EM PD - Ask Me Anything

[gamerEMdoc]

@gamerEMdoc
Hi, thanks for your advice. Just wanted to ask 1 question. Is it frowned upon doing an EM sub specialty rotation at the same place as my audition rotation and getting a SLOE and sub-spec SLOE. I am having a difficult time finding a sub specialty rotation within my area and was thinking of asking the PEDs EM department were I am currently doing my audition for a rotation. Is this alright to do?

Yeah, Peds EM is a subspecialty; its one of the choices for a subspecialty sloe

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[gamerEMdoc]

Got my Step 2 CK score back today with only a 2 point increase from my Step 1 score last year. Step 2 CK is in the upper 230s. Any idea on how I can go about salvaging my application for this upcoming year? Only ever have wanted to match into EM, and currently feel like I just torpedoed my chances with this mediocre score with hardly any increase from last year.

Edit: Also, I'm a DO student.

That step score would predict a match rate over 95% for an MD and probably about 90% for a DO. I'm not sure why you think it torpedoed your application. I think you have an unrealistic expectation of how competitive EM is. People match in EM with far lower board scores than that. The people that don' match in EM don't match because of poor SLOEs, not because of their board scores.

 

[Pokedoc]

That step score would predict a match rate over 95% for an MD and probably about 90% for a DO. I'm not sure why you think it torpedoed your application. I think you have an unrealistic expectation of how competitive EM is. People match in EM with far lower board scores than that. The people that don' match in EM don't match because of poor SLOEs, not because of their board scores.

Thank you for the reply. Yeah it looks like I panicked and overreacted, probably because I have been spending too much time on SDN and Reddit looking at scores and reading random experiences of previous students. It probably doesn't help that I haven't been able to get much help in regards to this from my advisor.

Thank you again it cleared my head. I'll just make sure to crush my audition and get a great SLOE!

 

[jerseyguy123]

Yeah, Peds EM is a subspecialty; its one of the choices for a subspecialty sloe

@gamerEMdoc Thank you for your response. Is it frowned upon to do the Peds EM rotation at the same hospital I currently have my EM audition at, and get a SLOE and sub-speciality SLOE from both rotations?

 

[gamerEMdoc]

@gamerEMdoc Thank you for your response. Is it frowned upon to do the Peds EM rotation at the same hospital I currently have my EM audition at, and get a SLOE and sub-speciality SLOE from both rotations?

I don't think so. I mean, ideally in other years you'd have more variety, but this isn't most years. I think that is perfectly acceptable.

 

[jerseyguy123]

I don't think so. I mean, ideally in other years you'd have more variety, but this isn't most years. I think that is perfectly acceptable.

Thank you for your response and help

 

[pillowsnice]

Do you think it is necessary to attend the virtual residency fair at the end of this month?

 

[gamerEMdoc]

Do you think it is necessary to attend the virtual residency fair at the end of this month?

There is a residency fair this month? The EMRA residency fair is usually in October. It will be virtual, and details of this years virtual fair haven't been announced yet as fare as I know. I'm not aware of one this month.

That being said, it is definitely not necessary to attend a residency fair but can be helpful if you feel like you may be screened out from programs you are specifically interested in because of geography or board scores or something else.

 

[ERinspired]

There is a residency fair this month? The EMRA residency fair is usually in October. It will be virtual, and details of this years virtual fair haven't been announced yet as fare as I know. I'm not aware of one this month.

That being said, it is definitely not necessary to attend a residency fair but can be helpful if you feel like you may be screened out from programs you are specifically interested in because of geography or board scores or something else.

SAEM is holding one this month

 

[Doctor_Strange]

EM med student twitter is mad annoying. all the enthusiasm seems fake as hell

Dude, I agree 100%. It is a bit nauseating, and I think many do it to sell themselves which I guess is okay everyone is anxious but still. I actually like #medtwitter though for the #FOAMed. It legitimately makes me a better student. The rest I can do without.

 

[gamerEMdoc]

Dude, I agree 10000%. It is nauseating. I actually like #medtwitter though for the #FOAMed. It legitimately makes me a better student. The rest I can do without.

Disagree. I enjoy medtwitter and medstudenttwitter quite a bit. Different strokes for different folks I guess.

 

[Doctor_Strange]

Disagree. I enjoy medtwitter and medstudenttwitter quite a bit. Different strokes for different folks I guess.

