Doing Well on Away

[SeekerOfTheTree]

---

Members do not see this ad.

Hello,

I am sure this has been asked before but doing a search on the mobile app version of SDN I was not able to find the answer.

I wanted to ask what are good tips for doing well on away rotations? I am not a rockstar but would like to think am an average student by SDN standards. I would be happy matching at where I am doing my aways but am not sure what I can do to increase the odds. Any tips?

Looking at the SLOR format I feel like I have to better than everyone else to get a good SLOR. It seems pretty hard.

 

[Arcan57]

Hello,

I am sure this has been asked before but doing a search on the mobile app version of SDN I was not able to find the answer.

I wanted to ask what are good tips for doing well on away rotations? I am not a rockstar but would like to think am an average student by SDN standards. I would be happy matching at where I am doing my aways but am not sure what I can do to increase the odds. Any tips?

Looking at the SLOR format I feel like I have to better than everyone else to get a good SLOR. It seems pretty hard.

Work hard, don't look at the clock, say "yes" to any requests for help, use your free time (off-shift) to study up on what you saw, be nice to everyone, make sure you understand what the expectations are for you during a shift and if you don't then ask, and BE ON TIME.

If you have lecture in the middle of a shift that's not attended by the residents then make your departure time and arrival well known to your supervisor (and call if you're going to be significantly later). Know at every minute of the shift why the patients you are following are still in the emergency department.

And I guess specifically for away rotations, don't bash the city where you are rotating. Also, if you can socialize with the residents without turning into a drunken sh-tshow then take every opportunity to do so.

 

[SeekerOfTheTree]

Thank you. That's a really good response. Just doing those things can make me have a good SLOR? I have a week off an I have been studying for EM like crazy.

 

[Aesculapius]

Recognize that you're doing EM and not IM, and tailor your H&P's and presentations accordingly.

 

[SeekerOfTheTree]

This will sound silly but what if I access epocrates on my phone to look stuff up. I don't want to seem like I am goofing off.

 

[SeekerOfTheTree]

Would it be too much to ask for an example of an EM HP. Is it like surgery?

 

[OccupyTheED]

Show up about 15 minutes before your shift, stay after to finish up any procedures and help dispo your patients. Read this, it's got a lot of great info

 

[OccupyTheED]

Sorry, missing attachment

 

[OccupyTheED]

This will sound silly but what if I access epocrates on my phone to look stuff up. I don't want to seem like I am goofing off.

Not at all, most people do. If there's any question just make it clear that you're accessing a medical resource

 

[SeekerOfTheTree]

Thank you for that link!

 

[SeekerOfTheTree]

Thank you for the help and the clerkship guide!

 

[SeekerOfTheTree]

.

 

[dotcb]

Show up for sign-out 10 min early. Never be late. Own your patients. Stay after your shift to finish up all relevant work related to your patients (example: finish a lac, get someone admitted). Clarify w/ Attg or senior before your shift - ask if they have any particular preferences or expectations for the shift. A good goal is 1-2 min presentations. Have a good differential diagnosis with at least 5 things on it, ordered from most to least dangerous. Tell them what you think is actually going on with the patient. Come up with your own plan, including diagnostic testing, treatment, and disposition (admit, discharge, consult). Shoot for 1 patient an hour. Listen to the EM BASIC podcast. At the end of every shift, thank your supervisor for teaching you and ask if they have any feedback for you. The things I look for in students that make them stand out are enthusiasm/attitude, ownership, hustle, curiosity,and having a solid knowledge base.

 

[gman33]

Understand the workflow and know how you picking up patients impacts those you are working with. If you are presenting directly to attendings, you are probably creating more work for them if there is no resident involved in the process.
I.e - they have to do all the documentation etc.
Some may not like it if you pick up too many patients with this setup.

Better to pick up fewer patients and really know what is going on and be generally helpful.

Also, make sure you present patients quickly even if you have to be somewhat pushy (without being too annoying).

