Downtime for Med Students during ED Shifts

[Dr.CCM]

What do you guys suggest doing for the brief 5-20 minutes of downtime med students sporadically get during a shift?

After asking if the residents need help with anything, I've been bringing my assigned EM readings and one of those pocket EM books to read while I wait on a new patient to arrive. I try not to look at my phone much or the iPad.

I dont want to seem disinterested but not sure what else I should be doing besides studying, is this a good idea?

Any suggestions from attendings on how studying looks or what else I should be doing?

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[WilcoWorld]

Most ED's have copies of EM texts around. You can try reading up on something you saw that shift from one of these texts. Alternatively, if none of the docs needs help, you can ask the nurses or techs if there are any IV's you can start for them.

Staying off of the iDevices is a good idea. It's hard for a spectator to tell if you're looking up a drug dosage or updating your Facebook status.

 

[EMmotherhen]

Be a volunteer. Ask to help with IVs, procedures, fetch/carry. Even if it's just grabbing me a water out of the fridge I'm going to remember that really helpful guy more than the one who stayed in the shadows and my SLOE will say so....

 

[Doctor Bob]

Staying off of the iDevices is a good idea. It's hard for a spectator to tell if you're looking up a drug dosage or updating your Facebook status.

^^^^ If you get nothing else from this whole thread remember this. ^^^^

Also, often if you're engrossed in your tablet/iphone/whatever I may pass you up to ask another student to help with something because I figure you're busy.

There is so much going on in the ED all the time that there is always something you can find to do... but only if you're motivated. And inability to find something to do is either lack of interest on your part or timidity but I have no way of knowing which.

 

[dotcb]

Make sure you've introduced yourself to all the staff in the ED. Offer to help the nurses. Don't be too intense. Try not to create extra work for the people supervising you.

 

[Dr.CCM]

Great point with all these suggestions. I'll make sure to offer to do some IV starts next time I'm sitting down with nothing to do. Prob just gonna leave my phone in my backpack so I'm not tempted to look at it.

Just wanted to make sure that reading an EM Pocketbook and our assigned readings was okay too.

 

[EM4life]

Bringing some sort of study guide or book is good, but the best students I've worked with take the initiative to follow up on labs/imaging, reevaluate the patient. These are things that are an immense help for the resident and will also show your ability to follow through with a patient rather than just the initiate eval and ordering of tests which most students are capable of. Nothing makes me more happy than a med student showing that initiative and to do it before I've had a chance to get to it.

 

[Birdstrike]

What do you guys suggest doing for the brief 5-20 minutes of downtime med students sporadically get during a shift?

After asking if the residents need help with anything, I've been bringing my assigned EM readings and one of those pocket EM books to read while I wait on a new patient to arrive. I try not to look at my phone much or the iPad.

I dont want to seem disinterested but not sure what else I should be doing besides studying, is this a good idea?

Any suggestions from attendings on how studying looks or what else I should be doing?

Downtime? There is no downtime. Wipe the entire concept out of your gray-matter flash drive right now. Nothing will make you stick out like a sore thumb like being the one person in a busy ED with "downtime." If you have downtime, go see another patient. Nothing can make you appear to "get it" and fit in more than always keeping moving, and exuding the appearance that no matter how busy, how tired, how exhausted or overwhelmed you are, that you always have the fire in your belly for seeing more, and more, and more, and more patients. If you want a summary of Emergency Medicine in eight words, that's it: "More, and more, and more, and more patients". If that seems weird, irrational, or distasteful, take note Jedi. Take note.

 

[sylvanthus]

I would not try and read in the ED. Do what everyone is suggesting and work hard and try and make everyone elses job easier. You will be remembered for that.

 

[WilcoWorld]

Downtime? There is no downtime. Wipe the entire concept out of your gray-matter flash drive right now. Nothing will make you stick out like a sore thumb like being the one person in a busy ED with "downtime." If you have downtime, go see another patient. Nothing can make you appear to "get it" and fit in more than always keeping moving, and exuding the appearance that no matter how busy, how tired, how exhausted or overwhelmed you are, that you always have the fire in your belly for seeing more, and more, and more, and more patients. If you want a summary of Emergency Medicine in eight words, that's it: "More, and more, and more, and more patients". If that seems weird, irrational, or distasteful, take note Jedi. Take note.

Well yeah, but the floors and ICUs have nurse to patient ratios and caps. The ED, on the other hand, has expanding walls.

 

[DrYoda]

I would not try and read in the ED.

Agree. If you're going to read anything scan uptodate real quick to learn something about a patient you have. Cracking open a book to read in the ED is going to look weird. you can probably find a new pt to pick up, or a procedure to assist with/do instead of reading.

Ask the residents to grab you if there's suturing or procedures to do. Suturing especially residents are usually happy to let the student take the time sink to do instead of them, and it's great practice for you.

 

[swamprat]

What about attendings that are not that student "friendly" and/or r too busy to hear about a new patient? What do u do if u haven't presented a pt I think at least where I'm rotating at its frowned upon to pick up a new one without presenting the other one first. The other resident would b busy too in this scenario.. Do u just wait? And besides the sloe it seems pretty hard to get in with any attending box they seem to want to hear only from residents and hence I am always presenting and learning from the pgy3s which is awesome I'm learning a lot but they can't write me a lor outside of the sloe.

