EM R-1's Report!

[corpsmanUP]

Let's hear from you interns....how are things going at your program thus far? It's been a blast here at the U of Iowa. I'm about burned out though of merrit badge courses and animal labs. ATLS, PALS, ACLS, NRP.... I think they serve their purpose obviously, but to have them back to back almost is tough, when interspersed in between a bunch of orientation shifts. And so much for orientation shift.....I stopped trying to get oriented about 2 hours into my first shift and decided that it was better to learn as I went. I've learned that you get to do almost as much as you want if you simply step up to the plate and start making decisions. Sure the attending or upper level will grab you buy your collar and jerk you back to reality when you make a dumb decision, but I am finding a healthy balance of autonomy and teaching. Our attendings are all unbelievably patient and interested in our learning.

The downside is the major academic teaching facility and it's paperwork and processes that seem to cause everyone to do more work than necessary. But overall I would say that our scutwork is way less than average. If I had one wish, it would be to come up with an efficient way of balancing the need for EMR charting and actual patient care. We have this multi-million dollar EMR that is extremely nice, but gone are the T sheets and now we are expected to do some serious documentation. And so it is not uncommon for our upper levels to be about 7-8 charts behind at the end of the shift, requiring them to either do them at home online or stay and do them after work for an hour or two. This is not every shift, but it can be frequent. We are breaking in a new EMR so it is not perfect yet.

So what do you other "terns" have to say? Let's hear ya!

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[12R34Y]

It's going pretty well. Orientation shifts are just that.....orientation. Lots of suturing, lots of I&D's.

ACLS, PALS, ACLS instructor, NRP, ATLS etc....fun stuff.

next month will be on off service ICU. should be interesting.

later

 

[kbrown]

I am sad...if anyone has read, I am off service for 8 of my 12 months this year. I started on Nephro. Today, as I was walking to the lab to look at pee under the microscope, I walked past the Dept of EM offices...I almost cried (not literally of course). But I was begging for them to take me back to the ED. I miss seeing patients, treating them and transferring or discharging. This whole "long term care" crap is killing me. I always wondered how I would do without the continuity of care..........RESOUNDING ANSWER IS JUST DAMN FINE.

I love my patients, really fun people, but emotionally, its too much. Today had 3 DNR consents, one angry family meeting and a trip to the lab to look at pee (seriously). I am learning a ton but, WOW. Starting on Nephrology is kind of like trying to sip from a fire hose. Not to mention that b/c I am starting (and staying) off service for awhile, I always get the "stupid ER" comments. Getting old. Oh well. Whatever. Today was a bad day, I am tired and have to be in by 530-545 AM tomorrow, gotta jet. I have had many great days, hell I got flowers from a patient the other day.

 

[DrMom]

I'm off service for 7 months and am currently on surgery (wound care/plastics). I get to spend 6 hrs in the ED when I'm off service, which helps some, but I can't wait to spend some real time there.

Today was tons better than yesterday because I wasn't scrubbing in all day. Somehow I've got to read 40 pages of Rosen tonight, though.

 

[corpsmanUP]

I don't like someone telling me to read. I read on my own because I want to get better. I had two patients last night who were altered elderly nursing home residents. So tonight I spent time reading on AMS out of various texts. BTW, I hate the way Tintinalli's breaks down AMS into delerium, dementia, and coma, as if there is no in between. Both my elderly patients had infectious etiologies, but they were not comatose! GCS 11 actually.

That stinks to be on off-service stuff like nephro. Who the hell agreed to let your residents go on that crazy rotation....sounds rather freaking pointless to me. At least our off service rotations are pertinent. I have 6 months off service this year....rads, IM, trauma, ortho, burn, and anesthesia. I have a rather nice schedule for fall but a tough schedule in the spring.

I just try to focus on the good things I am getting to do and things I am learning every day. I tubed my first kiddo last night...thought for sure they were going to kick me out of the room when I snuck up to the head of the bed with the scope, tube, and suction over my shoulder. But no, they just pushed the atropine, fentanyl, and succ, and told me to take my time. I couldn't believe my upper level and attending let me do it being on my 5th orientation shift and having taken PALS the same day!!

