How would you prepare to be an EM phys?

[Stumbledintomedschool]

So I know I have a few years before I really need to think about this, but I have some ideas of specialty and most aren’t too crazy (psych, peds, PCP). But the one thing I really thought I wanted was EM. After starting school though, I just feel like I would be totally unprepared.

I work well under pressure and I’m fine with knowing a little of everything. I guess what makes me feel unprepared is that you just can’t know EVERYTHING for every situation, and if I was unprepared I’d feel incompetent for not knowing something or potentially losing someone for a lapse in memory or spur of the moment decisions under time constraints. So what is really expected of EM physicians? I’ve worked in ER and I know that most of the stuff that you deal with is pretty low risk, or your typical stabbing, GSW traumas, ODs (at least in my area). But how do they handle it when something crazy comes in and it’s time sensitive but they have no idea what it is or what to do? So they feel incompetent? Do people blame them? I guess this will kind of determine whether or not I consider it.

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[AllBleedingStops]

So I know I have a few years before I really need to think about this, but I have some ideas of specialty and most aren’t too crazy (psych, peds, PCP). But the one thing I really thought I wanted was EM. After starting school though, I just feel like I would be totally unprepared.

I work well under pressure and I’m fine with knowing a little of everything. I guess what makes me feel unprepared is that you just can’t know EVERYTHING for every situation, and if I was unprepared I’d feel incompetent for not knowing something or potentially losing someone for a lapse in memory or spur of the moment decisions under time constraints. So what is really expected of EM physicians? I’ve worked in ER and I know that most of the stuff that you deal with is pretty low risk, or your typical stabbing, GSW traumas, ODs (at least in my area). But how do they handle it when something crazy comes in and it’s time sensitive but they have no idea what it is or what to do? So they feel incompetent? Do people blame them? I guess this will kind of determine whether or not I consider it.

You say you worked in an ED right? Do you think any of the physicians there would be open to talking? Ask them. Talk to the ones who have gone through those situations and you will find the best advice.

 

[Redpancreas]

So I know I have a few years before I really need to think about this, but I have some ideas of specialty and most aren’t too crazy (psych, peds, PCP). But the one thing I really thought I wanted was EM. After starting school though, I just feel like I would be totally unprepared.

I work well under pressure and I’m fine with knowing a little of everything. I guess what makes me feel unprepared is that you just can’t know EVERYTHING for every situation, and if I was unprepared I’d feel incompetent for not knowing something or potentially losing someone for a lapse in memory or spur of the moment decisions under time constraints. So what is really expected of EM physicians? I’ve worked in ER and I know that most of the stuff that you deal with is pretty low risk, or your typical stabbing, GSW traumas, ODs (at least in my area). But how do they handle it when something crazy comes in and it’s time sensitive but they have no idea what it is or what to do? So they feel incompetent? Do people blame them? I guess this will kind of determine whether or not I consider it.

I used to think this about EM in general then I worked for some time in it and realized there are two settings: Acute (Trauma) and lower acuity. For the lower acuity stuff, you’re basically a GP doing ambulatory stuff. For that, you’ll work as your own in similar ways as a FM/IM doctor does seeing patients and fixing the problem or admitting them. For trauma, there’s a reason there’s a TEAM doing everything. There’s like 15 people and at times especially during your first few years of residency, you’re essentially following the attending around and shadowing.

When choosing a residency, don’t look at what someone 7 years down the line from you is expected to do because then you’ll feel unprepared for all fields.

 

[Rendar5]

So I know I have a few years before I really need to think about this, but I have some ideas of specialty and most aren’t too crazy (psych, peds, PCP). But the one thing I really thought I wanted was EM. After starting school though, I just feel like I would be totally unprepared.