I had a situtation on an away where I wasn't able to present a patient for like 2 hours. I told the attending multiple times that I needed to present, but there were a lot of crazy things going on in the department and this was a very stable patient with nothing much going on. Don't want to go into the details too much, but I think this really hurt me on my eval, even though overall I did very well with the other attendings.

 

[SeekerOfTheTree]

Thank you for the tips. Which EM podcast should I listen to? I have subscribed to one by a resident in San Antonio. It sounds good.

 

[strongboy2005]

If you could recommend one book, to be read from cover to cover, in the two weeks leading up to the rotation, what would you choose? I would like to have a book that can be read over the course of 2 weeks with some dedication before starting my EM rotation.

 

[dotcb]

I like Emergency Medicine Secrets (no conflict of interest). Very readable in short, digestible chapters.

 

[EM_Rebuilder]

Dont try to carry a bunch of patients at once.

You should have one, at most, two patients at one time. Know them well. When the attending/senior resident asks 'Whats the status of the CT scan?'.. The answer is not "I dont know, its been ordered". The answer should be "I just checked with the nurses, the MVC in room 2 is going first and our guy is up next"... etc.

Know your patients well, know whats going on with them at all times, watching labs/scans/etc and bird dog those constantly..

Be nice to nurses/techs/etc.

It was already mentioned, but I will say it again. If asked to socilize with the residents, GO.. even if they get plastered, DONT... a little is ok, but dont become 'that one visiting med student that was drunk'...

Show up early, stay late.

Ask the Residency Coordinator when/if there is Jounral Club and if you can go...

 

[Old Grunt]

Hello,

I am sure this has been asked before but doing a search on the mobile app version of SDN I was not able to find the answer.

I wanted to ask what are good tips for doing well on away rotations? I am not a rockstar but would like to think am an average student by SDN standards. I would be happy matching at where I am doing my aways but am not sure what I can do to increase the odds. Any tips?

Looking at the SLOR format I feel like I have to better than everyone else to get a good SLOR. It seems pretty hard.

A massive screw up I made on one of my aways was not introducing myself to the PD (I didn't get any shifts with them, but had several with the APD).

Huge mistake and really stupid.

So don't do that.

 

[High Roller]

I did three EM rotations, all at very competitive west coast programs. I wasn't even close to the most knowledgable student, but I did well at all of them and got great SLORS. Only reason I mention this is to show that you don't have to be the sharpest guy or give the best patient presentations to do well.

My advice:

1- Show up early to every shift. About 20 mins or so.

2- Stay late until everything is taken care of.

3- ATTITUDE. Never ever complain. Work really hard when you're there. Learn to make fun of yourself and accept criticism with grace. And be positive and friendly to everyone. Hate to say it, but a few of my fellow rotators sucked at this. You'll probably see this happen too. Super bright students, but just not fun people to be around.

4- Get to know people. If residents ask if you want to go grab a beer after a shift (and they probably will) "hell yes" is your answer. These people have a say in your grade and ultimately in the interview process (at least at my place).

It may have just been my experience, but very little of doing well dealt with medical knowledge and patient presentations. Given, you need to be somewhere near par with this stuff, but you don't need to be exceptional. I think more what they want to know is that you're enjoyable to work with and that you're teachable. Again, n=1, so take it with a grain of salt, but it does seem lots of other posters are echoing some of this simple stuff.

Hope it helps, good luck. You got this.

 

[pianoman511]

All of the above. In addition -

1) If you have time or are able to, look up/reference some info about the top things on your differential list before presenting to an attending including any relevant criteria (i.e. Nexus, Canadian CT, Ottawa, TIMI, etc.).

2) If there is ANY concern about looking like you're goofing off on your phone (some older attendings definitely may think this), grab a few print references to throw in your white coat to review when you have down time. Some good ones include Tarascon pharmacopeia, EMRA's clinical decision card (has all the often used criteria), EMRA's clinical problems in EM (has a great outline of common chief complaints), and your Maxwell's. Sometimes they're actually quicker than whipping out your phone plus the batteries never wear out 😛.

