Any Advice for New EM interns-to-be??

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DOnut

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I saw a similar thread in peds with some great stuff for those who will be doing pediatrics. Sooooo, I am seeking the advice, knowledge and expertise of our EM seniors. What should we in coming R1's expect, and do you have any recommendations for a successful transition?
 
DOnut said:
I saw a similar thread in peds with some great stuff for those who will be doing pediatrics. Sooooo, I am seeking the advice, knowledge and expertise of our EM seniors. What should we in coming R1's expect, and do you have any recommendations for a successful transition?
Click to expand...


Outgoing intern, but some advice:

1. Listen to your seniors. They've worked in the system for 3 years, they will usually steer you correctly.

2. Don't argue with attendings (save that for the end of senior year).

3. Learn to recognize sick/not sick within 1 minute of talking to a patient. They single key point in EM when presenting a patient is to have a plan: Admit/Discharge. Master that and the rest will follow.

4. Take time to go out and have fun. Intern year is hard, so get some stress relief.
 
I would add:
1. Make a point to foster good relationships during your off service rotations and with the ED nurses, it will make your 2nd and 3rd year so much easier.
2. You won't have much time to do extensive reading, but create a plan to do a little each day(like on one patient a day or chapters related to offservice rotations) so that you can get through a basic EM text cover to cover(Tintinalli, Hardwood-Nuss) by your intern/second year.
3. Try if possible to go out of town on a real vacation during your time off-this is key to not running out of gas half-way through the year!!
4.Have fun...
limabean
 
Number one thing: treat your patient when you identify something serious.

Nothing annoys me more than watching an intern or medical student take a 10- to 15-minute history while a patient is in AFib/CHF with a HR of 150 or is struggling to breathe while the 'tern is asking "do you smoke?"

A good emergency physician will start treatment during an interview. If you see a guy with AFib/CHF with a HR of 150, start treating it by asking the nurses to draw up your meds while you are talking to the patient.
 
Sleep now, while you can.

Take care,
Jeff
 
DOnut said:
I saw a similar thread in peds with some great stuff for those who will be doing pediatrics. Sooooo, I am seeking the advice, knowledge and expertise of our EM seniors. What should we in coming R1's expect, and do you have any recommendations for a successful transition?
Click to expand...


hey do not be afraid of your attendings, your seniors............but be afraid of your patients..........when you walk into residency, try to become the best doctor for your patients, in short, think that you are more accountable to your patients rather than the attendings or to your seniors or being nice to the ancillary staff.

If you are the best doctor for the patients, you would be the best protege/student for your attendings and best colleague to your seniors
 
Buy River's Review for the boards - make that your first book as an intern and read as much as you can from cover to cover. Use this book as an outline and throughout your residency, add things you didn't know (from Tintinalli's and Rosen's) into the appropriate sections of the book. Buy Peer V and VI and read them cover to cover each year before the inservice. By the end of your residency, you will have read River's twice, you will have your own personal reference book, and you will do very well in the future.

Be sure to find the time to keep a life during intern year - it is very easy to lose yourself if you get too caught up in the medical world. Most important - HAVE FUN! Think of next year as a year to remember fondly and proudly, not as a time to get through and remember with disdain...

Keep great relationships with the off-service residents - they will either help or hinder in your future.

Be mindful of every interaction you have with everyone you see in the hospital (patients, nurses, attendings, residents, orderlies, janitors). You never know who else is listening (or watching) and as an EM resident, you are under more scrutiny than any other resident to get along with everyone - that will be the single most important determining factor of your success in this field (yes! - above your clinical knowledge).

Relax, show up early, stay late. You will do just fine!
 
NinerNiner999 said:
Buy River's Review for the boards - make that your first book as an intern and read as much as you can from cover to cover. Use this book as an outline and throughout your residency, add things you didn't know (from Tintinalli's and Rosen's) into the appropriate sections of the book. Buy Peer V and VI and read them cover to cover each year before the inservice. By the end of your residency, you will have read River's twice, you will have your own personal reference book, and you will do very well in the future.