I amended my statement actually since I like #medstudenttwitter too; it's just those select tweets that come off a bit artifical. And then it becomes almost an arms race of who can sell their love for EM better than others. I know that's a pessimist view, but I've seen it in person.

Edit: I have friends joining Twitter and treating their profiles almost as an extension of ERAS. I'm not sure it's necessary. I could be wrong.

 

[gamerEMdoc]

I amended my statement actually since I like #medstudenttwitter too; it's just those select tweets that come off a bit artifical. And then it becomes almost an arms race of who can sell their love for EM better than others. I know that's a pessimist view, but I've seen it in person.

Edit: I have friends joining Twitter and treating their profiles almost as an extension of ERAS. I'm not sure it's necessary. I could be wrong.

Yeah i find that absurd. Honestly I like it more when people are anonymous anyways bc you know they are more than likely being honest and sincere.

 

[boolin_1]

I amended my statement actually since I like #medstudenttwitter too; it's just those select tweets that come off a bit artifical. And then it becomes almost an arms race of who can sell their love for EM better than others. I know that's a pessimist view, but I've seen it in person.

Edit: I have friends joining Twitter and treating their profiles almost as an extension of ERAS. I'm not sure it's necessary. I could be wrong.

this is exactly how it is. they're putting on a persona to show programs and PD's that they have lots of enthusiasm. that enthusiasm can be real or it can be fake. every student who has created a medtwitter account within the last 2 months has ulterior motives.

 

[boolin_1]

Also it’s a little hard reading all these other students coming off their shifts with all this energy and being super excited, knowing full well this is exactly what they want to do. Tweeting out all this super cool **** they got to see & do.

and there’s me getting chewed out by the attendings, trying to get a full H&P in a 100% Spanish patient population, jokes about my name from residents,all rooms are full so I’m trying to see patients in hallways and in the waiting room, not knowing where anything is, not knowing if im even doing bad, and worried about SLOE looking like ****.

medtwitter sucks to be a part of sometimes

 

[gamerEMdoc]

Also it’s a little hard reading all these other students coming off their shifts with all this energy and being super excited, knowing full well this is exactly what they want to do. Tweeting out all this super cool **** they got to see & do.

and there’s me getting chewed out by the attendings, trying to get a full H&P in a 100% Spanish patient population, jokes about my name from residents,all rooms are full so I’m trying to see patients in hallways and in the waiting room, not knowing where anything is, not knowing if im even doing bad, and worried about SLOE looking like ****.

medtwitter sucks to be a part of sometimes

To be fair, they may just be having a better rotation experience than you. They may be at a place that just is more supportive to medical students. I can see how frustrating that would be though to read if you aren't having the greatest experience. But that doesn't mean they are lying.

 

[boolin_1]

To be fair, they may just be having a better rotation experience than you. They may be at a place that just is more supportive to medical students. I can see how frustrating that would be though to read if you aren't having the greatest experience. But that doesn't mean they are lying.

Yeah I don’t think they’re lying, it’s just hard to read that sometimes when I’m not having a great time. It makes me wonder if I would be doing better/feeling better if I chose a different program to rotate at that was a little more supportive. And who knows what the end of rotation SLOE would look like at one of these more supportive places. Idk. Grass is always greener so I’m rolling with the punches

 

[pillowsnice]

Yeah I don’t think they’re lying, it’s just hard to read that sometimes when I’m not having a great time. It makes me wonder if I would be doing better/feeling better if I chose a different program to rotate at that was a little more supportive. And who knows what the end of rotation SLOE would look like at one of these more supportive places. Idk. Grass is always greener so I’m rolling with the punches

It's difficult to not look at those accounts, but for your own sanity try your best to worry about yourself and improving throughout your rotation. From personal experience, I've noticed that some students do "lie" a bit to make their lives look more exciting and enjoyable, but they are most likely struggling in the same way.

The only part that bothers me is the jokes about your name. Are they being playful with you or are they being downright mean? I feel like that could be a mistreatment case if it's the latter.

 

[boolin_1]

It's difficult to not look at those accounts, but for your own sanity try your best to worry about yourself and improving throughout your rotation. From personal experience, I've noticed that some students do "lie" a bit to make their lives look more exciting and enjoyable, but they are most likely struggling in the same way.

