school that gives the SLOR gives out honors and high pass, but the form from your school only lets them give you a pass, then you are stuck with a pass on a form that says "we give 10% honors, and 20% high pass" and the like.

No histogram on our MSPE either.

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It shouldn't matter, your interviewers should have a copy of the SLOR itself, not just the grade from your school.

EricVorheese said:

st george's doesn't give out honors? that just sounds ridiculous. I can understand it in basic science yrs but rotations?

what about ross? do they give out honors/high pass etc?

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Ross is still on the letter grade system. They give out A, B, C and I would imagine F, if you failed.

Thank you everyone for the good advice on how to do well on EM. This is very helpful