Be sure to find the time to keep a life during intern year - it is very easy to lose yourself if you get too caught up in the medical world. Most important - HAVE FUN! Think of next year as a year to remember fondly and proudly, not as a time to get through and remember with disdain...

Keep great relationships with the off-service residents - they will either help or hinder in your future.

Be mindful of every interaction you have with everyone you see in the hospital (patients, nurses, attendings, residents, orderlies, janitors). You never know who else is listening (or watching) and as an EM resident, you are under more scrutiny than any other resident to get along with everyone - that will be the single most important determining factor of your success in this field (yes! - above your clinical knowledge).

Relax, show up early, stay late. You will do just fine!
Click to expand...

Thanks niner. I asked this question before with no response: given the cost of Rivers, I bought Ma's "Just the Facts". Is that good enough, or is Rivers really worth the extra $ for a review book?
 
Don't be afraid to say you don't know or didn't do/ask something.
 
Be super nice to nurses, and joke around with them! They can make you or break you.... They will often identify things you miss. Thank them a lot.

Also... go out and buy a small pocket notebook that can fit into your scrub pocket or whitecoat pocket. Add crucial information that you learn or need to know. It will become your best friend and great resource in the ER when time is critical. Things I have listed in mine are....

- Pressor drips
- Fibrinolysis/Anticoagulation contraindications
- A-Fib/A-Flutter/SVT management
- Hyperkalemia doses
- RSI drugs and doses
- Conscious sedation drugs and doses
- Early Goal Directed Therapy
- Hospital dependent management for CHF/Aortic Dissection/MI/CVA/DKA
- Pediatric vital signs
- Pediatric ETT sizes, foley sizes, insertion depth, Chest tube sizes
- Pediatric vent settings
- Pediatric code doses & cardiovert/defib voltage
- Workup for penetrating trauma by anatomic site (box, thoracoabdominal, neck, etc)

I realize that you can read all this in a book, but there is a big difference between what you will study and what is actually practiced at your hospital. If you know the protocol at YOUR hospital, your consultants will appreciate your work-up much more (less work for them).
 
NinerNiner999 said:
Buy River's Review for the boards - make that your first book as an intern and read as much as you can from cover to cover. Use this book as an outline and throughout your residency, add things you didn't know (from Tintinalli's and Rosen's) into the appropriate sections of the book. Buy Peer V and VI and read them cover to cover each year before the inservice. By the end of your residency, you will have read River's twice, you will have your own personal reference book, and you will do very well in the future.

Be sure to find the time to keep a life during intern year - it is very easy to lose yourself if you get too caught up in the medical world. Most important - HAVE FUN! Think of next year as a year to remember fondly and proudly, not as a time to get through and remember with disdain...

Keep great relationships with the off-service residents - they will either help or hinder in your future.

Be mindful of every interaction you have with everyone you see in the hospital (patients, nurses, attendings, residents, orderlies, janitors). You never know who else is listening (or watching) and as an EM resident, you are under more scrutiny than any other resident to get along with everyone - that will be the single most important determining factor of your success in this field (yes! - above your clinical knowledge).

Relax, show up early, stay late. You will do just fine!
Click to expand...



what exactly is the full title of river's review book and what exactly is Peer V and VI? Where can you get them?
 
1. Try your best to maintain a life, preferably a sex life.

2. Don't kill any patients on purpose; try not to kill any patients by accident either.

3. No admission is a good admission.

4. Don't drink on the job. Do sleep on the job.

5. Don't read any of that medical stuff; do read for pleasure.

6. No case is an “interesting” case, don't bore your fellow residents with one.

7. AMA is your friend.

8. Don’t be afraid to actually prescribe/give drugs. Doing nothing looks bad. Bonus points if you know what the drug is actually for.

9. Do hit on the nurses, preferably the ones that are hot and single. However, in a pinch - or on a call night - any will do.

10. The only journal you should be subscribed to is Playboy. This goes for women too.

11. Always remember that your fellow interns come before your patients at all times. (i.e. do not post-pone another intern's d/c home to do silly **** like "patient care" - take their sign-out now.)

