EM traits

[dotheDO92]

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This Q is for attendings/PDs/residents.
Strengths you look for in incoming resident candidate? Also weaknesses?
Building out my answers to common q’s esp what are your strengths and weaknesses and looking for inspiration.

 

[BoardingDoc]

This Q is for attendings/PDs/residents.
Strengths you look for in incoming resident candidate? Also weaknesses?
Building out my answers to common q’s esp what are your strengths and weaknesses and looking for inspiration.

Strength: being able to think on your feet
Weakness: feeling the need to come up with canned answers for questions instead of giving an honest response

I know you're just trying to prepare for interview season but this post comes across as looking for a cheat sheet to memorize and rattle off answers from. Unless you are a good actor, reciting memorized responses will generally be obvious and will be off putting.

 

[thegenius]

Spending 30 minutes searching this forum will probably give you the answers you want anyway. Just take a little more time and do some research.

 

[HoosierdaddyO]

Ill put a more genuine spin on this question... if I had to explain to the layman person what characteristics/qualities/and traits make an awesome and effective emergency medicine physician... what would you say!!!

I’ll start off... I found having thick skin, and the resiliency to bounce back and not let things phase you or distract you for extended periods of time. To focus on the topic at hand all the while playing a game of chess in the back of your head (essentially multitasking).

 

[deleted497653]

This Q is for attendings/PDs/residents.
Strengths you look for in incoming resident candidate? Also weaknesses?
Building out my answers to common q’s esp what are your strengths and weaknesses and looking for inspiration.

They’re probably looking for a hardworking guy or gal who is nice to be around, doesn’t annoy staff, can redeem themselves if they make mistakes and can pass step 3/ in service exams etc... some elite programs might have specific step score cutoff that they probably will downplay.

 

[gro2001]

This Q is for attendings/PDs/residents.
Strengths you look for in incoming resident candidate? Also weaknesses?
Building out my answers to common q’s esp what are your strengths and weaknesses and looking for inspiration.

Just don't go the faux weaknesses route and say "you work too hard" or are "a perfectionist".

Try to actually answer the question truthfully. You can still turn it into a positive but talking about what you've been doing to get better at your weakness and how far you've come.

 

[deleted497653]

Just don't go the faux weaknesses route and say "you work too hard" or are "a perfectionist".

Try to actually answer the question truthfully. You can still turn it into a positive but talking about what you've been doing to get better at your weakness and how far you've come.

That’s always so lame when someone says “my weakness is that I’m too nice and I can be a perfectionist”....

 

[dchristismi]

My greatest weakness is warm tortilla chips and good salsa.

I actually said that at an interview, and it's still true today.

 

[dotheDO92]

My greatest weakness is warm tortilla chips and good salsa.

I actually said that at an interview, and it's still true today.

This is exactly what I was looking for hahaha

 

[dotheDO92]

I should have specified. I am not building out my answers to have things scripted. I'm brainstorming traits and thinking of qualities that are specifically relevant to me, and above all, TRUE. No need to be condescending 😉 just wanted to have a little chat.

Answering "what is your greatest weakness" is a challenging question to answer genuinely, without shooting yourself in the foot, and also not answering with something ridiculously stupid like "i work too hard" or "i'm a perfectionist".

But the tortilla chips and salsa thing..... that's brilliant. 5 stars

 

[RustedFox]

My greatest weakness is warm tortilla chips and good salsa.

I actually said that at an interview, and it's still true today.

Had bomb-ass salsa two nights ago from "Mi Pueblo" round these parts.
Maaan.
So good.
There's nothing like proper fresh-cut salsa. It is a gift from God.

 

[thegenius]

Answering "what is your greatest weakness" is a challenging question to answer genuinely, without shooting yourself in the foot, and also not answering with something ridiculously stupid like "i work too hard" or "i'm a perfectionist".

It's an easy question. That is an underhand pitch. You think of a less than desirable personality trait that isn't directly absolutely necessary for being a doctor, acknowledge you have it, and say you been working on it for a long time and it's in general struggle and you have good days and bad days. And over time you have made improvements.