The only part that bothers me is the jokes about your name. Are they being playful with you or are they being downright mean? I feel like that could be a mistreatment case if it's the latter.

it was just a one time thing, I don't think he meant it to be malicious but just the timing of when he said it made it hurt since I am feeling pretty lost currently. But I am slowly getting better, the attending even said so at the end of the shift. So all hope is not lost. im just gonna keep chugging

 

[Doctor_Strange]

Also it’s a little hard reading all these other students coming off their shifts with all this energy and being super excited, knowing full well this is exactly what they want to do. Tweeting out all this super cool **** they got to see & do.

and there’s me getting chewed out by the attendings, trying to get a full H&P in a 100% Spanish patient population, jokes about my name from residents,all rooms are full so I’m trying to see patients in hallways and in the waiting room, not knowing where anything is, not knowing if im even doing bad, and worried about SLOE looking like ****.

medtwitter sucks to be a part of sometimes

Yeah, I am in a COVID hotspot. I get to see about half the patients my buddy in a more rural location gets to see. It is what it is. My only worry is what will the quality of my SLOE be when it is all said and done.

I have not yet been chewed out by anyone, but in an almost perverse way I kind of want one only because most of my feedback has been generic, "you are doing a good job" "you are taking the initiative" and a favorite feedback is to "try to own your patient " which is almost impossible when I cannot access the EMR to write a note or reassessment (I can go reassess the patient on my own and keep an eye out for impending labs/imaging but often times the resident gets to them before me and if I inform him or her they already read them).

it was just a one time thing, I don't think he meant it to be malicious but just the timing of when he said it made it hurt since I am feeling pretty lost currently. But I am slowly getting better, the attending even said so at the end of the shift. So all hope is not lost. im just gonna keep chugging

Yeah, sounds like a one-off. The fact that you took the joke in stride is a good thing.

 

[Doctor_Strange]

It's difficult to not look at those accounts, but for your own sanity try your best to worry about yourself and improving throughout your rotation. From personal experience, I've noticed that some students do "lie" a bit to make their lives look more exciting and enjoyable, but they are most likely struggling in the same way.

The only part that bothers me is the jokes about your name. Are they being playful with you or are they being downright mean? I feel like that could be a mistreatment case if it's the latter.

Yeah, embellishment is common among medical students -- both on Twitter and real life. I think, and I may be guilty myself on occasion, talk about a case as if I were running the show, when in fact we commonly are on the sidelines. I've noticed my surgery-minded friends tend to do this more so than others lol.

 

[Doctor_Strange]

I might as well offer my thoughts to the thread, spurred by @boolin_1, on how my rotation at a COVID hotspot is going:

Overall, I'm just happy to be here. The program has said we are not allowed to see any patients with fever, cough, or URI symptoms as they are presumed to be COVID until proven otherwise. Of course, the difficulty is someone can come to the ED c/o abdominal pain and end up being COVID positive. Half of the ED has been converted to a COVID unit and not even interns are allowed to see those patients. PPE so far is in good supply, but I am reusing my masks for at least three shifts before discarding them. We are not allowed to participate in traumas for the above reasons either which again I understand. As a result, the many COVID-likey patients that come through the med student cannot go so, so as a result, I saw only 2 patients by myself yesterday from start to finish (the interns say 1 the entire time). Regardless, Residents at this site are mostly happy to teach and involve me when I ask or let me tag along on cases at interesting points. I could see how someone who has a required EM rotation -- and does not want to pursue the specialty -- comes in, sits at a computer all shift and sees maybe one patient. However, most of the students I am with are applying EM.

It is pretty obvious that the only time to shine in front of the resident or attending is your case presentation. The rest appears to be just bonus points, ie. do a lac repair, help with patient set up, go get flush, etc. The other variable to account for is that I am also in a largely Spanish speaking location and using an interpreter on the phone makes an otherwise 10 minute patient encounter a bit longer.

The site I am at does a group SLOE and I think that may make sense on behalf of the program, but I worry that the end result is a more generic SLOE for the students. My take is that I feel that residents, as a whole, rarely offer critical feedback to students beyond good job, unless a student really does botch it with either a presentation or lies. Attendings are more likely to just tell you their unfiltered feedback which I appreciate, but so far it has tilted to 95% positive / seemingly generic. Probably the most critical piece of feedback I got was when I fumbled on naming the top three ddxs for a patient I presented or that I did not know the toxicity of a certain medication. And I worry that the written feedback at the end of these shifts could be more critical than the verbal feedback.