3) Be honest and do your best. It's as simple as that. 😀

 

[dhbighit]

First post in a few years, so first of all, thanks for the great advice in here so far. Second, im not a big smart phone fan, what would you say are the two best pocket resources for: 1- Pharm (dosing), and 2- EM differential formation.

 

[SeekerOfTheTree]

Thanks for all the helpful tips guys. It is good to know that I have a chance of doing well if I work hard even if I might not know the answer to everything. I am excited.

 

[Daiphon]

Thanks for all the helpful tips guys. It is good to know that I have a chance of doing well if I work hard even if I might not know the answer to everything. I am excited.

Good attitude. As I'm sure you already know, dispo trumps diagnosis (though diagnosis is very important).

As such, knowing the answer to *everything* isn't as important as knowing what to do to find it. This is why we have DDx & workups.

Breathe. Relax. Kick some @$$. d=)

-d

PS - nurses love it when someone helps with their stuff (IVs, NGTs, ABGs, etc) & for your level those things are really good learning. Help them out when you can & they'll get your back when the excrement collides with the oscillating air circulator. d;-)

Sent from my DROID BIONIC using Tapatalk

 

[Aesculapius]

First post in a few years, so first of all, thanks for the great advice in here so far. Second, im not a big smart phone fan, what would you say are the two best pocket resources for: 1- Pharm (dosing), and 2- EM differential formation.

For print references:
1. Tarascon Pharmacopeia
2. Couple different options. EMRA makes a little handbook (most common clinical problems or something like that). Tarascon EM, although pretty abbreviated. Pocket Emergency Medicine is fairly comprehensive but not that well-organized, and doesn't have dosages.

 

[dotcb]

Make sure you introduce yourself to everyone on shift, including the nurses. Communicate with the nurses once orders have been put in - "Just wanted to let you know we put in some orders on Ms. X for Y and Z."

 

[SeekerOfTheTree]

Man these are all really good tips. Stuff that would have been easily overlooked by me. I love talking and introducing myself and generally come off as a friendly guy. So I hope this works for me.

 

[dhbighit]

For print references:
1. Tarascon Pharmacopeia
2. Couple different options. EMRA makes a little handbook (most common clinical problems or something like that). Tarascon EM, although pretty abbreviated. Pocket Emergency Medicine is fairly comprehensive but not that well-organized, and doesn't have dosages.

Thanks a lot- Yeah I have the pocket EM and its not my favorite, think im gonna go with the EMRA book, I think I got that in the mail a few months back for joining EMRA, I just have not been able to find where I put it, ha.

 

[jbar]

The best advice I can give for medical school (EM too but just in general) if the phrase "what can I do to help?"

If it's slow and you say this is shows that you aren't just goofing off, you are interested, you are ready to go. That helps a lot. And it shows you are a team player.

Other tips:

really invest in finding out where things are in the department. One of the things that goes far in EM is autonomy, being given a task and being able to go and acomplish it. So if you are going to suture or start an IV, learn where the stuff you need is kept so you don't have to keep asking people. Learn where x-ray, CT, the lab is so when someone tells you to go bring a patient somewhere or get bloods you know where you are going.

Also keep in mind the the levels of a medical learner. Level 1 is "here's what I found" level 2 is "here is what I'm worried about" and level 3 is "here's what I want to do"

So it's easy to go see a patient and come back and know they have chest pain and shortness of breath, the next level is saying "I'm worried about PE, MI, dissection." And the finial level is to be able to say "I want to get an ECG, chest x-ray, troponins."

Work towards that third level. Lots of med students give a great info gathering history, and then stop. If you know what you are talking about say what you want to do. They'll overide you if you are wrong but you'll get better teaching and look like a more advanced student if you can come up with some of your own plan.