 

[Apollyon]

I'm just a nobody, and maybe just a crusty old man, but "you", "are" and "be" are all words. If it is the way you express yourself to use single letters that sound the same as the words while writing, just don't be surprised if someone mentions it, and not in a good way.

 

[DoctorMedic]

What about attendings that are not that student "friendly" and/or r too busy to hear about a new patient? What do u do if u haven't presented a pt I think at least where I'm rotating at its frowned upon to pick up a new one without presenting the other one first. The other resident would b busy too in this scenario.. Do u just wait? And besides the sloe it seems pretty hard to get in with any attending box they seem to want to hear only from residents and hence I am always presenting and learning from the pgy3s which is awesome I'm learning a lot but they can't write me a lor outside of the sloe.

I would echo all above statements of definitely no electronics, use the computer to look something up on epocrates, micromedex, uptodate, etc. I would frequently print up some articles from up to date and read those while on shift. If you absolutely need to check your phone for something go to the bathroom and do it there, out of sight of residents and attendings.

The problem you described can be tough, I definitely worked with a few attendings as an MS4 that only wanted the resident to present to them. The key is don't think these residents don't have any say in your SLOR or ranking. Also attendings are usually pretty observant and they aren't looking to see if you know every disease and treatment, they ware watching your work ethic the most. Keep working and you should be fine.

 

[TooMuchResearch]

I would echo all above statements of definitely no electronics, use the computer to look something up on epocrates, micromedex, uptodate, etc. I would frequently print up some articles from up to date and read those while on shift. If you absolutely need to check your phone for something go to the bathroom and do it there, out of sight of residents and attendings.

The problem you described can be tough, I definitely worked with a few attendings as an MS4 that only wanted the resident to present to them. The key is don't think these residents don't have any say in your SLOR or ranking. Also attendings are usually pretty observant and they aren't looking to see if you know every disease and treatment, they ware watching your work ethic the most. Keep working and you should be fine.

I use my phone for EMRA Abx, Wiki EM, and 10 Second EM. I do not sit around texting, writing emails, checking SDN, etc. I think the resident and staff docs are savvy enough to realize that if I am writing orders or working on a note and whip out my phone for 15 seconds, it was probably work related.

 

[e30ftw]

If you have downtime, go see another patient. Nothing can make you appear to "get it" and fit in more than always keeping moving, and exuding the appearance that no matter how busy, how tired, how exhausted or overwhelmed you are, that you always have the fire in your belly for seeing more, and more, and more, and more patients.

I agree with the overall sentiment of your post however I don't agree that med students should be picking up patients whenever they have a moment to spare. We use EMR so all charting/orders must be done by MDs. Med students are helpful for lacs/abscesses but otherwise for medical patients they slow down overall disposition.

I encourage students to take time to read about the patients they see, go see an interesting patient in the ED (who has already been charted on, etc), or observe/perform procedures.

However for the majority of patients, having a student see the pt at onset disrupts and slows dispo. If I have 8-10 patients, some of them sick, and a trauma/stroke/STEMI is rolling in, and a med student says "hey will you see Mr. Jones with me?" that basically means I have to pick the patient up and do ALL the work (h&p, orders, consults, dispo) when if they would've just left it in the chart another less busy resident would've picked it up. This is obviously fine occasionally but when there is a never ending onslaught of students picking up patient after patient and having no idea what is going on with them and then me having to figure it out, chart, order, consult, chief, dispo, etc it gets annoying. Sometimes we let studs chart but that takes forever as they aren't used to the system.

cliff notes: med students, carry 2-3 pts at a time, know your pts, help out with lacs/i&ds and other procedures, help out with tech/rn type stuff (wound care, splinting, IVs, trauma) and read about your patients. Picking up 5 patients in 30 minutes just because you have time is NOT going to help ED flow.

 

[gutonc]

I use my phone for EMRA Abx, Wiki EM, and 10 Second EM. I do not sit around texting, writing emails, checking SDN, etc. I think the resident and staff docs are savvy enough to realize that if I am writing orders or working on a note and whip out my phone for 15 seconds, it was probably work related.

Even if I know you can do all that stuff on your phone, I will always assume you're updating your FB status. Always.

 

[deleted547339]

Even if I know you can do all that stuff on your phone, I will always assume you're updating your FB status. Always.

Give him the benefit of the doubt. He could be sending a text or possibly tweeting.

 

[Dr.CCM]

Wow. Thanks for all the suggestions.

My institution doesn't allow students much access to patients records or the EMR. So I can really only monitor labs or imaging or orders unless I want to bug a resident who are swamped.

What I did do was help out the staff, took any new patient that came off the board, volunteered for anything that needed to be done and just did it. Barely sat down for the entire shift except in a patients room. Day went by much faster too.

Thanks for all the suggestions! Tough friggin work. Real helpful though!

