I will be doing an away rotation at a hospital that I am very interested in and want to make a great impression. What are some ways to make yourself stick out without going too overboard? I have been told that I should go in early and stay late, etc... I heard this from a Surgery Resident Director and I'm wondering if that would work for em as well or if I would just be in the way and make a bad impression instead.
How to go above and beyond...
- Thread starter Manda
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Pretty much the same wherever you go. I'm a senior in the ED and I have to evaluate patients every shift, so I know what I look for:
1) Be nice, be friendly.
2) Work hard.
3) See lots of patients, but don't forget to follow up on the patients you do see.
This much you know. A few pointers.
1) Be ORGANIZED when you present your patients. Nothing is more painful that taking a med student presentation that's all over the board when you have 4 patients waiting for dispo. I prefer:
Hx
CC with pertitient PMH
HPI - be really detailed here. Here's where 90% of all diagnoses are made.
a very tight review of systems with important negatives
PE
level of distress: none (sleeping) vs severe (screaming and sweating)
Vitals (stable vs unstable)
pertinent positive and negative physical exam findings (if it's a twisted ankle I don't care much if they have an S1 and S2 over the apex)
Management plan: labs, x-rays, treatment
Probable disposition (admit, ICU, or dc)
2) Look up some information about each patient on the web and tell me something I don't know. I like to hear obscure or new details on an old story "Did you know they're treating MRSA with minocycline?", etc.
3) look up patient old records, cath reports, old CAT scans, in order to make my life easier. It also shows you know how to use the resources at your disposal.
The last three, in my mind, will really set you apart.
1) Be nice, be friendly.
2) Work hard.
3) See lots of patients, but don't forget to follow up on the patients you do see.
This much you know. A few pointers.
1) Be ORGANIZED when you present your patients. Nothing is more painful that taking a med student presentation that's all over the board when you have 4 patients waiting for dispo. I prefer:
Hx
CC with pertitient PMH
HPI - be really detailed here. Here's where 90% of all diagnoses are made.
a very tight review of systems with important negatives
PE
level of distress: none (sleeping) vs severe (screaming and sweating)
Vitals (stable vs unstable)
pertinent positive and negative physical exam findings (if it's a twisted ankle I don't care much if they have an S1 and S2 over the apex)
Management plan: labs, x-rays, treatment
Probable disposition (admit, ICU, or dc)
2) Look up some information about each patient on the web and tell me something I don't know. I like to hear obscure or new details on an old story "Did you know they're treating MRSA with minocycline?", etc.
3) look up patient old records, cath reports, old CAT scans, in order to make my life easier. It also shows you know how to use the resources at your disposal.
The last three, in my mind, will really set you apart.
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Manda said:
I found that $20 bills folded inside the H+P for the Chief Resident's signature was very helpful on most rotations.
D
deleted52758
beyond all hope said:
the only thing i would add is to not pressure yourself to see x amount of patients per hour. see as many as you feel comfortable with and you can do a good thorough job on. ive heard from several attendings that they get more annoyed when a 4th year tries to take 4 patients and does a crappy job on those 4 patients, as opposed to seeing one patient and doing a good job on that one patient.
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Beyond all hope gave some good advice.
Some tips from a senior resident:
1. Be efficient. Don't take forever to get a history and physical. Don't take forever to tell me about it.
2. Know the EM killers inside and out. By that I mean, you should know the chest pain killers inside and out: ischemia, dissection, PE, etc. Know these for all the major complaints.
3. Have a differential when you present and know what you think the diagnosis is. If you have to take a few minutes to read or look at uptodate, do it. It will be a much more impressive presentation. Also have a general idea of the patient's disposition.
4. Have a plan. Don't look to me to tell you what to do, although I will certainly help.
5. Follow-up on the results. Look for the EKG, the CXR. Check labs early and often. Know what's going on with the patient before I do and keep me up to date but not with every minute detail. When a clear picture is beginning to emerge, let me know.
6. If the patient is going home, write the discharge instructions.
7. Try to be managing 2-4 patients at a time depending on how sick and complicated they are. It's only helpful to pick up another patient if you are totally on top of your patients and not letting things fall through the cracks. Don't leave a mess for your senior to clean-up.
8. Make sure you sign out every patient to the senior resident whether you give it to another resident or not. Have a clean sign out--make sure you have checked lab results and xray reads. NEVER SIGN OUT A PROCEDURE. It is extremely poor form to sign out a lac, a pelvic, an LP, or other procedure. You will be dinged in a major way on an evaluation if you do this.
9. Be willing to work until the end of your shift. Nothing is more impressive than someone who picks up a lac with only 30 minutes to go in the shift.
10. Have fun, show interest, be enthusiastic, and learn everything you possibly can.
11. Try to identify attendings who you will be working with frequently early in your rotation (this may mean only 2 to 3 shifts). The best attendings to work with are program directors, medical student coordinators, and senior attendings who are well known in EM. Let them know you are going into the field and would like a recommendation. This allows them to watch you early on and form an impression. Likewise, let residents know you are going into EM. We will be more likely to show you the ropes, give you interesting opportunities, and MAY make us friendlier to an eval if you do a decent job.
12. Use the correct terminology. You are working in the ED and are going into Emergency Medicine. The attending is an Emergency Physician, not an ER doc. These are details, but to some of us they are very important details.
13. Be nice to the nurses and do not irritate them. They will complain to us and we do not like unhappy nurses. Medical students can be somewhat notorious for rubbing the nurses the wrong way. If you are having a problem with a nurse or something is not getting done, let your senior know. That is what we are there for and we will help you.