 

[Dr.MISHKA D.O.]

I started off service as well, on OB/GYN - yeah!. I must say that with so many c-sections and high risk OB that it is a real fight to get the 10 normal vaginal deliveries the RRC requires, but I finished them off last night. I must say I feel a bit impotent, what with the OB/GYN interns always giving me the stink eye for "stealing their deliveries," and the residents and nurses giving me the old "oh your the EM intern, just sit over there and wait for a delivery."
Mostly I do scut work, such as q 2 hr labor notes, Delivery notes, and sign orders that nurses plop in front of me "I turned up the Pit to 14, here sigh this - I put in a foley, here sign this, write me an order for 4 of zofran." Yes Ma'am! Not how I really pictured my residency going.
The OB Residents largely ignore the students and the OB intern doesn't even aknowledge their existence, so I try to teach them simple things about OB that yes even a dumb EM intern knows. One of them on the last week of their rotation told me they had never even done a pelvic exam, so I took the time to show them how on a model - the residents won't let the students anywhere close to the real thing, even with me supervising. And yet, they still ask me dumb esoteric OB questions that of course I don't know, to which I reply "that would be something excellent to look up and present to the group."
Anyway, next month I am in the ED and things have to get better. At least I'm getting paid, but I certianly don't think I earned my paycheck this week even though I "worked" 76 hours.
Oh yeah, and after reading 100 pages of Rosen for this months text review exam, our program director informs us at conference we will be instead staring to reading those chapters in Rosen pertinent to our rotation (i.e. OB Emergencies) and taking a CORD online test that we must pass to get credit for our rotation. Yeah! Back to the drawing board - what freaking chapter is that in Rosen anyway.

Best wishes

The Mish

 

[JackBauERfan]

I am sad...if anyone has read, I am off service for 8 of my 12 months this year. I started on Nephro. Today, as I was walking to the lab to look at pee under the microscope, I walked past the Dept of EM offices...I almost cried (not literally of course). But I was begging for them to take me back to the ED. I miss seeing patients, treating them and transferring or discharging. This whole "long term care" crap is killing me. I always wondered how I would do without the continuity of care..........RESOUNDING ANSWER IS JUST DAMN FINE.

I love my patients, really fun people, but emotionally, its too much. Today had 3 DNR consents, one angry family meeting and a trip to the lab to look at pee (seriously). I am learning a ton but, WOW. Starting on Nephrology is kind of like trying to sip from a fire hose. Not to mention that b/c I am starting (and staying) off service for awhile, I always get the "stupid ER" comments. Getting old. Oh well. Whatever. Today was a bad day, I am tired and have to be in by 530-545 AM tomorrow, gotta jet. I have had many great days, hell I got flowers from a patient the other day.

Don't worry, I'm in the same situation here, doing the prelim medicine, I have heard some of those 'that er doc was crazy ordering that test' type comments, and everyone knows I'm going into EM, but I just brush it off. I'm really enjoying this year though, I definitley agree that EM will be much better, and some of the 'moving patients and talking to family' they do a lot of in internal medicine is just boring to me. I try to make it interesting by sticking out in the ED when I'm on call and just answering calls and stuff from there. I was on call last night and had admissions nonstop until about 2am, so did not get the chance.

So far the countdown to EM is 350 days, except I am doing an EM month in December!

 

[GeneralVeers]

Mostly I do scut work, such as q 2 hr labor notes, Delivery notes, and sign orders that nurses plop in front of me "I turned up the Pit to 14, here sigh this - I put in a foley, here sign this, write me an order for 4 of zofran." Yes Ma'am! Not how I really pictured my residency going.

Many rotations are like that, especially in the ICU. If there were good nurses who wanted something done, I would say "Tell me what you want to do and I'll write the order".