12. All in-patients should be written for low calorie, ADA, no salt diets. If they're not diabetic now, they will be. If they’re not fat yet, they will be. This is preventive medicine at its finest. More importantly, it also tastes like **** and will enhance their desire to go home. This will leave you with less work and more time for #1.

13. Always remember, nurses are the enemy. Take Sun Tzu's advice and keep them closer than your friends. Especially when engaged in #2.

14. Don't waste your precious money on buying monogrammed scrubs. They make you look like a douchebag and divert precious funds from your beer/hooker fund.
 
EMApplicant said:
1. Try your best to maintain a life, preferably a sex life.

2. Don't kill any patients on purpose; try not to kill any patients by accident either.

3. No admission is a good admission.

4. Don't drink on the job. Do sleep on the job.

5. Don't read any of that medical stuff; do read for pleasure.

6. No case is an “interesting” case, don't bore your fellow residents with one.

7. AMA is your friend.

8. Don’t be afraid to actually prescribe/give drugs. Doing nothing looks bad. Bonus points if you know what the drug is actually for.

9. Do hit on the nurses, preferably the ones that are hot and single. However, in a pinch - or on a call night - any will do.

10. The only journal you should be subscribed to is Playboy. This goes for women too.

11. Always remember that your fellow interns come before your patients at all times. (i.e. do not post-pone another intern's d/c home to do silly **** like "patient care" - take their sign-out now.)

12. All in-patients should be written for low calorie, ADA, no salt diets. If they're not diabetic now, they will be. If they’re not fat yet, they will be. This is preventive medicine at its finest. More importantly, it also tastes like **** and will enhance their desire to go home. This will leave you with less work and more time for #1.

13. Always remember, nurses are the enemy. Take Sun Tzu's advice and keep them closer than your friends. Especially when engaged in #2.

14. Don't waste your precious money on buying monogrammed scrubs. They make you look like a douchebag and divert precious funds from your beer/hooker fund.
Click to expand...
😀 😀 😀
May I have your permission to copy this as my signature?
As I have allready nominated a niner post for post of the month I nominate this for the post of April.
 
EMApplicant said:
1. Try your best to maintain a life, preferably a sex life.

2. Don't kill any patients on purpose; try not to kill any patients by accident either.

3. No admission is a good admission.

4. Don't drink on the job. Do sleep on the job.

5. Don't read any of that medical stuff; do read for pleasure.

6. No case is an “interesting” case, don't bore your fellow residents with one.

7. AMA is your friend.

8. Don’t be afraid to actually prescribe/give drugs. Doing nothing looks bad. Bonus points if you know what the drug is actually for.

9. Do hit on the nurses, preferably the ones that are hot and single. However, in a pinch - or on a call night - any will do.

10. The only journal you should be subscribed to is Playboy. This goes for women too.

11. Always remember that your fellow interns come before your patients at all times. (i.e. do not post-pone another intern's d/c home to do silly **** like "patient care" - take their sign-out now.)

12. All in-patients should be written for low calorie, ADA, no salt diets. If they're not diabetic now, they will be. If they’re not fat yet, they will be. This is preventive medicine at its finest. More importantly, it also tastes like **** and will enhance their desire to go home. This will leave you with less work and more time for #1.

13. Always remember, nurses are the enemy. Take Sun Tzu's advice and keep them closer than your friends. Especially when engaged in #2.

14. Don't waste your precious money on buying monogrammed scrubs. They make you look like a douchebag and divert precious funds from your beer/hooker fund.
Click to expand...


That's great!!! 👍 Thanks for all of the advice everyone. Keep it coming if there are other tidbits!!
 
EMApplicant said:
1. Try your best to maintain a life, preferably a sex life.

2. Don't kill any patients on purpose; try not to kill any patients by accident either.

3. No admission is a good admission.

4. Don't drink on the job. Do sleep on the job.

5. Don't read any of that medical stuff; do read for pleasure.

6. No case is an “interesting” case, don't bore your fellow residents with one.

7. AMA is your friend.

8. Don’t be afraid to actually prescribe/give drugs. Doing nothing looks bad. Bonus points if you know what the drug is actually for.