As I am halfway through this rotation, it has made me acutely aware that having one SLOE seriously makes this cycle a lot more anxiety-inducing. Not to mention half of the medical students here have not taken their boards so we are all studying CK / Level 2 on the side. To toot my own horn very briefly, continuing to study for boards was an asset a few days ago as I was able to answer a bunch of questions regarding SBP. Anyways, those are my stream-of-conscious thoughts -- hope that helps other med students on or about to begin their auditions.

Any insight @gamerEMdoc on my thoughts or experience? Trying to not let the typical med student neuroticism get the best of me!

 

[boolin_1]

having 1 SLOE is incredibly anxiety inducing. I didn't think it was going to be that big of a deal but now that i'm rotating, I am terrified. all of my residents have told me that by their 3rd SubI, that's where they really started to shine and got much much better. and I have one SubI with no prior experience. I really hope that gets taken into account, but we'll see.

and i'm couples matching. so great

 

[gamerEMdoc]

I think the issue is, by only having one sloe, the sloe will be devalued a bit this year in the application process. Other letters (like off service sloes) will play an important role. Maybe boards get weighed heavier than they usually do. Or medical school success. Who knows. Every program is going to weigh apps differently, and we've never gone through this before. But I can without a doubt say that the SLOE will be devalued at least somewhat, because there is no way programs can weigh someones competitiveness as an applicant all based on one rotation.

 

[Dr.Bruh]

I think the issue is, by only having one sloe, the sloe will be devalued a bit this year in the application process. Other letters (like off service sloes) will play an important role. Maybe boards get weighed heavier than they usually do. Or medical school success. Who knows. Every program is going to weigh apps differently, and we've never gone through this before. But I can without a doubt say that the SLOE will be devalued at least somewhat, because there is no way programs can weigh someones competitiveness as an applicant all based on one rotation.

The thing that really sucks about that is that bc these changes all happened so abruptly and late (after everyone was already pulled from rotations) a lot of applicants had no time or opportunity to adjust their apps to focus on the things that will now be weighted more heavily. I was always told off service letter don’t mean anything so I never bothered getting any. Now I’m struggling to find a rotation to get one prior to eras apps. Covid and all the prometric cancellations really threw a giant Wrench in my board studying (scored much lower than all of my practice exams for step 2). Scores are still fine for EM but I was always thinking “if I crush my sloes boards will be an afterthought”. But now it seems no matter how well i do on my audition it’s not gunna be enough to make up for the rest of my lackluster app and being a DO.

 

[Doctor_Strange]

The thing that really sucks about that is that bc these changes all happened so abruptly and late (after everyone was already pulled from rotations) a lot of applicants had no time or opportunity to adjust their apps to focus on the things that will now be weighted more heavily. I was always told off service letter don’t mean anything so I never bothered getting any. Now I’m struggling to find a rotation to get one prior to eras apps. Covid and all the prometric cancellations really threw a giant Wrench in my board studying (scored much lower than all of my practice exams for step 2). Scores are still fine for EM but I was always thinking “if I crush my sloes boards will be an afterthought”. But now it seems no matter how well i do on my audition it’s not gunna be enough to make up for the rest of my lackluster app and being a DO.

Right there with you. That's why I delayed my Step 2 CK exam date after a few forced cancelations. And then I thought, well let me go ahead and crush my own SLOE. But, @gamerEMdoc has reaffirmed my initial assumption which was that this year it seems -- unfortunate for all -- that board scores will generally be given more weight. I suspect other factors too will matter like where you went to school and geography connections (which has of course mattered in the past but now even moreso).

This cycle is not optimal for anyone. Hoping it works out for us all...

 

[gamerEMdoc]

Yeah I mean thats the thing, what else can you really do. It sucks for everyone. The spots will all still get filled, so the opportunity is still there. How they get filled, who knows. Programs are scrambling, you see so many of them doing "online meet and greets" already to try and separate themselves from others. Its all a crapshoot.

Honestly I'm looking at it like its only one year. Maybe two if we truly continue to screw this up as a country. It is really stressful and unfortunate for the medical school classes that have to go through it, but there's nothing you can do about it. You can't change the situation you are all put in. All you can do is do your best from an application standpoint. All programs can do for recruiting is do their best despite having way less rotations and no onsite interviews. There's really nothing else you can do other than continue to adapt.

