ER rotation hours

[DD214_DOC]

---

Members don't see this ad.

So, my ER rotation seems to be pretty laid back (I guess). There are about 5 different docs and 4 PAs who all rotate shifts every day, so I never know who will be there. I as told they are, "flexible".

I basically have been making up my own hours as I go along. Last pm I worked 5:30p - 6:30a just to see what nights were like (They're like days but more boring). I decided to skip today and work 7a-7p TH and FR to get back into a day schedule so I can take care of my son on the weekend.

My question, then, is this a bad idea? I don't know how stringent most ER rotations are. It seems nobody in the ED really knows when I should be there, nor do they seem to care if I am. What should I do to cover my own ass in the event they come back and give me a bad eval for being, "lazy" and "never there", even though I was. I'm guessing I should print out what my intended schedule is and get whoever I'm with at the end of the shift to sign off on it? This has never been an issue on any other rotation so if this does occur I think it would stand-out as an outlier. I just really don't want to repeat ER.

 

[Law2Doc]

So, my ER rotation seems to be pretty laid back (I guess). There are about 5 different docs and 4 PAs who all rotate shifts every day, so I never know who will be there. I as told they are, "flexible".

I basically have been making up my own hours as I go along. Last pm I worked 5:30p - 6:30a just to see what nights were like (They're like days but more boring). I decided to skip today and work 7a-7p TH and FR to get back into a day schedule so I can take care of my son on the weekend.

My question, then, is this a bad idea? I don't know how stringent most ER rotations are. It seems nobody in the ED really knows when I should be there, nor do they seem to care if I am. What should I do to cover my own ass in the event they come back and give me a bad eval for being, "lazy" and "never there", even though I was. I'm guessing I should print out what my intended schedule is and get whoever I'm with at the end of the shift to sign off on it? This has never been an issue on any other rotation so if this does occur I think it would stand-out as an outlier. I just really don't want to repeat ER.

From what I've heard, 3 twelve hour shifts a week (or a comparable number of hours in 10 hour or 8 hour shifts, depending on your hospital policies), plus attending whatever didactics/grand rounds they may have during your rotation, is a pretty common 4th year elective schedule. Most places want you to do a decent number of overnight shifts, to get a better feel for it, and also because the docs are more willing to let med students do stuff with the kinds of things that come in overnight (drunks with lacerations from bar fights, etc). Having somebody sign off on that type of schedule probably is the safest course. I suspect the folks bound for EM do even more than 3 shifts/week, to maximize their contact with attendings, so a lot of what you do depends on how interested you are in the field. FWIW, Most places are more formal with the med student schedules, I suspect.

 

[DD214_DOC]

Interestingly, we do ER in our third year as a required core.

 

[Law2Doc]

Interestingly, we do ER in our third year as a required core.

Well if it's a required 3d year core rotation, then I suspect the expectation is higher than the minimal schedule I described. The expectation for fourth years is frequently more relaxed.

 

[DD214_DOC]

Well if it's a required 3d year core rotation, then I suspect the expectation is higher than the minimal schedule I described. The expectation for fourth years is frequently more relaxed.

It seems others are doing 4 10s or 3 12s.

 

[psychbender]

I agree with your idea of coming up with a schedule, and seeing if they will approve it. Make sure your schedule is also posted somewhere that the docs hang out, so they can plainly see when you plan to be there.

My third-year EM rotation schedule went something like this:
Week 1: M-Th 0700-1700 Trauma/Overflow, Fri-Sun off
Week 2: M/T 1100-2300 Fast Track, Wed off, Th/Fri 1500-2300 Peds ED, Sat/Sun off
Week 3: M-W 1900-0700 Main ED, Th/Fri off, Sat/Sun 0700-1900 Main ED
Week 4: M/T 0700-1900 Main ED, Wed 0700-1500 Peds ED

Since I didn't know who I was going to work with each day (and they didn't know if they were going to work with me), I was told to get my attending to sign off on my schedule after every shift, so that the student coordinator could verify that I was actually there.

 

[DD214_DOC]

That's kinda what I've been doing. Last week I was with a doc in the main ED. He's out this week so I've been working with PAs in fast-track. Next week I will be back in the main ED. I will get something on Friday and have the PAs sign it so I will have proof I've been around.

 

[Doc Henry]

I've spent a lot of time volunteering doing research in the ED over the past two years and can't help but notice that the med students always seem to be just standing around and shadowing. It really worries me because I'm interested in EM, so I really don't want to just be watching like a fly on the wall through that rotation. I'm not going to the school where I see this, so no way of knowing what its like at my future school.

Any input about your EM experiences?

 

[BobBarker]

EM can be very variant. At my school there were 2 attendings out of around 10 were you first had to present to a resident, and then the resident presented to the attending. The other's would just ask the student what was going on with the patient and not involve a resident. A few attendings would let you pretty much decide on your own what the patient had/needed to be done. If a student proved competent you would get more and more leeway.

