How to best evaluate one's fit/interest in EM?

[BPlaysItCool]

I know things are busy with residency applications but...any advice would be appreciated.

I am trying to be active in evaluating my fit for this and other careers as an M-1. I'm mid 30's so taking too long to figure things out impresses on me the benefits of not doing that again.

I have been an ED tech and loved the environment. I love the undifferentiated-ness of things. I like the random element. And love the overall environment.

What makes me doubt myself in EM is I don't particularly like adrenaline rushes or trauma etc. I don't dislike it. I just don't get a charge out of it. Like most people applying to EM.

Any ideas on pushing a deeper self-evaluation. I'm doing all the shafowing I can do right now.

Thanks.

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[qwerty1234]

Best way to tell is to try everything (ie MS3). Short of that, here's some questions that I think are useful:

1. Acuity - do you need to feel like your patients reason for their visit must be addressed immediately (ie trauma surgery) or sometime during their lifetime (family medicine). EM is a mix of that whole span.

2. Patients - do you care if they're rich, poor, smelly, insured, take care of themselves or not?

3. Talking - do you like your patients to be awake? Do you like to have to talk to them? How long do you like to have to talk to them before you take an action?

 

[Nasrudin]

deleted

 

[dchristismi]

Honestly, keep your mind open until you actually rotate as an M3. You can be interested in plenty of things, but with EM, you'll know pretty quickly into the rotation if its for you. You might find something else you love even more - so do try to keep your mind open.

 

[in1Q84]

I think no one knows for sure until they actually do an EM rotation... (I don't think it's even possible to know from shadowing.) So, I think my recommendation would be for you to do a rotation as soon as possible... Because by the fourth year comes, it's kinda too late.

 

[alwaysaangel]

Because by the fourth year comes, it's kinda too late.

I would disagree with this.

The vast majority of schools don't allow students to rotate through the ED until 4th year. So its kind of silly to say its too late if you wait until 4th year to do a rotation, since most of us do.

Shadowing should give you a pretty good idea, its not the same as actually rotating but it will give you an idea.
If your school has an EMIG get involved: they usually have good lectures on the nature of the field and you may get an idea if you like it or not.
Talk to an attending at your school about why they did EM and about your goals for your future. Just find an attending you like and trust, if you're applying EM you'll need a mentor anyway. If your school doesn't have an ED at all then the ACEP has a mentorship program.
Go to an ACEP or SAEM student tract at one of their assemblies...they usually do a great job of discussing pros/cons, and the overall state of EM. Should give you a pretty good idea.

But overall, you won't know for sure until you hit your rotation during 4th year. Its unfortunate but it happens to everyone if it makes you feel any better.

 

[jbar]

Also keep an eye open for what kind of pathology/patients on your other rotations you enjoy. I found my favorite encounters on ortho going to the ED to reduce fractures. Favorite neurosurgical patients were emergent trauma cases, favorite IM patients sick people who needed to be intubated etc. If you find yourself interested more in the 10% sickest patients of each field rather than their bread and butter stuff that's a sign.

Also if you get patients admitted to you third year, they say "go see the 65 yo female with pneumonia and COPD, who got put on vanc and azithro in the ED" and you think "this is boring, we already know the diagnosis and treatment has already begun," that's a sign.

 

[in1Q84]

Yea, it really is unfortunate that many schools don't allow EM rotation until 4th year. What I meant to say is that... It's kinda too late if you think you want to do EM and change your mind right before ERAS opens up, which DOES happen to people. It would have happened to me too if I had not liked EM. Fortunately, I enjoyed my EM rotations. But, I get chills thinking what if I had not. I would have been in a really bad position... So, I guess what I meant to say was to keep your options open until you do a rotation and know for sure.

Well, I shadowed and volunteered in ER too. But, they weren't enough... I loved shadowing and volunteering. But, actually taking on responsibilities of a (student) doctor is whole lot different.

I also agree with Jbar. I loved two weeks of trauma that I got during surgery and going down to the ED for admits during inpatient. That helped me decide...

 

[NinerNiner999]

Try this - (tongue and cheek yet fairly realistic suggestion):

Sit down in an uncomfortable industrial chair and begin to study for the hardest clinical test of your life - the test you need an A in to ace your rotation. Turn the temperature of the room up to 75 degrees. Do the following before you proceed:

1) let a piece of meat rot for a week, place it in a sock, and place it under your chair. Be sure the aroma fills the room where you sit.

2) Take a crying baby and place it in the back room of your home with the door open. keep it crying.

3) Have someone you don't really want to talk to call you every two minutes to randomly interrupt what you are doing with questions or complaints. You must answer every call.

4) Get up from your chair every 5 minutes and walk into a different room of your home, stay there for 5-10 minutes, and return to the chair.

5) Study for your test while all of this is happening for 12 hours and get an A on your exam.

If you can do this, you will have come close to simulating the shift of an attending physician. If you can do it the entire time with a smile on your face, a cheerful voice on the phone, and want to do it again the next day, than you are fit for EM.