For programs, they have the benefit of this only being a 1-2 year thing (hopefully). It mostly sucks for the applicants, because this is their one year.

 

[12jas]

The thing that really sucks about that is that bc these changes all happened so abruptly and late (after everyone was already pulled from rotations) a lot of applicants had no time or opportunity to adjust their apps to focus on the things that will now be weighted more heavily. I was always told off service letter don’t mean anything so I never bothered getting any. Now I’m struggling to find a rotation to get one prior to eras apps. Covid and all the prometric cancellations really threw a giant Wrench in my board studying (scored much lower than all of my practice exams for step 2). Scores are still fine for EM but I was always thinking “if I crush my sloes boards will be an afterthought”. But now it seems no matter how well i do on my audition it’s not gunna be enough to make up for the rest of my lackluster app and being a DO.

This is my exact situation. I had four auditions lined up that I anticipated getting letters from so i did not bother getting letters during third year. Now I am scrambling to find any rotations I can so I can get letters for my app.

Edit: one was a third year elective not an audition.

 

[gamerEMdoc]

To be fair, it has never been recommended to do four auditions and get foUr sloes. 2 EM rotations/sloes, 3 max, has always been the standard.

Still though, sucks nonetheless.

 

[hopefulERdoc251]

Hey @gamerEMdoc, quick question. Do you have any suggestions for reviewing material prior to an EM sub-I? It's my first rotation of M4 so I'm a bit antsy since I've been out of the clinical space for a year. I've remotely been keeping up with questions etc to try keeping stuff fresh. Is there any review resources you'd recommend to brush up on clinical knowledge? I just don't want to seem like a complete ***** when I start M4 and have it negatively impact my SLOE haha. Thanks!

 

[gamerEMdoc]

How much time do you have before your sub-i? ALIEM has a good bridge to EM curriculum that uses EMRAPs c3 episodes and a variety of blogs, but that takes like 6-8 weeks I think. The CDEM M4 curriculum is also free online and you could review that in a week or two prior to rotation.

 

[Phoodie]

Thoughts on academic vs. community EM programs? MS4 looking to eventually practice in a big city. I'm also highly considering a fellowship so 3 year programs are quite appealing.

 

[gamerEMdoc]

No matter where you go you will get adequate training. Fellowships in EM arent hard to get typically. Go where you want to live and/or where you really like the people.

University programs may have more resources and probably groom residents to enter a career in academia more, community programs you’ll likely have less consultants/residents to compete with for procedures (fracture reduction for example). But I’m sure there’s a university-based programs that have great procedural experiences, and there’s community programs the graduate people who become faculty straight out of residency at places.

All in all, I dont think its a terribly big deal.

 

[bigbrowndude]

@gamerEMdoc
I have a quick question that needs clarification (not sure if it’s already answered). I’m an MS4 at a DO school. Our MS3 rotations are done outside of our school’s state in what we refer to as “hubsite”. I’ve done an EM rotation at my hubsite last year at a non-residency center. I was going to ask my preceptor for a non-EM residency SLOE. For my audition rotation, I have one scheduled in a school-affiliated residency program next month back in our school’s state. The following month I have an US sub-speciality rotation scheduled out of state (not my hubsite or school state).

My question is if it is ok to have 3 different SLOEs in this case? I will have 1 EM-residency SLOE, 1 non-residency SLOE, and I have the possibility of earning 1 sub-speciality SLOE. Given this year’s circumstances and limitations, is this “too many” EM rotation and will this number of SLOEs be red-flagged?

 

[hopefulERdoc251]

How much time do you have before your sub-i? ALIEM has a good bridge to EM curriculum that uses EMRAPs c3 episodes and a variety of blogs, but that takes like 6-8 weeks I think. The CDEM M4 curriculum is also free online and you could review that in a week or two prior to rotation.

Unfortunately only ~3 weeks, but hoping to continue using it during my rotation...not really sure what'll be expected of us since the third years had been out of clinic since early March soooooo...but thanks!!

 

[Dr.Bruh]

@gamerEMdoc
I have a quick question that needs clarification (not sure if it’s already answered). I’m an MS4 at a DO school. Our MS3 rotations are done outside of our school’s state in what we refer to as “hubsite”. I’ve done an EM rotation at my hubsite last year at a non-residency center. I was going to ask my preceptor for a non-EM residency SLOE. For my audition rotation, I have one scheduled in a school-affiliated residency program next month back in our school’s state. The following month I have an US sub-speciality rotation scheduled out of state (not my hubsite or school state).

