How to do well in the EM subI

[GladifImakeit]

Help! I start my 4th year in 2 weeks. I was forced to take an EM subI due to bad luck in the lottery. I really wanted psych, but I didn't get psych or medicine until the fall, and I have to do a subI before the end of summer. All that was left over was EM subI

I don't like stressful situations and EM isn't the field for me. Nonetheless, I'm on "thin ice" at my school and have to do well.

How can I maximize my chances for success? Thank you very much for your help!

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[winkleweizen]

1) Show up early
2) Stay until youve wrapped everything up
3) See patients in order and after you go and do the H and P make sure to process them for a minute and write up specific orders before you present to your attending (even if youre wrong, i feel like they appreciate this)
4) Read

5) Can you not switch SubIs? I feel that EM would probably be a more highly sought after SubI then Psych. Perhaps a classmate will switch?

 

[EM2BE]

Know what is going on with your patients and re-evaluate them. Biggest peeve of mine is a student that has 5 patients but no idea what is going on with them or how they are doing. Also, before leaving, make sure the resident/attending knows you are leaving. I've had students leave who still had active patients. Have some differentials ready when presenting a patient. If a patient is critically ill, walk out of the room and get help before getting the H&P.

 

[GladifImakeit]

1) Show up early
2) Stay when youve wrapped everything up
3) See patients in order and after you go and do the H and P make sure to process them for a minute and write up specific orders before you present to your attending (even if youre wrong, i feel like they appreciate this)
4) Read

5) Can you not switch SubIs? I feel that EM would probably be a more highly sought after SubI then Psych. Perhaps a classmate will switch?

This might sound silly, but it's a big fear of mine: I don't know how to write orders. I can do an H & P and also feel good with the assessment and plan in general terms. I can recognize, say, that a patient with ACS needs MONA, but besides the aspirin, I don't know what doses I write or how the patient will actually get what I want to give. I am quite worried about never being a subI, How do I learn the things subIs need to do that are different from 3rd year?


Yea, I got the short end of the stick with the lottery. There is a third fewer psych subI spots the next several months because one site director will be on leave, There are plenty of open psych spots later in the year, but nothing before the deadline to do my first subI. I can't explain why, but EM was the best remaining choice. That or pediatrics. I'd make a horrible pediatrician.

 

[winkleweizen]

This might sound silly, but it's a big fear of mine: I don't know how to write orders. I can do an H & P and also feel good with the assessment and plan in general terms. I can recognize, say, that a patient with ACS needs MONA, but besides the aspirin, I don't know what doses I write or how the patient will actually get what I want to give. I am quite worried about never being a subI, How do I learn the things subIs need to do that are different from 3rd year?


Yea, I got the short end of the stick with the lottery. There is a third fewer psych subI spots the next several months because one site director will be on leave, There are plenty of open psych spots later in the year, but nothing before the deadline to do my first subI. I can't explain why, but EM was the best remaining choice. That or pediatrics. I'd make a horrible pediatrician.

Dude your super self depricating. You can look up doses in epocrates or whatever source you wanna lose. Orders? Youll learn quickly.

Youll be fine, just be confident

 

[Daiphon]

One other thing...

The ED is frequently the intake spot for a *lot* of psych complaints; as long as you're making sure to see a smattering of other patients (chest pain, belly pain, headache, etc), if you tend to gravitate towards the psych patients, and do a bang-up job, then this is one way to do very well on your month while playing towards what I perceive from your post to be your strength...

Doing well in EM, if you don't want to do EM, involves making people *think* you want to go into EM; and that means focusing on what you like while being open to dealing with what you don't. Plus, while psych patients are fun, they can sometimes tie up attendings & residents while we need to be doing other things... if you are the point person for these individuals, you will make a lot of friends.

Oh, and be nice to the nurses. ALWAYS be nice to the nurses. This alone will get you far.

Cheers!
-d

 

[jbar]

Part of doing well is having a good mindset. If you walk into the first day saying "this is going to suck,"...well, it's going to suck. If for no other reason that you have to go through an general intern year to do psych you should think about what you are going to get called for on the floor and have to handle. You are going to be seeing patients at 3am with chest pain, or a fever, or shortness of breath. So you should work on getting comfortable with those bread and butter medicine complaints.

 

[gman33]

Get a good pocket book, like Pocket EM.
Gives you the workups and diff dx for the most common stuff.
Will make you look like a star if you know all the steps (and kind of know why, which isn't in there).

If you want to do some reading, go to one of the standard texts and read the sections on chest pain, abd pain, and abd pain/preg/first tri bleeding.

Good start for some of the more common things.

 

[AmoryBlaine]

I don't mean to sound flippant, but the students I remember the most for bad reasons were just douches. The showed up late, argued about plans in a condescending way, failed to joke around with us, and basically let it be known that they already knew that the EM docs were the bottom of the hospital prestige ladder.

One sure way to fail in EM is to not latch on to the idea that we test people and work them up. Your M4 pronouncement that they don't have McBurney's point TTP therefore they don't have appendicitis is not going to impress me. Your diligent pressing on the 55 m with CP's chest is not going to prevent me from admitting him. Get used to it: we test.

We had a legendary story going around the ED last year about an M4 who was going into urology so was basically fighting tooth and nail not to have urology consulted on a patient who was like 1 week post-op from a cysto with a bladder complaint. He went so far as to get in the attending's face and say "this consult is inappropriate." He did not get a good eval.

 

[GladifImakeit]

I have figured out one principle of success that has made a huge difference for me: do what you are told, and do it with a smile!

 

[GladifImakeit]

Don't laugh at my ignorance... what's the difference between synchronized and unsynchronized regarding ACLS? What about defibrillation vs. shock vs. cardioversion? What about monophasic vs. biphasic? I am reading the protocols about all these different rhythms and wow it's confusing! Thanks for your help!