 

[It'sElectric]

I've spent a lot of time volunteering doing research in the ED over the past two years and can't help but notice that the med students always seem to be just standing around and shadowing. It really worries me because I'm interested in EM, so I really don't want to just be watching like a fly on the wall through that rotation. I'm not going to the school where I see this, so no way of knowing what its like at my future school.

Any input about your EM experiences?

Definitely do not stand back and simply shadow. Get in there and take a proactive attitude with everything. Be a part of the team and help out when and where you can.

 

[JenHeart]

Just ask the group of physicians that are there that specific day what they'd like you to do. They will either say "choose an interesting complaint to see, see them, and present to me"... "shadow me"... "I don't really get involved with students"... point is, you'll know and meet their expectations.

 

[jonb12997]

I'm on my ER this month, and I'm doing 12 12 hour shifts through the course of the month. It's about even between 7a-7p, 12a-12p, 7p-7a shifts. They're pretty spread out, with a couple weekend shifts... basically enough to keep me busy.

The hardest part is figuring out what attendings want me on their heels all the time, what attendings want me to just do my own thing, and which attendings I need to not work with at all...

 

[Momentum70]

we do 8 random 10 hr shifts, its about even as far as night and day shifts, and just have to get signed off by any attending while we are there.

 

[vtucci]

Our 3rd year core we had didactics and workshops on M and T 800-1200/1300and then had 12 (I think) scattered 8 hour shifts with some night, overnight and day on the adult side. We also had one peds EM shift 1900-0300 and had to do an EMS ridealong.

For our adult EM 4th year elective, we had 16 8 hour shifts with some nights, overnights and days. We also had to attend grand rounds on wednesdays 0700-1200. It was a bit more relaxed than the 3rd year rotation. We also worked with the department big-wigs more frequently because we were interested in EM as a career.

Our department let students do alot more than just shadow. We were expected to suture, staple, put in foleys etc. We did the H&P on sick patient (even septic ones) with adequate supervision of course. I loved my home program (which is why I am staying for residency) and did see a good deal of variation in what I was permitted to do as a student when I did an away. I felt I was able to do more as a third year medical student than the interns at the away program I went to.

 

[Rendar5]

You guys are lucky you ahve EM requirements. My school has none, so it's kind of a mystery how we got enough interest in the field for 15 matches this year.

I only did one EM rotation at my home institution as an elective. You basically did as much as you asked to do, and you made ur own schedule and e-mailed it to the elective director. I'd be there in all codes, taking over the line for nurses (letting them do it if i failed 1st attempt), I'd also take over staples and suturing from other EM residents. I'd run my initial impression by the senior EM resident, but it was still pretty much me presenting to the attending directly. I'd just have 2 sets of guiding eyes instead of 1. I also took as many patients as i wanted to try and take care of safely, but really honestly wasn't expected to handle more than 1 every hour or two. The goal is to learn as an MS3/4, not to be a worker (credit that to some awesome attendings/fellows I asked when I did my rotation).

 

[scpod]

I did EM as a third-year elective. A month or so before I started I was emailed and asked if I had any specific requests for time off during the four-week period. A week or so before I was emailed my schedule, which had 15 shifts during the mointh which varied between 10 and 12 hours. I worked some day, some nights, some in-between and some weekends-- it was a typical schedule that the EM docs work there in a month.

Although there were EM residents, we were assigned to an attending each day. Typically, we picked up the first chart in the rack, did a quick h&p and presented the case tp the attending. He or she would say, "What do you wanna do?" We'd discuss it for a minute and do it. Pretty much any procedure you wanted to do you could do with most attendings. Or, you might watch one and do the next one. If you wanted in on traumas you could do that.... but you'd pretty much be watching as the surgery residents and students really did most of that. If you wanted to ride along with EMS some, you had the option to do that too.

There were scheduled didactics that all the other students went to, but the three of us in the ED rarely did because we had weird hours. We all had to spend a couple of shifts in fast-track too. Thata was probably the least enjoyable part to me because it was like family practice with a few more broken bones. But, I know a lot of places are a lot less structured.

 

[Rogue Synapse]

My school has 3-week electives and 6-week core rotations for third year. I'm on EM elective right now, and we have six 9-hour shifts a week for a total of 16 shifts over just under three weeks (the last weekend would round out the three weeks, but we get it off).

I like the 9-hour shift a lot. Plenty of time to learn cool stuff, but doesn't quite wear on you like a 12-hour shift would. The EM residents here seem to love it.

 

[45408]

I had a pretty relaxed EM rotation. It was an elective (I could've just taken that month as a vacation). It was 4 weeks, so out of 28 days, I had 12 shifts, 8 hours each (the length of an attending's shift, so we were matched with an attending). We had once weekly didactic sessions (the same ones the residents go to) that were 5 hours long, and once weekly simulator sessions with a robot patient. The simulator sessions were actually incredibly helpful, because for once, as an M3, you got to make decisions and act on them without seeking any input.