My question is if it is ok to have 3 different SLOEs in this case? I will have 1 EM-residency SLOE, 1 non-residency SLOE, and I have the possibility of earning 1 sub-speciality SLOE. Given this year’s circumstances and limitations, is this “too many” EM rotation and will this number of SLOEs be red-flagged?

No this is totally fine per cord recommendations. Just only one eSLOE (Residency non subspecialty). You can have as many of the other sloes that you want. I’ve seen PDs say the more letter in a “sloe” format the better.

 

[bigbrowndude]

No this is totally fine per cord recommendations. Just only one eSLOE (Residency non subspecialty). You can have as many of the other sloes that you want. I’ve seen PDs say the more letter in a “sloe” format the better.

Thanks!

 

[Pokedoc]

How important are solo shifts with residents/attendings for getting a good SLOE as a student while on an audition? Just got my schedule for my upcoming audition and I've got one solo shift with a resident while the other rotating students have around 4 or 5. The rest of the shifts we are paired with one other student.

I don't want to miss out on a chance to be evaluated properly on my own without having to split the patient load with another student and would like to politely ask if it's possible for me to get one or two more solo shifts, but I obviously also don't want to come off as annoying/neurotic since that could hurt me as well. I'm thinking I just need to make the best of the situation but thought I'd ask if you have any suggestions?

 

[gamerEMdoc]

How important are solo shifts with residents/attendings for getting a good SLOE as a student while on an audition? Just got my schedule for my upcoming audition and I've got one solo shift with a resident while the other rotating students have around 4 or 5. The rest of the shifts we are paired with one other student.

I don't want to miss out on a chance to be evaluated properly on my own without having to split the patient load with another student and would like to politely ask if it's possible for me to get one or two more solo shifts, but I obviously also don't want to come off as annoying/neurotic since that could hurt me as well. I'm thinking I just need to make the best of the situation but thought I'd ask if you have any suggestions?

I dont think its will make any difference.

 

[Phoodie]

@gamerEMdoc Any thoughts on the handful of EM programs not participating in ERAS 2021?

Link

 

[gamerEMdoc]

IDK, it seems odd. I went to two of their websites, Doctors and Duke, and both websites say the only way to apply is through ERAS. Maybe they didn't change their website? Or register for ERAS yet? IDK.

I don't know why a program would choose not to participate in ERAS. It makes no sense. How are you going to get a students letters of rec? Or MPSE?

My suspicion is, this is nothing but a registration issue or something like that.

 

[Dr.Bruh]

IDK, it seems odd. I went to two of their websites, Doctors and Duke, and both websites say the only way to apply is through ERAS. Maybe they didn't change their website? Or register for ERAS yet? IDK.

I don't know why a program would choose not to participate in ERAS. It makes no sense. How are you going to get a students letters of rec? Or MPSE?

My suspicion is, this is nothing but a registration issue or something like that.

On Reddit they are saying it just means that haven’t completed their eras app and will be added once that’s complete. Apparently Duke said not participating until a month before the app cycle opened last year.

 

[gamerEMdoc]

Figured it was something like that.

 

[DefinitelyNotMatt]

Trying to apply to a civilian EM residency after a tour in the Air Force. Completed an internship in pediatrics and switched into flight medicine. I’ll finish up my 3 year commitment this upcoming year and I’m trying to land a PGY-1 slot in EM. I’m a DO with above average COMLEX scores but not top 1%.
I’ve had a lot of PD’s tell me they’re interested in me but then a few say that they wouldn’t even interview me because of a funding issue. Apparently I wouldn’t be funded for the full 3 (or 4) years because I already completed an internship. I’ve heard anecdotal evidence where some people have no issue with funding. But I want to know the official guidance.
Am I going to be fighting an uphill battle for all programs? Is this a program specific thing? Wasn’t my internship federally funded through the Air Force instead of using Medicare money? What’s a good come back if I get a hard stop because of this issue?

 

[gamerEMdoc]

Not sure if you will get 2 or 3 years of funding, but I doubt it will be a big deal. So many programs are over their medicare cap. I highly doubt this will be an issue for you.