 

[EM2BE]

If there is down time (on occasion, even I have down time because we cleared the waiting room and we only have 5 pts in the ED like last night), please read something. I had students who were eager to learn, so it makes it so much easier to teach. They seemed to get it - went with me if there was a new patient, or if no one was in the room yet seeing the patient, they went in there. They didn't slow down the flow for the most part, plus we had time to teach them. It's an odd occurrence, but it's great when it happens. I've had students reading and totally missed an intubation and needle decompression on a pt just down the hall. If you are reading, make sure you are aware of your surroundings. We will remember if you were that one reading and not paying attention.

Also, I know phones have utility in looking things up. I have had students say they were going to look up a drug, looked it up, then talked about it. This is a good use of current technology.

 

[NERDY]

you can probably find a new pt to pick up, .

I would say picking up a new patient depends on the time left during the shift and how many patients the med student currently has. I would rather the med student do a good job with fewer patients than pick up a bunch and make a mess.

 

[NERDY]

I did two EM rotations, honored both and matched successfully. During down time, I did read EM Case Files or EM pre test. My school also had required provided reading. I did questions in USMLE world for step 2. At both places, I was able to track labs, imaging, etc. I think you just have to gauge the flow and decide what's best. I would stay off the iphone, blackberry, etc. However, make sure you check your email often on the computer (not smart phone) for interview invites, ERAS updates, etc once ERAS opens.

 

[dchristismi]

Eh, give me a medical student that only triples my work, and I'll kiss his feet. Isn't that how the saying goes?

Our students are not allowed to chart, so when they see another, it means my workload increases. I generally pick and choose who I have them see. Going and checking on your patients is always good. A pocket review book is good. Don't mess around on your idevices. Learn to suture. Learn to drain abscesses. Learn a really good physical exam. You can also ask around to see if anyone had any interesting physical findings. When I happen to see something cool, you'd better believe I'm going to teach about it, whether it's a classic ITP rash or a patient with a LVAD. (Hey student, go listen to the guy in 14 and come back and describe his heart sounds to me).

 

[alpinism]

Even if I know you can do all that stuff on your phone, I will always assume you're updating your FB status. Always.

FB? I'm not a 13yo girl. I'm usually looking up porn or my fav racist joke.











/sarcasm (Agreed, stay off the iPhone esp on audition rotations)

 

[Birdstrike]

Eh, give me a medical student that only triples my work, and I'll kiss his feet. Isn't that how the saying goes?

Laws of the House of God

Law #11.SHOW ME A BMS (Best Medical Student, a student at the Best Medical School) WHO ONLY TRIPLES MY WORK AND I WILL KISS HIS FEET.

 

[dchristismi]

(I made a crack about finding a patient at orthopedic height one day, and the nurse looked at me like I had 2 heads... sigh. I guess I'm getting old.)

The book may not really be relevant to modern practice, but the laws are still golden: They can always hurt you more.

 

[Xerxes1729]

The book may not really be relevant to modern practice, but the laws are still golden: They can always hurt you more.

A lot of the details about how teaching hospitals are staffed and function have definitely changed, but the dehumanization of patients engendered by the training process is still there. I always thought that was the main point of the book, rather than the corrupt business practices, lack of supervision, and sexual escapades.

 

[gimghoul]

IVs are almost always available.

 

[swamprat]

Aside from the SLOR(or SLOE) letter that by default you'll get, I need a LOR from an ER doc. What is the best way to go about doing this? Its strange because theres a lot of attendings so I may only work with one once or twice but I hear thats the best you can do. Should I email the attending at the end of the rotation and ask? Only reason I ask is because I don't know if I'll work with him/her again and right now itd be too soon to ask. Thanks.

 

[aqualung]

Ok, so I was the weirdo who brought a book with me and read briefly on the off chance that there was down time, and you know what? It was useful. I reviewed procedures and meds and found people were more likely to let me do things when I knew the indications for the procedure, complications, etc. Got an ED intubation as a med student this way.
Plus as a resident you will never have time like this to read on shift, let alone pee for 10-12 hours straight sometimes, so take advantage of it as a student.

Downtime is the best time to hang out with nurses and techs to learn more about IVs, setting up EKGs, etc.

And like has been stated before, don't overwhelm your resident or attending by seeing too many patients. Its tempting as a med student to just keep picking up patients, but someone else still has to also see, chart and put in order on them usually.

 

[KinesiologyNerd]

We had students rotating through our ED from time to time. I think the attending's favorite students were the ones who just sat back and shot the **** with us when it was slow. Also, if your ED has scribes, help a brother out and make sure they can hear you when you present the patient.

 

[gro2001]

Aside from the SLOR(or SLOE) letter that by default you'll get, I need a LOR from an ER doc. What is the best way to go about doing this? Its strange because theres a lot of attendings so I may only work with one once or twice but I hear thats the best you can do. Should I email the attending at the end of the rotation and ask? Only reason I ask is because I don't know if I'll work with him/her again and right now itd be too soon to ask. Thanks.

I would probably ask them at the end of the shift. You can also give them a list of the other attendings you worked with on that rotation so your LOR writer can ask around to substantiate whatever opinion he has formed about you.