clerkship question for residents or faculty in residency program

[ysm13n]

Hello,

I am an OMS II interested in EM. In a couple months we will be selecting our rotation sites. We have options of using our home institution's medical center which is an hour from where I live, or being set up in 2 community hospitals which are 10 minutes from where I live. The big medical center option has higher acuity patients ( approx 30 % admission rate) and the local options are more of the slower community types. there are no residents in the community hospital options so I get more one on one with the attending. I want to be as impressive as I can be when I eventually do our Sub-I's. Will my skipping out on the bigger medical center experience make me less prepared for when I do Sub-I's at bigger places? From reading a few threads, I understand that in terms of clinical knowledge I ll be expected to present patients well, go through basic clinical steps and not be a jerk. But I'm not sure if being at a smaller place will effect that.

Are SLOE's looked at differently from ED's with no residency? During fourth year we have plenty of elective time to try and get into other ERs. What do you guys think? Staying local would be easier on family life but I am willing to travel if it will make me a better candidate.

I have no ER adviser available at my school so thank you!

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[HankTheTank910]

Your fourth year is when you'll be doing the ER rotations that matter. That's when you'll get your SLOEs, and if you choose the smaller community hospital, then yes, you will probably need SLOEs from two larger institutions with ER residencies. I can say that without a doubt that the cases at the larger medical center will be more involved and acute than what you'll find at a smaller hospital. With that said, as long as the smaller hospital has good pathology and teaching I can't see a reason why you couldn't choose that option for your third year. You'll probably get more hands on experience, and won't be competing with residents for time, attention, or procedures. Remember that 3rd year is not about trying to learn how to manage the zebra pathology that you'll see in tertiary centers. For the most part you need to learn the basics of managing heart failure, the presentation of appendicitis, how to deliver a baby, and how to differentiate bipolar vs schizophrenia. These are the topics on step 2, and these are the concepts you first need to learn before you start thinking about your fourth year rotations.

Keep this in mind this, though: Working with attendings as a third year is way overrated, in my opinion. The residents you'll be working with, mostly anywhere you train, will have infinitely more knowledge than you about their field (maybe not the early interns). They'll understand better your level of knowledge, and can connect with you more than attendings- you'll also likely get more teaching. They can teach you everything you need to know as a third year medical student so long as they're decent residents. Not trying to dissuade you from choosing the community route, but that should not be a tipping point in your decision making as a third year medical student.

 

[ysm13n]

Your fourth year is when you'll be doing the ER rotations that matter. That's when you'll get your SLOEs, and if you choose the smaller community hospital, then yes, you will probably need SLOEs from two larger institutions with ER residencies. I can say that without a doubt that the cases at the larger medical center will be more involved and acute than what you'll find at a smaller hospital. With that said, as long as the smaller hospital has good pathology and teaching I can't see a reason why you couldn't choose that option for your third year. You'll probably get more hands on experience, and won't be competing with residents for time, attention, or procedures. Remember that 3rd year is not about trying to learn how to manage the zebra pathology that you'll see in tertiary centers. For the most part you need to learn the basics of managing heart failure, the presentation of appendicitis, how to deliver a baby, and how to differentiate bipolar vs schizophrenia. These are the topics on step 2, and these are the concepts you first need to learn before you start thinking about your fourth year rotations.

Keep this in mind this, though: Working with attendings as a third year is way overrated, in my opinion. The residents you'll be working with, mostly anywhere you train, will have infinitely more knowledge than you about their field (maybe not the early interns). They'll understand better your level of knowledge, and can connect with you more than attendings- you'll also likely get more teaching. They can teach you everything you need to know as a third year medical student so long as they're decent residents. Not trying to dissuade you from choosing the community route, but that should not be a tipping point in your decision making as a third year medical student.

Thanks for the great points.

 

[racerwad]

...

Are SLOE's looked at differently from ED's with no residency? During fourth year we have plenty of elective time to try and get into other ERs. What do you guys think? Staying local would be easier on family life but I am willing to travel if it will make me a better candidate.

I have no ER adviser available at my school so thank you!

SLOEs must come from residency program faculty (usually the clerkship director, PD, or some other faculty designee). Therefore, a SLOE from any institution without an EM training program will not help.

As @HankTheTank910 said above, it will be residents that are going to be the most helpful, both in day-to-day ED stuff as well as helping you through the process. I would not let short term inconveniences ruin the hard work you've already put in. Of course, that inflection point is different for different people. Good luck.

 

[ysm13n]

SLOEs must come from residency program faculty (usually the clerkship director, PD, or some other faculty designee). Therefore, a SLOE from any institution without an EM training program will not help.

As @HankTheTank910 said above, it will be residents that are going to be the most helpful, both in day-to-day ED stuff as well as helping you through the process. I would not let short term inconveniences ruin the hard work you've already put in. Of course, that inflection point is different for different people. Good luck.

Thank you also for the great points.