 

[Doctor_Strange]

Had a PGY-2 tell me in private to not rank their program. Seems he was in the middle of a rough stretch in his schedule -- said he got something like 9 hours of sleep in between 3 shifts. He was up mainly due to charts. I have enough awareness to know this resident was probably seriously burnt out at that point in time, but he told me a week later as well the same piece of advice -- in fact he specifically gave me a name of another program to look into.

It begs the question if having a dictation service available to residents should be seriously factored in when ranking programs. Being a DO, I feel already beggars can't be choosers, but while I have a strong Step 1 score (243) I still have not taken Step 2 and seems many of my classmates have been under-performing on CK by a good margin.

Anyways, it was a jarring moment for sure since I personally enjoyed the rotation, although many residents did stay back to finish charts. I'd venture to say this is not unique to this program, but rather endemic to EM (as a scribe I often saw attendings coming in 30 minutes early to finish charts from the night before).

 

[Oligodinero]

Had a PGY-2 tell me in private to not rank their program. Seems he was in the middle of a rough stretch in his schedule -- said he got something like 9 hours of sleep in between 3 shifts. He was up mainly due to charts. I have enough awareness to know this resident was probably seriously burnt out at that point in time, but he told me a week later as well the same piece of advice -- in fact he specifically gave me a name of another program to look into.

It begs the question if having a dictation service available to residents should be seriously factored in when ranking programs. Being a DO, I feel already beggars can't be choosers, but while I have a strong Step 1 score (243) I still have not taken Step 2 and seems many of my classmates have been under-performing on CK by a good margin.

Anyways, it was a jarring moment for sure since I personally enjoyed the rotation, although many residents did stay back to finish charts. I'd venture to say this is not unique to this program, but rather endemic to EM (as a scribe I often saw attendings coming in 30 minutes early to finish charts from the night before).

Yeah, finding a residency that has Dragon or some other speech recognition software will be a big part of where I rank. I worked as an EM PA prior to going back to med school and I never let myself get behind on charting.......I forced myself to finish up each chart as the patient was being discharged....which I'll concede was easier as I had my own scribe at nearly all times. This meant I never had to stay late or come in early for charting. I did see several physicians I worked with who'd get behind. A couple were nearly suspended because their charts were so far delinquent. One guy would come in 2 hours early every shift and sit in medical records working on his previous-day's charts. He drove 90 minutes to get to work, charted for 2 hours, then pulled a 10-hour shift, then 90 minutes back home...all in his early 70s. EFF THAT!

 

[gamerEMdoc]

When we went with epic, we put dragon on every computer and I built a bunch of dictation templates for everyone. No one has ever used the point and click templates. Prior to that, our charting was dictation.

Using a dictation based template with dragon is about the closest thing to dictation. The only thing that slows you down is correcting the mistranslations. Medical transcriptionist are much better than dragon at being accurate. Other than that, its not a super slow way to chart.

Some residents are better than others at getting out on time. Some keep up with their notes all shift and leave on time. Others for whatever reason never do their notes on shift, socialize during down time, and wait until the end. Which is a terrible habit to get into, because as you progress and it gets busier, it just means staying later and later.

Document past the physical exam after seeing the patient (should take a minute or two for most cases with dragon). Then at the closure of the case, finish the MDM. Do this every single time unless there is a critical patient that needs seen RIGHT NOW. Do not get in the habit of delaying your charts to the end. Its a terrible habit.

 

[gamerEMdoc]

You also have to consider shift length. We work 9's. If you work 8-9's, staying an hour after to dictate if you get behind way less of a deal than if you work 12's. Working 20 9's is a 40 hr work week. Working 20 12's is a 60 hour work week. It's a huge difference.

 

[bravotwozero]

When we went with epic, we put dragon on every computer and I built a bunch of dictation templates for everyone. No one has ever used the point and click templates. Prior to that, our charting was dictation.

Using a dictation based template with dragon is about the closest thing to dictation. The only thing that slows you down is correcting the mistranslations. Medical transcriptionist are much better than dragon at being accurate. Other than that, its not a super slow way to chart.

Dragon dictation is totally underrated, and frankly phenomenal in my experience. I purposely speak really fast into the dictaphone and it transcribes to near perfection. Way more efficient than most scribes mind you. With dragon plus a few pre-formed macros you can complete a chart in 2 minutes.