How busy / difficult are EM Ultrasound electives?

[Doctor_Strange]

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I may need to take one of my board exams during an EM Ultrasound month. I could not find a single thread about medical student experience regarding ultrasound electives. The program I am interested in says 40 hours is the average per week. I am not even sure what the workflow would be like if anyone can also provide insight into that as well.

Thank you!

 

[gamerEMdoc]

Just plan for it being 40 hrs/week if thats what the advertise. Assume you won't have any time to study while at work, and if you do its just an added bonus.

 

[Rekt]

I may need to take one of my board exams during an EM Ultrasound month. I could not find a single thread about medical student experience regarding ultrasound electives. The program I am interested in says 40 hours is the average per week. I am not even sure what the workflow would be like if anyone can also provide insight into that as well.

Thank you!

Every place I rotated that had students on ultrasound made it seem like a joke. It'll obviously vary by program, but it should be significantly easier than an EM month.

 

[gamerEMdoc]

Every place I rotated that had students on ultrasound made it seem like a joke. It'll obviously vary by program, but it should be significantly easier than an EM month.

Agreed with that. I can't imagine it being harder than an EM month, not even close. And even then, EM months aren't THAT hard as a student. You'll have a ton of days off on most EM rotations. Our students work 16/month.

 

[The Knife & Gun Club]

At least the US rotation I did was very tame. I think it was like 9 8hr shifts over 14 days, normal business hours. And the shifts were not cognitively difficult. Basically just walked around with the machine scanning people and practicing my probe technique. Virtually no off shift work.

You could easily study for CK during it.

 

[Doctor_Strange]

At least the US rotation I did was very tame. I think it was like 9 8hr shifts over 14 days, normal business hours. And the shifts were not cognitively difficult. Basically just walked around with the machine scanning people and practicing my probe technique. Virtually no off shift work.

You could easily study for CK during it.

I've been pretty spoiled, since I've been able to use a Butterfly on patients in the ED which piqued my interest in U/S.

As an aside, I find that EM docs either absolutely love U/S or don't care about it at all. Why the difference you think? From my vantage point, I feel like it has tremendous utility, but I've been told by a few docs that it is sort of an overblown tool in the ED. I don't know enough to obviously say otherwise, but the trend seems to be that the utility of U/S in the ED can only go up.

 

[alpinism]

The use of US is very dependent on your work environment. Its much more useful at high acuity academic hospitals with lots of unstable patients that need immediate intervention and can't wait for imaging results. At the same time its much less useful at low acuity community hospitals with lots of stable patients that don't need immediate intervention and can wait for imaging results. For example while you could go around scanning patients with uncomplicated chest pain in most cases you won't find anything meaningful that ends up changing your management.

 

[RuralEDDoc]

The above post unfairly equates academics to high acuity and community to low acuity. Academics does not by any means mean high acuity, nor does community mean low acuity. The hardest places I’ve worked by far are rural 50k+ volume EDs with a slant towards high acuity with no backup other than a hospitalist, UpToDate, and a helicopter that’s not flying half the time. That’s really hard work.
Why the love/hate dichotomy with US? I’m not sure, but I think it’s useful to me a couple times a month (outside of line placement). It’s just not that useful most of the time. It’s specific (pericardial effusion, obstructive gallstone) but the sensitivity for the pathology we care about is often poor even in experienced hands.

 

[thegenius]

Ultrasound is a big time sink and while we do get paid for ultrasounding and storing the images on a server that can be pulled out up to 5 years in the future....I usually just forgo it and see the next patient. So much easier. US doesn't pay much, each exam is 1-1.5 RVUs.

Occasionally I'll US a 1st trimester vag bleed or cramp if they are far enough out (> 6-7 weeks) because then I can really get rid of them quickly. But even then I usually don't because we are so busy.

You know the problem with US?

It's a frucking pain in the ass 1) finding it in the ED as it's never where it's supposed to be, 2) finding room in the patient room, 3) cleaning it before you use it because nobody cleans it after they finish using it, 4) realizing you are out of gel and have to make another trip to the other side of the ED to get a new bottle, 5) finding a towel to clean them up

By the time you US them the are giving birth.

 

[Apollyon]

The above post unfairly equates academics to high acuity and community to low acuity. Academics does not by any means mean high acuity, nor does community mean low acuity. The hardest places I’ve worked by far are rural 50k+ volume EDs with a slant towards high acuity with no backup other than a hospitalist, UpToDate, and a helicopter that’s not flying half the time. That’s really hard work.
Why the love/hate dichotomy with US? I’m not sure, but I think it’s useful to me a couple times a month (outside of line placement). It’s just not that useful most of the time. It’s specific (pericardial effusion, obstructive gallstone) but the sensitivity for the pathology we care about is often poor even in experienced hands.

If it is 50k for the ED, I don't care where it is, but, that's not rural. Hell, by those numbers, an EP will be seeing 3+ cases every year that are "rare", or beyond that. Rural, I saw one case of Kawasaki's. The estimate is 19k/year to not become "intellectually bored".

 

[Doctor_Strange]

Thanks for the replies everyone. Maybe I've had a spoiled experience? As a third year med student, when in the ED my doc has a Butterfly so he let me fool around with it on patients. I recall one patient came in c/o of RUE pain, PE was completely normal outside of vague parathesias, and my attending was really only worried about superficial thrombophlebitis. We U/S his arm, there wasn't any occlusions. It was a quick and easy workup, and it was cool to let the patient hold the phone and see for himself.

 

[WernickeDO]

Thanks for the replies everyone. Maybe I've had a spoiled experience? As a third year med student, when in the ED my doc has a Butterfly so he let me fool around with it on patients. I recall one patient came in c/o of RUE pain, PE was completely normal outside of vague parathesias, and my attending was really only worried about superficial thrombophlebitis. We U/S his arm, there wasn't any occlusions. It was a quick and easy workup, and it was cool to let the patient hold the phone and see for himself.

Hopefully, you should have a good amount of flexibility during your US elective. Personally, I have no interest in cracking the whip on a medical student during an elective. It may depend on the institution itself, which may have certain requirements about the schedule. Or, you can work out the schedule with your resident/attending. A board exam is a reasonable thing to schedule around. Maybe reach out to them and get a feel for what the culture is?

 

[Doctor_Strange]

Hopefully, you should have a good amount of flexibility during your US elective. Personally, I have no interest in cracking the whip on a medical student during an elective. It may depend on the institution itself, which may have certain requirements about the schedule. Or, you can work out the schedule with your resident/attending. A board exam is a reasonable thing to schedule around. Maybe reach out to them and get a feel for what the culture is?

Thanks for the advice. I am planning on reaching out in a few weeks. Their website says they are very flexible, can be anywhere between a 2-4 week rotation. I suppose my concern was balancing studying U/S material before and after my shifts relative to my need to take CK.