9. Do hit on the nurses, preferably the ones that are hot and single. However, in a pinch - or on a call night - any will do.

10. The only journal you should be subscribed to is Playboy. This goes for women too.

11. Always remember that your fellow interns come before your patients at all times. (i.e. do not post-pone another intern's d/c home to do silly **** like "patient care" - take their sign-out now.)

12. All in-patients should be written for low calorie, ADA, no salt diets. If they're not diabetic now, they will be. If they’re not fat yet, they will be. This is preventive medicine at its finest. More importantly, it also tastes like **** and will enhance their desire to go home. This will leave you with less work and more time for #1.

13. Always remember, nurses are the enemy. Take Sun Tzu's advice and keep them closer than your friends. Especially when engaged in #2.

14. Don't waste your precious money on buying monogrammed scrubs. They make you look like a douchebag and divert precious funds from your beer/hooker fund.
Click to expand...


I love #12! :laugh:
 
colforbinMD said:
😀 😀 😀
May I have your permission to copy this as my signature?
As I have allready nominated a niner post for post of the month I nominate this for the post of April.
Click to expand...


👍
 
EMApplicant said:
12. All in-patients should be written for low calorie, ADA, no salt diets. If they're not diabetic now, they will be. If they’re not fat yet, they will be. This is preventive medicine at its finest. More importantly, it also tastes like **** and will enhance their desire to go home. This will leave you with less work and more time for #1.
Click to expand...

I'm going to start implementing this... seriously! :laugh: :laugh: :laugh:
 
GeneralVeers said:
Outgoing intern, but some advice:

2. Don't argue with attendings (save that for the end of senior year).
Click to expand...

:laugh:
General Sir,

No intern has ever followed this advice, including you.
 
colforbinMD said:
😀 😀 😀
May I have your permission to copy this as my signature?
As I have allready nominated a niner post for post of the month I nominate this for the post of April.
Click to expand...

I didn't know we did post of the month, we should make it a club! you can start the thread colforbin!

Also, I like the prescribing drugs one best, haha bonus points if you know what its used for!!hahahaha.

This was actually a very helpful thread while I watch some TV and eat my burrito from Taco bell! Trying to get some multi-tasking practice in!
 
BKN said:
:laugh:
General Sir,

No intern has ever followed this advice, including you.
Click to expand...


These rules apply to others, not me.

I reserve the right to argue with any attending who wants to admit "back pain" or "sore throat" to the hospital. I'm an advocate for my patients, and the best thing for most patients is to go home.
 
waterski232002 said:
I'm going to start implementing this... seriously! :laugh: :laugh: :laugh:
Click to expand...

You will never get burned for ordering a patient healthy (but tasteless) food. You will look dumb on rounds if you accidentally admit that surgical patient, that just happens to also be a diabetic, with orders for a regular diet.
 
Koko said:
Thanks niner. I asked this question before with no response: given the cost of Rivers, I bought Ma's "Just the Facts". Is that good enough, or is Rivers really worth the extra $ for a review book?
Click to expand...

It really depends on your learning style. I have both and used Rivers extensively prior to the inservice. I use Just the Facts as a substitute for reading Tintinalli prior to our conference quizzes when I'm running out of time. Not that that ever happens as an intern.

I really like the bulleted, BRS-type approach of Rivers. Your mileage, obviously, may vary.

Take care,
Jeff
 
Jeff698 said:
It really depends on your learning style. I have both and used Rivers extensively prior to the inservice. I use Just the Facts as a substitute for reading Tintinalli prior to our conference quizzes when I'm running out of time. Not that that ever happens as an intern.

I really like the bulleted, BRS-type approach of Rivers. Your mileage, obviously, may vary.

Take care,
Jeff
Click to expand...

Thanks for answering my question. If anyone has thoughts on Rivers v. Just the Facts, I'd be curious to hear.
 
waterski232002 said:
I'm going to start implementing this... seriously!
Click to expand...