 

[Dwindlin]

Try this - (tongue and cheek yet fairly realistic suggestion):

Sit down in an uncomfortable industrial chair and begin to study for the hardest clinical test of your life - the test you need an A in to ace your rotation. Turn the temperature of the room up to 75 degrees. Do the following before you proceed:

1) let a piece of meat rot for a week, place it in a sock, and place it under your chair. Be sure the aroma fills the room where you sit.

2) Take a crying baby and place it in the back room of your home with the door open. keep it crying.

3) Have someone you don't really want to talk to call you every two minutes to randomly interrupt what you are doing with questions or complaints. You must answer every call.

4) Get up from your chair every 5 minutes and walk into a different room of your home, stay there for 5-10 minutes, and return to the chair.

5) Study for your test while all of this is happening for 12 hours and get an A on your exam.

If you can do this, you will have come close to simulating the shift of an attending physician. If you can do it the entire time with a smile on your face, a cheerful voice on the phone, and want to do it again the next day, than you are fit for EM.

Totally doing this for my musculoskeletal exam coming up. . .

 

[gutonc]

Try this - (tongue and cheek yet fairly realistic suggestion):

Sit down in an uncomfortable industrial chair and begin to study for the hardest clinical test of your life - the test you need an A in to ace your rotation. Turn the temperature of the room up to 75 degrees. Do the following before you proceed:

1) let a piece of meat rot for a week, place it in a sock, and place it under your chair. Be sure the aroma fills the room where you sit.

2) Take a crying baby and place it in the back room of your home with the door open. keep it crying.

3) Have someone you don't really want to talk to call you every two minutes to randomly interrupt what you are doing with questions or complaints. You must answer every call.

4) Get up from your chair every 5 minutes and walk into a different room of your home, stay there for 5-10 minutes, and return to the chair.

5) Study for your test while all of this is happening for 12 hours and get an A on your exam.

If you can do this, you will have come close to simulating the shift of an attending physician. If you can do it the entire time with a smile on your face, a cheerful voice on the phone, and want to do it again the next day, than you are fit for EM.

This essentially summarizes what my months on ED rotation as an IM resident were like, and why I was happy it was only a month or two and not a career. Works for some people, not for everyone.

 

[BPlaysItCool]

Good stuff here to chew on. I appreciate it.

 

[dl2dp2]

This essentially summarizes what my months on ED rotation as an IM resident were like, and why I was happy it was only a month or two and not a career. Works for some people, not for everyone.

Also something to keep in mind -- if you want to treat the sickest of the sick and deal with the most acute situation all the time, EM is not the right field. Patients in the ICU are on average much much sicker than patients in the ED. A career in critical care would be much more of a fit. Patient population in the ED is much more diverse than anywhere else in the hospital.

 

[tonem]

Also something to keep in mind -- if you want to treat the sickest of the sick and deal with the most acute situation all the time, EM is not the right field. Patients in the ICU are on average much much sicker than patients in the ED. A career in critical care would be much more of a fit. Patient population in the ED is much more diverse than anywhere else in the hospital.

That may be true but the vast majority of the ICU population gets there through the ED. The allure of emergency medicine is receiving an undifferentiated critical patient, resuscitating them, stabilizing them, then sending them on their way so that someone else can micromanage ventilator settings, I/O's, nutritional needs and countless specialty consultations. That's just my biased opinion.

 

[NSAIDAllergy]

Try this - (tongue and cheek yet fairly realistic suggestion):

Sit down in an uncomfortable industrial chair and begin to study for the hardest clinical test of your life - the test you need an A in to ace your rotation. Turn the temperature of the room up to 75 degrees. Do the following before you proceed:

1) let a piece of meat rot for a week, place it in a sock, and place it under your chair. Be sure the aroma fills the room where you sit.

2) Take a crying baby and place it in the back room of your home with the door open. keep it crying.

3) Have someone you don't really want to talk to call you every two minutes to randomly interrupt what you are doing with questions or complaints. You must answer every call.

4) Get up from your chair every 5 minutes and walk into a different room of your home, stay there for 5-10 minutes, and return to the chair.

5) Study for your test while all of this is happening for 12 hours and get an A on your exam.

If you can do this, you will have come close to simulating the shift of an attending physician. If you can do it the entire time with a smile on your face, a cheerful voice on the phone, and want to do it again the next day, than you are fit for EM.

The best sarcasm is the kind that has much truth. Nail-on-the-head-here.

 

[NSAIDAllergy]

Also something to keep in mind -- if you want to treat the sickest of the sick and deal with the most acute situation all the time, EM is not the right field. Patients in the ICU are on average much much sicker than patients in the ED. A career in critical care would be much more of a fit. Patient population in the ED is much more diverse than anywhere else in the hospital.

If you like acute care & crashing patients, go EM. If you like critical continuing care, go ICU. The sick patients in the ICU got there via the ED.