14. Keep your patients happy. Explain what is going to happen and go back frequently to give them updates. Be careful not to overstep your bounds. If you're not sure about something, wait until you talk to your senior. Do not give a sensitive diagnosis without discussing it with your senior first.
Hope that's helpful. Good luck to you!
Some tips from a senior resident:
1. Be efficient. Don't take forever to get a history and physical. Don't take forever to tell me about it.
2. Know the EM killers inside and out. By that I mean, you should know the chest pain killers inside and out: ischemia, dissection, PE, etc. Know these for all the major complaints.
3. Have a differential when you present and know what you think the diagnosis is. If you have to take a few minutes to read or look at uptodate, do it. It will be a much more impressive presentation. Also have a general idea of the patient's disposition.
4. Have a plan. Don't look to me to tell you what to do, although I will certainly help.
5. Follow-up on the results. Look for the EKG, the CXR. Check labs early and often. Know what's going on with the patient before I do and keep me up to date but not with every minute detail. When a clear picture is beginning to emerge, let me know.
6. If the patient is going home, write the discharge instructions.
7. Try to be managing 2-4 patients at a time depending on how sick and complicated they are. It's only helpful to pick up another patient if you are totally on top of your patients and not letting things fall through the cracks. Don't leave a mess for your senior to clean-up.
8. Make sure you sign out every patient to the senior resident whether you give it to another resident or not. Have a clean sign out--make sure you have checked lab results and xray reads. NEVER SIGN OUT A PROCEDURE. It is extremely poor form to sign out a lac, a pelvic, an LP, or other procedure. You will be dinged in a major way on an evaluation if you do this.
9. Be willing to work until the end of your shift. Nothing is more impressive than someone who picks up a lac with only 30 minutes to go in the shift.
10. Have fun, show interest, be enthusiastic, and learn everything you possibly can.
11. Try to identify attendings who you will be working with frequently early in your rotation (this may mean only 2 to 3 shifts). The best attendings to work with are program directors, medical student coordinators, and senior attendings who are well known in EM. Let them know you are going into the field and would like a recommendation. This allows them to watch you early on and form an impression. Likewise, let residents know you are going into EM. We will be more likely to show you the ropes, give you interesting opportunities, and MAY make us friendlier to an eval if you do a decent job.
12. Use the correct terminology. You are working in the ED and are going into Emergency Medicine. The attending is an Emergency Physician, not an ER doc. These are details, but to some of us they are very important details.
13. Be nice to the nurses and do not irritate them. They will complain to us and we do not like unhappy nurses. Medical students can be somewhat notorious for rubbing the nurses the wrong way. If you are having a problem with a nurse or something is not getting done, let your senior know. That is what we are there for and we will help you.
14. Keep your patients happy. Explain what is going to happen and go back frequently to give them updates. Be careful not to overstep your bounds. If you're not sure about something, wait until you talk to your senior. Do not give a sensitive diagnosis without discussing it with your senior first.
Hope that's helpful. Good luck to you!
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My colleagues all put forth excellent advice - one of our current rotators is doing these things just right, and she's well on her way to being almost securely in for next year.
My one point - in your presentation, I should know why the patient is there in the first 10 seconds; I mean, it's all well and good if the patient "has history of DM I, on insuling, CAD, HTN, CVA", but, after a minute (or more) and then I find out it's a finger lac on the nondominant hand, it's a little jumbled. If you don't know why (ie, diagnosis), go with the chief complaint - it never fails. Chest pain, trouble breathing that sounds like asthma, trouble breathing that isn't clear if it's pneumonia or CHF, and the sort.
Oh, one other point - life is in the details. If it's a hand complaint (lac, trauma, etc) - present what hand preference the hand is - had a day 3 weeks ago when both hand patients (one lac, one thumb cut off) were left-hand injured and left-hand dominant. Get the visual acuity. Do the rectal.
My one point - in your presentation, I should know why the patient is there in the first 10 seconds; I mean, it's all well and good if the patient "has history of DM I, on insuling, CAD, HTN, CVA", but, after a minute (or more) and then I find out it's a finger lac on the nondominant hand, it's a little jumbled. If you don't know why (ie, diagnosis), go with the chief complaint - it never fails. Chest pain, trouble breathing that sounds like asthma, trouble breathing that isn't clear if it's pneumonia or CHF, and the sort.
Oh, one other point - life is in the details. If it's a hand complaint (lac, trauma, etc) - present what hand preference the hand is - had a day 3 weeks ago when both hand patients (one lac, one thumb cut off) were left-hand injured and left-hand dominant. Get the visual acuity. Do the rectal.
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You don't have to get there early. Just be on time and work hard.
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Snoopy said:
Have we become that humorless and self-important as a specialty that we will worry about symantics?
I could care less if I'm called an "ER Doc" or "Emergency Physician" or "Glorified Triage Nurse". If a medical student says "ER" it doesn't bother me in the slightest.
To criticize a medical student for saying "ER Doc" is an example of the self-importance and arrogance of some in our profession.
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GeneralVeers said:
I think words matter, and I think we should use terminology that reflects the fact that we are a full-fledged specialty. When was the last time you heard a surgeon called an OR Doc? Medical students going into emergency medicine should know the correct way to speak about their future specialty. Would I write a bad evaluation on a student for saying ER? No. Would I correct them? You bet.