Examples:
"I procrastinate and it's a real problem. I believe in my life I've had great opportunities pass me by because I've procrastinated. Either I've turned in an assignment late, missed a deadline, I've even missed a plane flight because of this problem. I've known about this for years and very steadily I'm getting better at it, now I mostly have good days but I occasionally lapse."

"Sometimes I'm overly critical of other people's positions without thinking about it more. This was more of a problem when I was in high school and college when I felt I knew everything. The all-knowing teenager! Now it's blatantly obvious I know so little *chuckle under your breath in dis-believement.* I look back and think of some stupid arguments I would get into with friends over topics we know nothing about, like politics or ethics or sports. I'm still on the lookout for that kind of behavior and I've gotten much better."

See? easy peasy.

Interviewing is so damn easy. At least it was for me. I worked for 7 years prior to going to med school, raised a family, paid my own bills. I was so comfortable during them. I remember one interview at Cornell for med school, the guy was ripping me a new one...really questioning why I wanted to change careers (I used to be a software engineer). I said some general pleasantries, gave some banal answer about how I didn't just wasn't interested in software as much, always wanted to be a doctor, and he really grilled me. Saying "You have a family and you want to torture yourself for 4 years with no income to change careers? What is the real reason? We again had this back and forth and he just didn't believe me.

I finally told him "I'm too f'ing tired of losing my job ever 12-18 months! I've had 5 jobs in 7 years. Job security is in the hole! I want to have more control over my life. And I'm willing to do this sacrifice for 4 years to get there! I didn't volunteer at an ER for 1.5 years prior to applying just for the fun of it. I wanted to see if I really wanted to become a doctor." In in the middle of my answer I was quite animated, raising my voice, making more demonstrative movements with my arms.

The guy smiled and said "now I get it ...OK. Thank you. Next question."

The interview lasted 1.5 hours. I didn't feel all that good coming out of it.


(I ended up getting in!)

 

[Groove]

Agree with @thegenius. Interviewing is cake when you've been working out in corporate America for a few years and have interviewed alot. (Genius...I didn't realize we had such similar backgrounds. I was a network engineer for 6 years before jumping to medicine.) Anyway, it came in most handy when I was on the residency trail. I had more than one interviewer comment on my maturity, emotional i.q., etc.. blah blah. Try not to wrack your brain so much. The interview process for residency is more about the attendings trying to get a feel for whether they can tolerate you for 3-4 years as well as trying to decide whether you are going to be malleable, tractable, reliable and will reflect well on the residency program. They've already seen your scores and decided that you probably would pass the EM boards assuming you graduated from residency, so the interview is more about getting to know you for some of the reasons I mentioned. Just be natural. You really only need to worry if you're "naturally" a real assh*** and find it difficult to hide that fact.

 

[KeikoTanaka]

I am fascinated by doing EM (2nd year) because of the wide variety of pathology seen. However, I'm a horrible multi-tasker. And this is something that scares me about it. However, once I'm very proficient at things, I hope my multi-tasking will improve?

Otherwise, I'm gonna be stuck doing IM/Sports or FM/Sports for the slower rate of patients and ability to solo-task lol

 

[RustedFox]

I am fascinated by doing EM (2nd year) because of the wide variety of pathology seen. However, I'm a horrible multi-tasker. And this is something that scares me about it. However, once I'm very proficient at things, I hope my multi-tasking will improve?

Otherwise, I'm gonna be stuck doing IM/Sports or FM/Sports for the slower rate of patients and ability to solo-task lol

99.99999% of EM is multitasking.
Keep that in your back pocket.

Our oral board exams are even designed to interrupt you caring for a critical patient by asking you to take care of another critical patient... or two.

 

[thegenius]

I am fascinated by doing EM (2nd year) because of the wide variety of pathology seen. However, I'm a horrible multi-tasker. And this is something that scares me about it. However, once I'm very proficient at things, I hope my multi-tasking will improve?