 

[il matadori]

I started off service as well, on OB/GYN - yeah!. I must say that with so many c-sections and high risk OB that it is a real fight to get the 10 normal vaginal deliveries the RRC requires, but I finished them off last night. I must say I feel a bit impotent, what with the OB/GYN interns always giving me the stink eye for "stealing their deliveries," and the residents and nurses giving me the old "oh your the EM intern, just sit over there and wait for a delivery."
Mostly I do scut work, such as q 2 hr labor notes, Delivery notes, and sign orders that nurses plop in front of me "I turned up the Pit to 14, here sigh this - I put in a foley, here sign this, write me an order for 4 of zofran." Yes Ma'am! Not how I really pictured my residency going.
The OB Residents largely ignore the students and the OB intern doesn't even aknowledge their existence, so I try to teach them simple things about OB that yes even a dumb EM intern knows. One of them on the last week of their rotation told me they had never even done a pelvic exam, so I took the time to show them how on a model - the residents won't let the students anywhere close to the real thing, even with me supervising. And yet, they still ask me dumb esoteric OB questions that of course I don't know, to which I reply "that would be something excellent to look up and present to the group."
Anyway, next month I am in the ED and things have to get better. At least I'm getting paid, but I certianly don't think I earned my paycheck this week even though I "worked" 76 hours.
Oh yeah, and after reading 100 pages of Rosen for this months text review exam, our program director informs us at conference we will be instead staring to reading those chapters in Rosen pertinent to our rotation (i.e. OB Emergencies) and taking a CORD online test that we must pass to get credit for our rotation. Yeah! Back to the drawing board - what freaking chapter is that in Rosen anyway.

Best wishes

The Mish

"The OB Residents largely ignore the students and the OB intern doesn't even aknowledge their existence, so I try to teach them simple things about OB that yes even a dumb EM intern knows."

Nice to know that my school is not the only place where this crap happens. After the OB rotation I seriously went in front of a mirror to make sure I was still visible. I worte on my eval that I wanted my tuition money from that 6 weeks back......................

 

[8744]

We are off-service for 10 months. The downside is that I'm essentially repeating intern year but this time without the two easy months of out-patient peds and the month or so of touchy-feely, empathetic stuff that makes one vomit but does result in an easy schedule.

(Not to mention the half-day a week of clinic which could be a drag especially as I was starting to see the same patients again and again.)

The upside is that we have almost all EM rotations in second and third year with a relatively light schedule and no call. (14 twelve hour shifts per month)

I just have to repeat that they could drive a red-hot poker up my ass, even dip it in salt first, and I still prefer repeating intern year to what I was doing last year. Folks, if I hadn't have matched I would have probably gone back to engineering.

But it's all right now. I like my program so far, the other residents are pretty cool, and if I am ever tempted to complain I just remember how much I disliked my previous specialty and how lame it was.

"You sure look happy for an intern," is a comment I hear a lot.

 

[8744]

I started off service as well, on OB/GYN - yeah!. I must say that with so many c-sections and high risk OB that it is a real fight to get the 10 normal vaginal deliveries the RRC requires, but I finished them off last night. I must say I feel a bit impotent, what with the OB/GYN interns always giving me the stink eye for "stealing their deliveries," and the residents and nurses giving me the old "oh your the EM intern, just sit over there and wait for a delivery."
Mostly I do scut work, such as q 2 hr labor notes, Delivery notes, and sign orders that nurses plop in front of me "I turned up the Pit to 14, here sigh this - I put in a foley, here sign this, write me an order for 4 of zofran." Yes Ma'am! Not how I really pictured my residency going.
The OB Residents largely ignore the students and the OB intern doesn't even aknowledge their existence, so I try to teach them simple things about OB that yes even a dumb EM intern knows. One of them on the last week of their rotation told me they had never even done a pelvic exam, so I took the time to show them how on a model - the residents won't let the students anywhere close to the real thing, even with me supervising. And yet, they still ask me dumb esoteric OB questions that of course I don't know, to which I reply "that would be something excellent to look up and present to the group."
Anyway, next month I am in the ED and things have to get better. At least I'm getting paid, but I certianly don't think I earned my paycheck this week even though I "worked" 76 hours.
Oh yeah, and after reading 100 pages of Rosen for this months text review exam, our program director informs us at conference we will be instead staring to reading those chapters in Rosen pertinent to our rotation (i.e. OB Emergencies) and taking a CORD online test that we must pass to get credit for our rotation. Yeah! Back to the drawing board - what freaking chapter is that in Rosen anyway.

