Hello. I am going to be an M4 soon, looking to go into ER. I have scheduled an inpatient cardiology month for next year, and I was just wondering if you guys think that this is a useful experience for a future ER doc? or would it be just as well if I switch it for an outpatient month and just chill? Most people tell me to just relax and enjoy 4th year, but if this type of experience would be helpful to me going into residency, than I would rather tough it out. Let me know what you guys think. Thanks.
M4: inpatient cards? or just chill?
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The utility of a cards rotation to EM depends a lot on what type of patients you are predominantly seeing. Cardiology and EM have fundamental differences in perspective on low-risk chest pain pts (the whole sensitivity vs. specificity argument) and rounding on a floor full of rule-out ischemia pts all month has little utility (and you will be likely be exposed to significant EM bashing). If you will have significant exposure to the CCU, the management of severe CHF, post-MI complications, and valvular anomalies is incredibly useful in the ED.
I don't know if your school offers it, but I took a course called Heart Station (that's what we call our outpatient cards section, stress testing, echo, nuclear, etc). It was predominantly an month spent reading EKGs for half the day. We also had to spend a certain amount of time in the cath lab, the EP lab, stress testing, and a half day a week in outpatient clinic one on one with an attending, but that wasn't the focus of the rotation. We would roll in at 8:30 or 9:00 AM read 10-15 EKGs each from the previous night and then review each one with a cards fellow or an attending. When combined with the other students' ekgs we would see 30-40 a day (and most were abnormal in some way - we threw out the normals). We were typically gone just after lunch, so it was a great schedule too.
I thought it was a great month. We went into great depth with the EKGs, so we learned a lot. Instead of just saying, "that's a paced rhythm" we learned about the different settings, how to determine lead location, common malfunctions, etc. Since I was going into EM the cards fellows really hit SVTs hard (short RP, long RP, fast/fast, slow/fast, and fast/slow AVNRTs, etc) and the different options with them. And I'm only touching on the topics. I did an inpatient cards rotation 3rd year and there just isn't enough time to discuss all these things every day like we did on this rotation, and learning to competently read EKGs is essential to be a great ED doc.
If your school doesn't offer something similar see if you could set something up. A cardiologist somewhere in the hospital reads all the EKGs, so I wouldn't think it would be too much trouble for you to tag along and read some with them.
I thought it was a great month. We went into great depth with the EKGs, so we learned a lot. Instead of just saying, "that's a paced rhythm" we learned about the different settings, how to determine lead location, common malfunctions, etc. Since I was going into EM the cards fellows really hit SVTs hard (short RP, long RP, fast/fast, slow/fast, and fast/slow AVNRTs, etc) and the different options with them. And I'm only touching on the topics. I did an inpatient cards rotation 3rd year and there just isn't enough time to discuss all these things every day like we did on this rotation, and learning to competently read EKGs is essential to be a great ED doc.
If your school doesn't offer something similar see if you could set something up. A cardiologist somewhere in the hospital reads all the EKGs, so I wouldn't think it would be too much trouble for you to tag along and read some with them.
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I second what Arcan said it really depends on how admitting works at your med school. Where I went to med school the Gen Cards svc was pretty boring with alot of direct admits for repeat caths and stuff like that. Where I am now they tkae alot of UA and stuff like that which is very high yield for EM.
Chest pain is going to be a big part of your life in EM (a much bigger part than trauma or airway management) so to be around some people who actually have angina and severe CAD is pretty useful.
Chest pain is going to be a big part of your life in EM (a much bigger part than trauma or airway management) so to be around some people who actually have angina and severe CAD is pretty useful.