Otherwise, I'm gonna be stuck doing IM/Sports or FM/Sports for the slower rate of patients and ability to solo-task lol

There comes a point that when people say "chest pain" or anything pertaining to the chest, you order CBC, BMP, Trop, EKG, CXR. +/- a few other things. You stop thinking about it.

There comes a point that when people says "abdominal pain" or they point anywhere that can be construed as the abdomen, you order CBC, CMP, Lipase, UA, UPT if needed, and +/- CT.

Multi-tasking is nice to have, but the more you do ER the less you have to rely on it. ER heavily uses protocols, either those explicitly stated or implicit.

If you like wide variety of pathology, then do strongly consider ER. You have to inherently like two other things: shift work including nights and weekends, and most importantly taking care of critically ill people. If you like all three, ER is your career!!!

 

[RustedFox]

I have to echo thegenius' sentiment here.

Shift work is totally fine for me. When I clock out; I rock out. Don't call me. Byyye.

Nights/weekends are a drag, but I try to minimize them. There is something cool about being the "watchman" for the town at 3 AM.

Critically ill people are my jam. They generally don't talk and can actually be helped immediately. Nothing is worse for me than having a patient hand me a list of every food that they've eaten over the past 4 weeks and the corresponding notes about how it made their farts smell and why this might be relevant to their belly pain for which they have seen three other physicians first. Or, the old lady who is worried about how her systolic BP ranges between 150 and 170 mmhg, and how that's "not normal for her".

 

[thegenius]

Critically ill people are my jam. They generally don't talk and can actually be helped immediately. Nothing is worse for me than having a patient hand me a list of every food that they've eaten over the past 4 weeks and the corresponding notes about how it made their farts smell and why this might be relevant to their belly pain for which they have seen three other physicians first. Or, the old lady who is worried about how her systolic BP ranges between 150 and 170 mmhg, and how that's "not normal for her".

This is what I did out loud:

 

[deleted497653]

I have to echo thegenius' sentiment here.

Shift work is totally fine for me. When I clock out; I rock out. Don't call me. Byyye.

Nights/weekends are a drag, but I try to minimize them. There is something cool about being the "watchman" for the town at 3 AM.

Critically ill people are my jam. They generally don't talk and can actually be helped immediately. Nothing is worse for me than having a patient hand me a list of every food that they've eaten over the past 4 weeks and the corresponding notes about how it made their farts smell and why this might be relevant to their belly pain for which they have seen three other physicians first. Or, the old lady who is worried about how her systolic BP ranges between 150 and 170 mmhg, and how that's "not normal for her".

you left out those who take a picture of their poop or period and look offended if you don’t want to look at said picture.

 

[thegenius]

you left out those who take a picture of their poop or period and look offended if you don’t want to look at said picture.

On that note, I actually discharged a 60 yo F with hematochezia. She showed me a picture of her s&#t in the toilet, and after some normal labs said...you ok! Go home! She didn't come back. Maybe she's lying on the floor somewhere in a pile of her own diverticular blood. But I doubt it.

 

[SamtheWise]

you left out those who take a picture of their poop or period and look offended if you don’t want to look at said picture.

It's even more infuriating for them when the poop looks like normal poop and you're like, "um well looks good to me, sounds like you're safe to go home!"

"DONT YOU SEE IT"

"......."

 

[Groove]

Slap an eye patch on me and just call me the dreaded butt pirate of the ER because I put a finger up so many asses that come in with bloody poop complaints just to prove to them that they aren’t hemorrhaging from their anus. DSM 5 needs to come up with a dx for poop hypochondriacs because it’s a real entity.

I can’t even keep track of the number of times people tell me they are bleeding to death from poopy hemorrhage after googling causes of GI bleeds and getting diverted to a Mayo page on aortoenteric fistulas only to be heme....negative.

 

[thegenius]

Haven't we all seen hundreds and hundreds of dinguses. My finger has been in so many....

I've got an ER buddy who says he never does it (a DRE). He just believes you. He says if you think you are crapping blood or melena then he takes it at face value.

