EM Rotations - AM vs. PM

[thehealer]

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This post is directed mostly towards the MS4's out there, but anyone can certainly chime in. I'm an MS4 going into EM that just finished my 2nd EM away rotation (yes it's late in the year...long story) with one more to go. I really enjoyed my first one, but pretty much hated the 2nd one, which I am finishing up now. And here's why: At the first I was busy all the time. There were always new patients to be seen, and depending on how ambitious I was feeling that day, I could carry between 2 to 5 patients at any one time. At the 2nd rotation, which I am finishing now, I am miserable. And it's because I just can't seem to get any patients. Sometimes it's 2-3 hours before I can see my first patient, and I often find myself sitting there staring at the board clicking refresh over and over. But the weird thing is, the rooms are full and it's a busy ER.

So here's my question. At the first ER, I worked pretty much all day shifts, while at the 2nd I have been working all evening shifts (4p-12a). I am starting to wonder if the reason I saw so many patients at the first rotation was because more patients come in in the morning, giving students more opportunities to work up patients. And while the evening is known as a busier time for the ED, perhaps it's not as a good a time for students, because most patients have already been seen and differentiated.

I ask because I initially wrote off the 2nd EM program, committing it to the bottom of my rank list. But what if it's just because I picked the wrong shifts? I'm not looking for a list of what to look for in an EM program, but I'm curious if anyone has had a similar experience. Thanks guys!

 

[shoal]

Not shift related. Certainly it can depend on the hospital and bed situation but id expect things to open up sometine in the evening giving you as a student some opportunities to see patients. The residents at your second rotation may have been more go getters leaving you no ability to see pts. I often follow ems in if its slow as a resident that way i don't get undercut but this happens rarely at my.program and if it does, its during the day

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[TooMuchResearch]

Volume picks up late morning and tapers off sometime after midnight. Are there residents at the 2nd place that aren't good at sharing new patients? We try to make sure our students have patients to see or stuff to do.

Also, which program/hospital lets students see 5 patients at a time?

 

[thehealer]

Ok I guess I exaggerated a bit with the 5 patients. I was just trying to make a point that it was busy and I could essentially see as many patients as I could realistically handle.

 

[gman33]

Your job as a student is to learn as much as possible from each patient you see.
Having 1-2 patients and really knowing what is going on is what is important.
Many of the students I work with want to keep seeing patients and are really not on top of the ones they have.
Students really only add to my workload, but if I know lab results etc before they do, they aren't doing a good job.

Afternoon/evening is generally the busiest time.
This shouldn't be the reason for decreased activity.
It may be that there is more overall staffing, which left a relative lack of patients for you to see.

For what it's worth, once you become a resident you will be busy beyond your wildest dreams.
As long as you like the field, don't let one crappy rotation disuade you.

 

[engineeredout]

I felt how you did when I was a med student. I like actually being busy and there's nothing more boring than sitting around doing absolutely nothing. And honestly, that feeling has carried over into residency with me. Not saying that I like having my ass handed to me every second of every day, but the day certainly goes by faster when you're steadily busy versus doing absolutely nothing. Fortionately that absolutely nothing doesn't happen very often at my program.

You might get to do more at night because of fewer people around, you might not as some nights can be slow. You might have code after code after code come in, you might have nothing. Such is EM, and it is what keeps things interesting, that you never know what could come through the door at any given time.

Look at the overall volume of patients at a given ER and consider how many attendings/residents are on at any given time. When we rotate through one of the local Peds ERs, there could be as many as seven residents in a single pod, and it is MIND NUMBINGLY boring. On the other hand, we cover a small community hospital with 12K pts per year, but it's single attending coverage and single resident, so when it's busy, I don't feel like I'm searching hard for patients.

Agree with everything else said above with regards to student workload and what you should be doing. It really does mean a lot more to me that you see you one patient but know everything about them and know all the results, rather than seeing multiple and not keeping up with any of them. You should be refreshing the labs frequently and telling me "hey the K+ is 7.9" rather than me telling you. Also, being able to do minor procedures like I&Ds and lac repairs is a huge bonus. I never realized it as a student but it is immensely helpful when things are busy. I personally don't mind doing those procedures, but it's still time consuming for me, and when there are a pile of charts to work on and consultants to call it really eats up a lot of time. A good student who I can trust to do those procedures without ****ing things up is a huge asset. Plus if I see them doing well with those and working hard, I might be more inclined to let them attempt a bigger procedure like a central line

 

[Arcan57]

Try and remember what the tracking board looked like at shop#2. Our swing shifts tend to average the fewest patients seen despite it covering our highest volume of arrivals. The reason is that somewhere between 11-2 the ED becomes completely full and usually will hold patients for 3-7 hrs prior to them going upstairs. It's not until about 8-9pm that we start getting our boarded patients upstairs with any frequency and by then most people aren't picking up aggressively because the work-up won't come back in time to dispo prior to shift end and the overnight doc is still firmly in patient acquisition mode. So you're ability to pick up new patients on the swing shift is dependent on discharging patients currently in your rooms. However since the sickest are getting back first, most of the new arrivals are going to be admits that will occupy your rooms until the end of the shift.

Or maybe they're just jerks to their students.