hardest month in em residency

[shortbread9]

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i was wondering if any em residents out there could let us interns know what the hardest month was for them? i've heard trauma and micu? any words of wisdom on how to get through them ?

 

[GeneralVeers]

i was wondering if any em residents out there could let us interns know what the hardest month was for them? i've heard trauma and micu? any words of wisdom on how to get through them ?

Trauma is typically the hardest, followed by MICU if you're unlucky enough enough to be at one of those non-progressive places that hasn't yet adopted a night float system.

All rotations are going to be different, so it's hard to give universal advice. In short you have to do them, so don't complain, represent EM to the best of your ability, and look forward to the day when you never have to do that stuff again.

 

[Jeff698]

By hardest, you need to define your terms.

I probably worked the hardest in terms of most procedures and intensive medicine on my MICU month. Loved it, BTW. I also probably learned the most on that month.

Trauma was hard in terms of hours.

Ortho was hardest in terms of scut work (discharge summary after discharge summary).

Medicine was hardest in terms of not shooting myself. Even with that, I still learned a lot.

This all assumes we're only talking about off service rotations, of course.

Take care,
Jeff

 

[southerndoc]

Medicine was hardest in terms of not shooting myself. Even with that, I still learned a lot.

My thoughts exactly!

 

[DrQuinn]

I did a month of trauma as an intern, and think that any surgical intern on the trauma service is probably the most overworked intern in the hospital at any given time.

I learned a HELLUVA lot though, but it was a tough month.

Q

 

[Midwest Medic]

The hardest for my time-wise was SICU. MICU and straight medicine was the hardest to not jump from the top floor of the hospital.

 

[beyond all hope]

25-40 sick-as-dogs patients on THREE different floors (2, 3 and 9!), by myself on call as a 2nd year.

Imagine running two codes simultaneously on two different floors.

Work your *ss off all night, don't even get a chance to sit down, then get yelled at by the surgical attending in the morning for all the **** you didn't get to, why you didn't call when you were supposed to and why you called when they didn't want to hear from you.

 

[dchristismi]

I gotta agree with Jeff.
Trauma absolutely for sheer volume and work. We do 2 months. It can be fun, but man, it's work.

Ortho was a pain in the you-know-what. I thought it was more painful than trauma though because I had really awesome trauma teams and a sub-par ortho team.

Medicine is, well, medicine. It's predictable. Painful, but predictable.

Loved SICU. Loved MICU. (Both as R2)

We do an away MICU/CCU rotation at a community hospital where you are the only doc in house at night other than one or two in the ED. You do everything, round pretty much by yourself on 20-30+ ICU patients, and while you have on-call backup, you pretty much run the show. I worked my tail off, but man, I learned a ton.

 

[EctopicFetus]

Trauma. The hours are brutal the patients are often difficult to deal with (like my guy with a CT who would turn off the suction and then leave to go smoke cigarettes, then come back hook him self back up to suction. Thats just one of a lot of good stories.

 

[GeneralVeers]

I've done 4 months of trauma in total (2 in CA, 2 in TX). No one else can quite feel my pain on that one.

 

[corpsmanUP]

Ortho stunk for me because of the rounding at 5AM and clinic work where I saw non-trauma follow ups for days on end. I sat down with my PD and got things changed though. By the end of the rotation I was carrying the pager for all ED ortho stuff and doing no scut clinic. I don't know about your programs but at ours, if there are rotations we absolutely hate for certain reasons, our staff listens and makes changes to the best of their ability.

 

[AmoryBlaine]

Ortho stunk for me because of the rounding at 5AM and clinic work where I saw non-trauma follow ups for days on end. I sat down with my PD and got things changed though. By the end of the rotation I was carrying the pager for all ED ortho stuff and doing no scut clinic. I don't know about your programs but at ours, if there are rotations we absolutely hate for certain reasons, our staff listens and makes changes to the best of their ability.

That is awesome.

 

[WilcoWorld]

This is so program-dependant that I feel we should be posting our programs along with our answers.

I'm an R2 at Advocate Christ in Chicagoland.

Trauma is certainly the hardest in terms of hours, but those hours are spent intubating, putting in chest tubes, placing lines, laughing / crying about the absurdity of society... so it's pretty fun. I consider it the Gym class of residency.