 

[thegenius]

Critically ill people are my jam. They generally don't talk and can actually be helped immediately.

You are in and out of the room in 2 minutes.
HPI - cannot obtain due to pt's clinical condition. HPI is per EMS report.
ROS - unable to obtain.
Labs, UA, UCx, BCx, Lactate
2L IVF
Empiric Antibiotics
CXR
EKG
CT Head
***ADMIT***

Easiest critical care time you'll ever make. Just pray their BP doesn't fall because then you have to fiddle around with a meaningless central line that will never actually improve patient outcomes. The pt you are admitting is going to die in the next 6-12 months regardless of what you do.

 

[deleted109597]

Haven't we all seen hundreds and hundreds of dinguses. My finger has been in so many....

I've got an ER buddy who says he never does it (a DRE). He just believes you. He says if you think you are crapping blood or melena then he takes it at face value.

I do them very, very rarely.
Why is it that if they tell us they're pooping blood we don't believe them, but if they're coughing up blood or vomiting blood we do?
It's not like we do some ridiculously invasive test to check that

 

[thegenius]

What are you talking about? I stick my whole arm down their esophagus and sample their gastric juices.

 

[GonnaBeADoc2222]

Haven't we all seen hundreds and hundreds of dinguses. My finger has been in so many....

I've got an ER buddy who says he never does it (a DRE). He just believes you. He says if you think you are crapping blood or melena then he takes it at face value.

I rarely do them.

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[RustedFox]

One more for "rarely".

 

[SamtheWise]

I believe strongly in the DRE, it's a useful exam for either proving or disproving pathology, if you're going to blow off a 'GI Bleeder' as low risk or nothing it beefs up your documentation and story to have 'DRE with light brown stool' rather than 'patient reports red blood in stool but hemoglobin and vital signs reassuring so discharged' right next to a triage nursing note 'patient reports 'alot' of blood from rectum, states it's 'everywhere''

However, fecal occult blood testing is a different matter. I get actively angry even thinking about those useless little cards.

 

[Groove]

I believe strongly in the DRE, it's a useful exam for either proving or disproving pathology, if you're going to blow off a 'GI Bleeder' as low risk or nothing it beefs up your documentation and story to have 'DRE with light brown stool' rather than 'patient reports red blood in stool but hemoglobin and vital signs reassuring so discharged' right next to a triage nursing note 'patient reports 'alot' of blood from rectum, states it's 'everywhere''

However, fecal occult blood testing is a different matter. I get actively angry even thinking about those useless little cards.

Bingo. Maybe it was how I was trained, but we did tons of DREs and I actually don't mind them for all the reasons you listed. It's fast, definitive and is the ultimate buff to a non emergent "rectal bleeding" chart. If something ever happened, it's really difficult to defend something that sounds like a GI bleed that you discharged home with no documented DRE. I can always make a strong argument that there was no evidence of GI bleeding based on my clinical exam. Brown stool, no hematochezia, heme neg, stable HCT, VSS. Done. Even if there was scant hematochezia but no evidence of melena, no high risk features, etc.. that still buffs my disposition.

I don't do them for some of the simple complaints like external hemorrhoids, etc.. but if they are going to come in describing their bowel movements like a scene out of Hellraiser, then they are getting the finger.

 

[Apollyon]

Slap an eye patch on me and just call me the dreaded butt pirate of the ER because I put a finger up so many asses that come in with bloody poop complaints just to prove to them that they aren’t hemorrhaging from their anus. DSM 5 needs to come up with a dx for poop hypochondriacs because it’s a real entity.

I can’t even keep track of the number of times people tell me they are bleeding to death from poopy hemorrhage after googling causes of GI bleeds and getting diverted to a Mayo page on aortoenteric fistulas only to be heme....negative.

My program director said that, when she was a resident, she saw a pt with an aortoenteric fistula, who bled out in less than 10 seconds when it ruptured. Entire blood volume, straight out the ass.