EMApplicant said:
You will never get burned for ordering a patient healthy (but tasteless) food. You will look dumb on rounds if you accidentally admit that surgical patient, that just happens to also be a diabetic, with orders for a regular diet.
Click to expand...

I know.... that's why I love it so much!
 
DOnut said:
I saw a similar thread in peds with some great stuff for those who will be doing pediatrics. Sooooo, I am seeking the advice, knowledge and expertise of our EM seniors. What should we in coming R1's expect, and do you have any recommendations for a successful transition?
Click to expand...

How about in terms of what kind of shoes are MOST comfortable. No, I'm not a female, and can't believe I'm actually asking this, but it is late and just in the typing mood. Really, what shoes?
 
JackBauERfan said:
How about in terms of what kind of shoes are MOST comfortable. No, I'm not a female, and can't believe I'm actually asking this, but it is late and just in the typing mood. Really, what shoes?
Click to expand...

Nike bought out Cole-Haan so now you can get full leather uppers on a dress shoe with a Nike "Air" heel. They are awesome, super comfortable, worth the $$$ (these are the most expensive shoes I've ever owned!) And the full leather cleans well if you have a good layer of polish on.

http://store.nordstrom.com/product/...75097&NextStyleID=2857227&PrevStyleID=2858927
 
Dansko professional clogs (with the enclosed heel...the open backed ones should come with a coupon for free physical therapy). Go for comfort, not dress shoe appeal. The patients don't notice, but your feet will. And they're gonna get dirty if you're doing your job right.

JackBauERfan said:
How about in terms of what kind of shoes are MOST comfortable. No, I'm not a female, and can't believe I'm actually asking this, but it is late and just in the typing mood. Really, what shoes?
Click to expand...

I'll second the "get out of town" advice listed above. Go somewhere...anywhere. This time is precious, and use it well.

Don't waste this time reading trash (Tintinalli's, journals). If you need to read something useful, read "The Spirit Catches You and You Fall Down" by Anne Fadiman, a thoughtful and highly entertaining book about the misunderstandings between doctors and our patients. It should be required reading for ALL fourth year medical students.
 
JackBauERfan said:
How about in terms of what kind of shoes are MOST comfortable. No, I'm not a female, and can't believe I'm actually asking this, but it is late and just in the typing mood. Really, what shoes?
Click to expand...


Dude...I love my Birkenstock Bostons. I've worn dansko clogs (too girly, and more importantly too narrow a heel), and running shoes (great for the first 4 hours, less so as the shift goes on), but the Birks are now it...I wear them everywhere now.

BUT, footwear is such an individual thing that you may have to try a few out before settling on something.

Good luck.


Willamette
 
JackBauERfan said:
How about in terms of what kind of shoes are MOST comfortable. No, I'm not a female, and can't believe I'm actually asking this, but it is late and just in the typing mood. Really, what shoes?
Click to expand...

I've never worn shoes more comfortable than Danskos - they even help my back on long days. I second the closed heel version. For a long time I resisted trying them because I thought that they were girly, but I don't care anymore and I've had various non-medical people comment on how "cool" they look. Regardless, my s.o. hasn't left me because of them. 🙂
 
Anyone have clog advice/recs for a size 14 guy?
 
Koko said:
I've never worn shoes more comfortable than Danskos - they even help my back on long days. I second the closed heel version. For a long time I resisted trying them because I thought that they were girly, but I don't care anymore and I've had various non-medical people comment on how "cool" they look. Regardless, my s.o. hasn't left me because of them. 🙂
Click to expand...

Ok so it seems like Birkenstock Bostons, and Danskos are up in the running. But I understand trying them on is the best thing because everyone has different preferences.
 
chalk up one more vote for the dansko's. i have two pair, the typical ones that you see everyone wearing...and now for my favorito pair...the dansko sports. those damn shoes rock the world. kinda squishy like normal shoes, but still provide all the necessary support that one needs. i too have tried the tennis shoe route, major uncomfortable, feet feel like they might fall off. be prepared to shell out 125 for danskos, kinda pricey but i can all but guarantee that you will never wear them out.
 
