How to be a Great MS3 in the ED

[stiffany]

---

Members don't see this ad.

Hi. So I started my first clinical rotation yesterday, which is a four week stent in the ED at the local children's hospital. It's a bit of a steep learning curve with the computer system, patient variability, attending differences in preferences, and just general newness of third year. However, I'm totally loving it despite having to ask a million questions of everyone.

I'm interested in emergency medicine as a possible specialty choice and I was wondering if anyone had any advice on how to stand out as a med student. How do you learn the most? How do you at least look like you know what you're doing? In short, what are the characteristics of a great MS3 on an emergency medicine rotation?

 

[Rendar5]

A lot really depends on the set-up of the rotations and the function of the ED. Early MS3 is hard because you don't have bearings yet and clinical medicine is very new.

1. So you impress by really knowing your patients and being on top of their labs and x-rays as soon as they're available.
2. Even though you're not used to it, when presenting, offer a brief thought on what you think they have, and what you think the management should be and whether they're likely to admit or discharge in the end. These dont' ahve to be correct. Just show you think about this stuff
3. Try to time your shifts so that you work with an attending for multiple shifts.

 

[Doctor Bob]

3. Try to time your shifts so that you work with an attending for multiple shifts.

Yes! This is key. Especially if you plan to ask for a LOR from anyone there.

 

[shortbread9]

this may sound obvious to most people out there but you should
1) actually offer to see patients
2)see patients
3) show up to any trauma or critical patients and offer to help even if it means undressing the patient or grabbing a blanket or gown
4)do not surf the net the whole shift
5)please do not follow your intern or resident like your attached to their butt the whole time...be a bit proactive...make sure who ever your paired with shows you the interesting cases or procedures...there is nothing worse than being followed all shift by a student so close they dont realize your now in the bathroom
6) make sure to know your patients, keep up on their labs/rad studies and try to come up with a few simple plans for the patient

im at a very prestigious institution and shockingly i more unimpressed with their students each and every day. But in general, ED residents are happy with independent students that offer to see a couple patients, follow up on their labs, try to be involved in procedures ....and have fun!!! Good luck!

 

[Tiger26]

Since I just got my eval back from my peds ED month, I'll just post that, since it was a pretty good reflection of what worked for me in that setting:

Doc 1: "Tiger was able to perform thorough history and physical exams, develop a differential diagnosis, and develop patient care plans independently. He was eager to learn and showed great initiative. He was enthusiastic, hard working, and took initiative in seeing patients. He communicated well with patients and families. Overall, Tiger is working above his level of training"

Doc 2: "Tiger is highly motivated not only to the field of EM, but also with primary care issues. Tiger has good PE skills and certainly improved over the month, particularly with infants and preschool aged children. He is often able to recognize those kids with a higher level of severity of illness as well as those who had the potential to progress towards that severity. Tiger is able to accurately interpret x-rays. Oral presentations, as well as quick, problem focused/pertinent positive and negative presentations were detailed. His discharge instructions and medication management were clear and precise"



Overall, I think being really motivated and taking the initiative to see patients and being eager to see or do procedures really helped me come across well.

Since you're just starting M3 year, not as much should be expected as far as differential and plan goes, but always come up with something that you want to do--i.e. don't just be a historian.

Just be yourself, be thorough and don't be afraid to practice physical exam skills (act confident though when doing them), only see 1 and then maybe 2 patients at a time, write quality discharge info and get all the paperwork ready without being asked, and pick up a new chart as soon as your all finished with your last one.

*Last thing, make sure to enjoy it because before you know it, you'll be thinking of all the different ways you can gouge your eyes out while discussing minuscule electrolyte changes for hours on inpatient medicine . . .

 

[Rendar5]

forgot to add, since i was running out the door, EM is very problem focused. You don't need a detailed PMH, you don't need to know t heir life story. You need to know why they're there and PERTINENT past history and social circumstances. If you can really focus down while still not missing things, you'll do a good job. Knowing EVERYTHING about the patient is for IM and PCP's =p.

 

[Greenbbs]

Remember, as a MS3, nobody's gonna expect you to know everything.

Your primary goal is to learn how the ED works. Get to know the flow, how to efficiently see a patient (yeah, a single patient...you're not gonna see a ton at a time), develop your differential, and learn the magic of figuring out what tests will efficiently and cost-effectively get you to your diagnosis.

Just absorb things. See how the good residents do things, and how the bad ones dont.

And, start IV's, do simple things to help out.....starting IV's is like manna from heaven....you can never do too much.

 

[hornsfan]

Simple rules to excel on any rotation as an MS3 (esp. EM):
1) Be early
2) Stay late (but don't be that guy who is hanging out 3 hours after your shift despite people have told you to go home)
3) Work hard - this is really key on EM rotations
4) Don't complain (amazingly hard for some people)
5) Always ask for more to do (or be proactive and figure out what needs to be done and do it without being asked to)
6) Read, read, read then show that you've read by applying what you've read to your patients (but don't be that guy who says "as i was reading last night in NEJM")

 

[Hard24Get]

Simple rules to excel on any rotation as an MS3 (esp. EM):
1) Be early
2) Stay late (but don't be that guy who is hanging out 3 hours after your shift despite people have told you to go home)
3) Work hard - this is really key on EM rotations
4) Don't complain (amazingly hard for some people)
5) Always ask for more to do (or be proactive and figure out what needs to be done and do it without being asked to)
6) Read, read, read then show that you've read by applying what you've read to your patients (but don't be that guy who says "as i was reading last night in NEJM")

In addition to what all have said; people told me I stood out because I 1) Always offered a differential/plan (though it was usually overly-paranoid and conservative) and 2) I always asked for feedback at the end of a shift and asked how I could take it to the next level if they didn't offer the info. Hmmm, maybe I should start doing that more now, but I usually get plenty of feedback on a per pt basis....