 

[GonnaBeADoc2222]

One more for "rarely".

Same as the pelvic exam. Low utility.

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[deleted497653]

I do them selectively... most serious GI bleeds have GI bleed + other symptom or sign (vitals, labs off, pt dizzy, pt is alcoholic with varies, pt with ulcers, severe abdpain, or an older pt on blood thinner etc).
I do look at anal area to rule out fissures in benign sounding rectal bleeds. Most older people with gi bleeding need an admit or obs regardless of the DRE.
But really we should believe people who say they are pooping blood. You can still get a normal looking stool sample during DRE depending on the timing..

also something to consider, the patient can do their own DRE if you just need them put the smear on the card. Just saying.... there isnothing special about it needing to be my finger. If I was a patient, I’d prefer to do my own DRE. Just can’t see your own fissures....

 

[deleted109597]

also something to consider, the patient can do their own DRE if you just need them put the smear on the card. Just saying.... there isnothing special about it needing to be my finger. If I was a patient, I’d prefer to do my own DRE. Just can’t see your own fissures....

Women can do their own pelvic swabs.
Sure, you can find some pathology doing the exam. Just like you can find pathology CT scanning everyone. But finding benign pathology isn't emergent.

 

[RoyBasch]

Easiest critical care time you'll ever make. Just pray their BP doesn't fall because then you have to fiddle around with a meaningless central line that will never actually improve patient outcomes.

The way I place central access as an attending is by calling PICC team.

(kind of a joke, for the residents learning to place lines is good because there are a few situations where you need one and you need it now, etc. )

 

[Groove]

But really we should believe people who say they are pooping blood. You can still get a normal looking stool sample during DRE depending on the timing..

That's the problem...I don't believe them, until I have proof otherwise. 50% of the time, there's nothing there. 20% of the time, I might get black stool but it's clearly heme negative. After they recover from the shock of there being zero blood in their stool, and after denying up and down that they took any iron supplements or pepto....they suddenly remember getting up at 3a.m. yesterday to drink some pepto for indigestion. As I'm sure you're already well aware, plenty of things can turn your stool black or red besides blood and virtually all of my patients, at least in my current pt population suffer from some variant of short term memory loss when it comes to food or medicines that they have ingested in the last 5 days.

Red stools = Red food coloring, beets, cranberries, tomato juice, soup, red gelatin, red drink mixes, red peppers and of course....wait for it....Flaming Hot Cheetos

Black stools = iron supplements, bismuth (pep-bismol, maalox, mylanta, rolaids, etc..), licorice, grape juice, oreos, charcoal health drinks, etc..

I mean, what do you do for someone like I described who's swearing that his stools are all turning black and denying any dietary/medicine confounders? Let's say he even demonstrates a mild to moderate anemia. Are you going to admit that guy...just because he swears to you there is blood in his poop and he's got a low HCT? There is nothing more embarrassing than reading a GI note the next day that documents "rectal exam demonstrates black stool that is clearly heme negative. Apparently, no DRE was performed in the ER which would have clearly demonstrated no evidence of melena and upon further inspection of the MAR, the pt apparently is taking iron supplementation for his documented iron deficiency anemia although he was not aware of this fact. Signing off."

 

[GonnaBeADoc2222]

That's the problem...I don't believe them, until I have proof otherwise. 50% of the time, there's nothing there. 20% of the time, I might get black stool but it's clearly heme negative. After they recover from the shock of there being zero blood in their stool, and after denying up and down that they took any iron supplements or pepto....they suddenly remember getting up at 3a.m. yesterday to drink some pepto for indigestion. As I'm sure you're already well aware, plenty of things can turn your stool black or red besides blood and virtually all of my patients, at least in my current pt population suffer from some variant of short term memory loss when it comes to food or medicines that they have ingested in the last 5 days.

Red stools = Red food coloring, beets, cranberries, tomato juice, soup, red gelatin, red drink mixes, red peppers and of course....wait for it....Flaming Hot Cheetos

Black stools = iron supplements, bismuth (pep-bismol, maalox, mylanta, rolaids, etc..), licorice, grape juice, oreos, charcoal health drinks, etc..