Agree - Dansko Sport are the bomb. I wear them outside of the hospital too...
 
I have the Merrell MOCs - they're incredibly comfortable and look nice with scurbs (though not so good with dress pants). However, since i'm on the short side, I go with Danskos since they add about 2.5 inches! 😀. Which brings me to a sad 5'5"... but anyway. Being a guy, you probably don't have this problem, so I would at least take a look at the Merrells (at least with scrubs).
 
quideam said:
I have the Merrell MOCs - they're incredibly comfortable and look nice with scurbs (though not so good with dress pants). However, since i'm on the short side, I go with Danskos since they add about 2.5 inches! 😀. Which brings me to a sad 5'5"... but anyway. Being a guy, you probably don't have this problem, so I would at least take a look at the Merrells (at least with scrubs).
Click to expand...

This shorty's gonna have to go for the Danskos.

2 WHOLE FREAKING INCHES!!! That's almost as much as I get from a respectable-height heel!!!
 
i converted from merrels to danskos - they're much more supportive and better for lots of walking. for standing maybe merrels would win, but for now i am all about the danskos!
 
So I dont want to read through the whole thread. Someone want to give me the Executive summary for the shoe thing.

Im 6'2 and I wear 13s... Anyone wanna help a brother out? Money is not an issue since this will be a grad gift 😀
 
EctopicFetus said:
So I dont want to read through the whole thread. Someone want to give me the Executive summary for the shoe thing.

Im 6'2 and I wear 13s... Anyone wanna help a brother out? Money is not an issue since this will be a grad gift 😀
Click to expand...
Apparently it's Dankso's in the lead, preferably the Sport, with a heel though most people agree they ARE girly they are still in the lead.
I am the same measurments EF, but for me money IS an issue, so I suggest you try em out and tell me what you think. 😀
 
EctopicFetus said:
So I dont want to read through the whole thread. Someone want to give me the Executive summary for the shoe thing.

Im 6'2 and I wear 13s... Anyone wanna help a brother out? Money is not an issue since this will be a grad gift 😀
Click to expand...

yeah seems like dansko's are in the top, i couldnt' really find a sport version, but only looked for like 30 seconds before I got bored and went to watch TV. But I think I'm going to get some!
 
JackBauERfan said:
yeah seems like dansko's are in the top, i couldnt' really find a sport version, but only looked for like 30 seconds before I got bored and went to watch TV. But I think I'm going to get some!
Click to expand...
Got ya covered again Jackyboy 🙂
http://www.plowhearth.com/product.a...tured&search_value=3060&cur_index=&pcode=8837

I can't find em on www.dansko.com. Closest looking shoe I found there was the Dankso Men's Professional clog. Maybe they don't make a Sport model and more?
 
colforbinMD said:
Got ya covered again Jackyboy 🙂
http://www.plowhearth.com/product.a...tured&search_value=3060&cur_index=&pcode=8837
Click to expand...

i checked out your link to the sports. they didn't have mine on the site. the
ones on the bottom (black) are the closest to mine. Mine are a more of a red-suede finish. the only reason that i bring this up is because those choices on the net are really not fashionable. those ugly things might deter people. whatever, they are for comfort not style...i'm such a girl!
 
kbrown said:
i checked out your link to the sports. they didn't have mine on the site. the
ones on the bottom (black) are the closest to mine. Mine are a more of a red-suede finish. the only reason that i bring this up is because those choices on the net are really not fashionable. those ugly things might deter people. whatever, they are for comfort not style...i'm such a girl!
Click to expand...
What about here?
http://www.dansko.com/Product_Detail.aspx?StyleName=Professional (Men)&ID1=206&ID2=020202&VID=701
 
JackBauERfan said:
Yeah thats what I did, went to dansko.com and went to the professional clog photo. Yep, saved me again! The sport ones do look cool.
Click to expand...
Yeah the first link I posted only has women sizes. I can't find Dansko Sports for Men. I find links for them but the pages won't open so I am guessing they are no more.
 
You can always go for the fire engine red patent leather for that manly look. :laugh:
 
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