I work well under pressure and I’m fine with knowing a little of everything. I guess what makes me feel unprepared is that you just can’t know EVERYTHING for every situation, and if I was unprepared I’d feel incompetent for not knowing something or potentially losing someone for a lapse in memory or spur of the moment decisions under time constraints. So what is really expected of EM physicians? I’ve worked in ER and I know that most of the stuff that you deal with is pretty low risk, or your typical stabbing, GSW traumas, ODs (at least in my area). But how do they handle it when something crazy comes in and it’s time sensitive but they have no idea what it is or what to do? So they feel incompetent? Do people blame them? I guess this will kind of determine whether or not I consider it.

If it’s something crazy that I’m unfamiliar with, which is rather rare, I consult the appropriate specialist. For those truly time sensitive issues, I’m trained on those from residency. I don’t feel incompetent because I know my field well. Competence is developed in residency just like in all fields. Some people don’t feel competent and some people are overly confident sure, but that’s person and not specialty dependent. Yes we get blamed for plenty of stuff because hindsight is 20/20. Though you’ll see most of that second guessing in academic centers by people who are specialists and expect everyone to know the details of their field.

 

[Stumbledintomedschool]

You’re right, I probably should just accept that I’ll be prepared by then. And I suppose that’s why they have more experience people do trauma and with a team. I just wouldn’t want to get there and realize, oh crap! I’m not cut out for this. But who knows how I feel by then.

 

[Stumbledintomedschool]

For some reason I just felt like EM, since it’s the jack of all trades type, is harder to be prepared for whereas other specialties you could probably go your entire career without seeing something you don’t know how to deal with. But I suppose every specialty has the moments too. And the few ER docs I’ve heard from basically accept that they’re not expected to know and be fully prepared for everything because, well, you just can’t. And they’re very comfortable admitting that they don’t know. I guess that confidence comes with time because I can’t imagine having an emergency in front of me and not knowing what to do but I’m just a first year so I don’t know much.

 

[deleted480308]

The best way to prepare to be an em doc (or any competitive specialty) is to do well on step 1

 

[Rendar5]

For some reason I just felt like EM, since it’s the jack of all trades type, is harder to be prepared for whereas other specialties you could probably go your entire career without seeing something you don’t know how to deal with. But I suppose every specialty has the moments too. And the few ER docs I’ve heard from basically accept that they’re not expected to know and be fully prepared for everything because, well, you just can’t. And they’re very comfortable admitting that they don’t know. I guess that confidence comes with time because I can’t imagine having an emergency in front of me and not knowing what to do but I’m just a first year so I don’t know much.

Every single field routinely sees stuff that they are not sure how to deal with. That is why consultations exist and medicine is not a field that is practiced in isolation, ever. Even if you are a solo practitioner and encounter an issue that you are not sure how to manage, you’re gonna send the patient to a hospital, outpatient specialist, or the emergency department for someone else who has appropriate expertise to manage.

 

[Tenk]

The best way to prepare to be an em doc (or any competitive specialty) is to do well on step 1

This is actually true.

Long story: you can never be prepared for everything that comes through your doors but you can develop a set of skills like Liam Neeson. Skills that allow you to keep people from dying or literally bring them back to life. Your main job is resuscitation and identifying sick from non sick. This comes with time and is not something that happens overnight so don’t worry about it. The main question is: can you handle stress and shift work?

 

[Stumbledintomedschool]

This is actually true.

Long story: you can never be prepared for everything that comes through your doors but you can develop a set of skills like Liam Neeson. Skills that allow you to keep people from dying or literally bring them back to life. Your main job is resuscitation and identifying sick from non sick. This comes with time and is not something that happens overnight so don’t worry about it. The main question is: can you handle stress and shift work?

Love the reference. And I can handle shifts...whether my spouse could is different. Lol

 

[Crayola227]

Just for the time sensitive nature of stuff, as pointed out you have a team, but also there is an element of algorithmic thinking in EM which exists not because EM docs aren't creative problem solvers thinking on their feet (they are many times called on in this way) but also to save time when time matters. Sorta like Gawande's book about checklists.