However, my winter EM months are by far the hardest months. Our ED is very busy and full of sick patients - from December to March we are slammed. Our residents tend to put a lot of pressure on themselves to be both complete and efficient. As such I am beat after those shifts. I learn an amazing amount though, as nearly every attending makes sure to take time out of even the busiest shifts to teach. Thank goodness we only work 18 shifts a month, or I'd be really exhausted.

Our MICU months totally depend on the team we end up on. If your senior is fair & helps carry the load, it's a great month with plenty of reading time. If not, well...

In general, our PD is exceptionally responsive to resident critiques. He does not tollerate abuse of his residents. Our General Surgery month was brutal untill the current 3rd year class told him about the abuse / duty hour violations (that was 2 years ago). He promptly pulled us from that service & put us on another service where we are now appreciated rather than abused.

 

[NinerNiner999]

Strangely, I would say that the first month of my third year in Emergency Medicine was the hardest month of my residency. The hours weren't nearly as long as my other months, but as Third years, we manage the department, including triage patients, critical cares, traumas, and we assign beds and control flow. This was very difficult being that I rotated in July, with inexperienced interns, off-service rotators, and record ED volumes in downtown Baltimore. There were 8-hour shifts where I personally examined, wrote, and dispo'd over 40 patients per shift - while supervising and managing a department for the first time.

Of course, things have gotten easier since then😉

 

[trkd]

I have a feeling that August is going to suck. I have Trauma then, after a month long orientation. I am hoping that the excitement of being in residency will help carry me through this month but based on some of the comments here, it might suck. Oh dear....😳

 

[Northeaster]

My hardest month of intern year has been Cardiology. For us it is just a very undercovered service and you are managing the CICU and floor with little attending or senior help.

I would agree that Medicine was the longest month. I don't remember it being so painful as a medical student.

 

[roja]

I agree with Wilco. My hardest months were winter months of my intern and second year. its dark, its cold, lots of hours and in our 160K/year ED, busy as all get out. Sick, sick, sick, sick. and more sick. I have never been so tired or beat.

 

[paramed2premed]

I have a feeling that August is going to suck. I have Trauma then, after a month long orientation. I am hoping that the excitement of being in residency will help carry me through this month but based on some of the comments here, it might suck. Oh dear....😳

Yup, my first rotation as well, except I only get one week of orientation. Eek.

 

[Northeaster]

Trauma is a great place to start. You are excited so the hours don't hit you too hard and you learn to do procedures and look like a pro for the rest of the year.

 

[trkd]

Trauma is a great place to start. You are excited so the hours don't hit you too hard and you learn to do procedures and look like a pro for the rest of the year.

You just made my day!!😀

 

[Hawkeye Kid]

Trauma is a great place to start. You are excited so the hours don't hit you too hard and you learn to do procedures and look like a pro for the rest of the year.

agreed. also, you don't mind scut as much because you're still not used to making your own decisions/writing orders/dictating, etc, and the pts typically have fewer comorbitidities, so they tend not to be quite as complex. there's also a lot of interaction with other services (esp. ortho) so you get to know those residents/staff which helps when you're in the ED.

 

[turtle md]

and look forward to the day when you never have to do that stuff again

I have arrived!! Finished my last off-service month. EM for the rest of the time...

 

[turtle md]

Christiana

Trauma (EM1) - hours, incredibly busy, company of surgeons, but good for procedures

SICU (EM2) - more hours, but confined to sick patients instead of crap all over the hospital, company of surgeons, but great for procedures

MICU (EM1) - medicine, but sick patients, some procedures (I did it late Spring, so had done everything else, and was supervising my senior IM residents on lines), luckily the night float system makes the hours bearable

Medicine (EM1) - medicine, but gone from our curriculum after protest of the lack of relevance to EM (replaced by a 2nd MICU month)

PICU (EM2) - pediatrics, another hospital system, some sick kids but mainly post-op cases (no PACU), hours are bearable

CICU (EM1) - like MICU-lite

NICU (EM2) - not really hard or long, just boring. Also gone, replaced by another EM block

OB (EM1) - we work in their OB-triage area, and try to sneak off for deliveries... Use to be hard, then made easier, and now progressing back to harder. Still, bankers hours and no call

The rest is EM or cake

 

[Northeaster]

I am impressed that you got your program to drop medicine. I am convinced that the main reason to rotate on a medicine service is to make you appreciate the rest of your life!

 

[turtle md]

I am impressed that you got your program to drop medicine. I am convinced that the main reason to rotate on a medicine service is to make you appreciate the rest of your life!

Yes, it is an Emergency Medicine re-affirmation month 😀