I mean, what do you do for someone like I described who's swearing that his stools are all turning black and denying any dietary/medicine confounders? Let's say he even demonstrates a mild to moderate anemia. Are you going to admit that guy...just because he swears to you there is blood in his poop and he's got a low HCT? There is nothing more embarrassing than reading a GI note the next day that documents "rectal exam demonstrates black stool that is clearly heme negative. Apparently, no DRE was performed in the ER which would have clearly demonstrated no evidence of melena and upon further inspection of the MAR, the pt apparently is taking iron supplementation for his documented iron deficiency anemia although he was not aware of this fact. Signing off."

Why would you admit them? Young healthy person not on AC, doesn't need DRE, even with mild anemia it's outpt follow up.

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[Groove]

Why would you admit them? Young healthy person not on AC, doesn't need DRE, even with mild anemia it's outpt follow up.

Sent from my Pixel 3 using SDN mobile

My whole point is that patients are terrible judges of blood in their own poop. Therefore, I judge it for them.

 

[deleted497653]

My whole point is that patients are terrible judges of blood in their own poop. Therefore, I judge it for them.

All you can do is go by their account and a stool sample. They can give you a sample of stool or you can do the DRE. If their hemoglobin is low (low to me is less than 7) (and you have no other previous labs showing it’s chronic and they deny meds that cause black stool) then admit if the patient is symptomatic regardless of age. Let GI rule them out. Sometimes the hospitalist or specialists will hate you for what they consider unnecessary admits....

 

[Cinclus]

All you can do is go by their account and a stool sample. They can give you a sample of stool or you can do the DRE. If their hemoglobin is low (low to me is less than 7) (and you have no other previous labs showing it’s chronic and they deny meds that cause black stool) then admit if the patient is symptomatic regardless of age. Let GI rule them out. Sometimes the hospitalist or specialists will hate you for what they consider unnecessary admits....

]

I get so much pushback on my LGIB patient admits. Like, old people with gross hematochezia on exam. I see a lot of it at my shop, too, so it's quite painful to deal with.

 

[thegenius]

Red stools = Red food coloring, beets, cranberries, tomato juice, soup, red gelatin, red drink mixes, red peppers and of course....wait for it....Flaming Hot Cheetos

Black stools = iron supplements, bismuth (pep-bismol, maalox, mylanta, rolaids, etc..), licorice, grape juice, oreos, charcoal health drinks, etc..

I was reading this...thinking...my patient population doesn't eat beets, cranberries, tomato juice..etc...etc until saw "FLAMING HOT CHEETOS". My population eats a lot of those.

Black Stool? again they eat nothing of that except for oreos. Tons of oreos. But I think you have to eat an entire package to get black stool, no?

 

[thegenius]

Meh. I see it as a way of deterring people from coming to the ER for complaints of poop changes unless its pretty pronounced.
..... Or, you end up getting the patients that like having a gloved finger in the butt to check their poop.

Then may I recommend...two fingers. Two fingers will increase the chance of getting stool over 1 finger.

Just sayin

 

[Groove]

I was reading this...thinking...my patient population doesn't eat beets, cranberries, tomato juice..etc...etc until saw "FLAMING HOT CHEETOS". My population eats a lot of those.

Black Stool? again they eat nothing of that except for oreos. Tons of oreos. But I think you have to eat an entire package to get black stool, no?

Yep, I also live in the land of flaming hot cheetos. Many times, my pt's have a bag of them open, munching on them when I enter the room.

The dark stool with oreos I've only seen with kids. I'm actually not quite sure how many it takes to turn your poop. Sounds like a fun experiment.

Next time you see a young kid with mommy distraught over his/her dark poop, ask if he/she ate oreos and drank grape juice. I get more affirmatives to that than anything else and it makes it easy to talk them down. Although not a common presentation where I'm at, it's not exactly uncommon for me either.