 

[Crayola227]

I've been told over and over by EM docs to anyone considering the field: you have to be OK with some degree of ambiguity. You frequently are making decisions without a full picture or context, or even knowing how it ends up. You have to be OK with making the best decision you can at the time with what you have, and making peace with that. Or it's true, then the field is not for you.

That said, assuming you can handle some ambiguity, EM residency is precisely about teaching you how to go about making the best decisions under the constraints you must make them under.

 

[STcmOCSD]

As an EM physician, you’re trained to know what could be the worst thing happening to a patient based on their symptoms. If it’s not that and the patient isn’t dying, you get another specialty in as a consult.

 

[CherryRedDracul]

One of the most important things to know as an EM physician (IMO) is when you order imaging studies, PLEASE put appropriate clinical indications such as pertinent symptoms, physical exam findings, and labs, if applicable. Then you can mention what disease process you are looking to evaluate for.

PLEASE don't just write something like "rule out fracture". We can't bill for that.

Sincerely,

Your Friendly Neighborhood Radiologist

 

[Gurby]

For some reason I just felt like EM, since it’s the jack of all trades type, is harder to be prepared for whereas other specialties you could probably go your entire career without seeing something you don’t know how to deal with. But I suppose every specialty has the moments too. And the few ER docs I’ve heard from basically accept that they’re not expected to know and be fully prepared for everything because, well, you just can’t. And they’re very comfortable admitting that they don’t know. I guess that confidence comes with time because I can’t imagine having an emergency in front of me and not knowing what to do but I’m just a first year so I don’t know much.

I was shadowing recently with a surgeon who has been an attending for 20+ years, when he got called to the OR by another surgeon with 20+ years of experience who wanted to get a second opinion on something. I thought it was a pretty neat moment. Even after doing this procedure literally probably 5,000 times, there was still some question that arose that needed another set of eyes or a different perspective on the situation.

 

[Trogghunter]

All you need to know is how to....
1) make residents put in a femoral line
2) make residents or resp therapy intubate but not well
3) force consults on grounds of emtala
4) admit to medicine
5) complain about the ER being full
6) order donuts etc
7) repeat

 

[sliceofbread136]

know your pals/acls very well. Know the warning signs for an emergency etiology of the various common symptoms that you will see

 

[Stumbledintomedschool]

One of the most important things to know as an EM physician (IMO) is when you order imaging studies, PLEASE put appropriate clinical indications such as pertinent symptoms, physical exam findings, and labs, if applicable. Then you can mention what disease process you are looking to evaluate for.

PLEASE don't just write something like "rule out fracture". We can't bill for that.

Sincerely,

Your Friendly Neighborhood Radiologist

Will keep in mind!

 

[Stumbledintomedschool]

All you need to know is how to....
1) make residents put in a femoral line
2) make residents or resp therapy intubate but not well
3) force consults on grounds of emtala
4) admit to medicine
5) complain about the ER being full
6) order donuts etc
7) repeat

They always had donuts! Sounds legit

 

[Stumbledintomedschool]

I appreciate all your responses! I love working under pressure as I long as I feel well equipped to do so, so I suppose only time will tell if I feel confident enough to go into EM.

 

[Crayola227]

the EMRA book "Top Clinical Problems in EM" made me look really good on rotation, and it was actually useful into residency

I had EM and other docs ask to look through it at times, I highly rec it for anyone, really

it's important no matter where you go to keep emergent etiologies in mind for whatever you're assessing, I saw someone start to have an MI in an optho clinic

random but yeah

 

[Rendar5]

One of the most important things to know as an EM physician (IMO) is when you order imaging studies, PLEASE put appropriate clinical indications such as pertinent symptoms, physical exam findings, and labs, if applicable. Then you can mention what disease process you are looking to evaluate for.

PLEASE don't just write something like "rule out fracture". We can't bill for that.

Sincerely,

Your Friendly Neighborhood Radiologist

I don’t think that is really restricted to the EM physicians. All physicians need to know that.