Best wishes

The Mish

That's unusual. At Duke, it was my impression that the OB people loved the EM residents because they could put them in triage and everybody was happy.

You have to be aggrssive on OB if you do it early. I was fortunate to have had it in May so the OB interns were tired of doing vaginal deliveries and were happy to let me do them.

But I hear you about doing OB as an intern. Please see my blog where I relate my experiences as an FP intern on the Duke OB service.

 

[Apollyon]

But I hear you about doing OB as an intern. Please see my blog where I relate my experiences as an FP intern on the Duke OB service.

So I was reading your blog (haven't in a while) and note the one line about "As the emergency department sends up every pregnant patient who is not spurting arterial blood, it also functions as an obstetrical emergency department."

Oh, how wrong you are, and did we WISH we could do that. God's honest truth, people are so stupid, I was constantly 1. amazed that instinct actually kicked in and people could deduce/guess what goes where 2. demoralized by how ignorant and apathetic women were about their bodies.

When you are in the ED, you will realize how much Ob DOESN'T go upstairs.

 

[bulgethetwine]

So I was reading your blog (haven't in a while) and note the one line about "As the emergency department sends up every pregnant patient who is not spurting arterial blood, it also functions as an obstetrical emergency department."

Oh, how wrong you are, and did we WISH we could do that. God's honest truth, people are so stupid, I was constantly 1. amazed that instinct actually kicked in and people could deduce/guess what goes where 2. demoralized by how ignorant and apathetic women were about their bodies.

When you are in the ED, you will realize how much Ob DOESN'T go upstairs.

Yup. Gotta side Apoll on this one. Sorry Gus.

 

[8744]

Yup. Gotta side Apoll on this one. Sorry Gus.

I stand corrected. But I have to point out that I saw many patients in OB triage who had complaints unrelated to their pregnancy who who did not belong in OB triage.

I won't sat where, but on a medical school EM rotation every pregnant patient who was not a trauma or medical emergency was sent directly to OB triage as a matter of course.

I'm not saying I agreed with the practice but that's what they did.

 

[Dr.MISHKA D.O.]

Don't get me wrong I got along fine with the nurse's (my wife is a nurse) and I thought that OB residents were very cool, and we got along fine it is just frustrating to finally be a resident, but be down graded to student status, I wasn't even allowed in triage, and couldn't even write some pt notes as "that pt is too complex for the EM intern."
I don't think that this was done to be a d!@% to the EM intern, it was just CYA. None the less frustrating, making me way jealous of those staring on EM. Didn't mean to highjack the thread with the OB thing.

Best Wishes

The Mish

 

[ERMudPhud]

I won't sat where, but on a medical school EM rotation every pregnant patient who was not a trauma or medical emergency was sent directly to OB triage as a matter of course.

You can argue the pro's and con's of it but there are plenty of places where this is policy/tradition for any patient over a certain gestational age, usually around 20-24 weeks. At those places every patient who isn't grossly unstable goes up to L&D, gets evaluated, and sent back to the ED if it isn't an OB problem. I've seen SOB, chest pain, corneal abrasions, all sorts of things make a pit stop in L&D first before coming back down.

 

[EctopicFetus]

FYI we had our retreat weekend.. Awesome time.. Man I am glad to be here.

 

[Dr.MISHKA D.O.]

Survived my first night of call (newborn nursery) without any gliches and didn't even fall asleep during the post call EM conference. Yeah for me!
Thirty hours straight, man I am glad I picked EM, can't imagine doing that every 4th night for 3-5 years.

Best Wishes

The Mish