Most new PGY3 EM residents have done countless intubations, lines, chest tubes, at least a handful of crics on cadavers or in sim lab (or pt), delivered a few babies on their OB rotation and resuscitated many trauma/medical adults and kids and ran a heck of a lot of codes, etc.. I think this experience makes them decidedly better equipped to handle an ER. Look, it’s no secret that 90% of what we do can be done by just about anybody, but that 10% can burn you without experience. If an IM resident wants to take a chance, go for it, but I wouldn’t recommend it. I’d stick to comfortable territory. As for residents moonlighting, there’s always the risk of litigation or bad outcome. In an ideal world, it’s always better to wait until after residency to moonlight, but the lure of extra money for cash strapped residents is often too great. Most PDs are really very good at identifying which of their residents are competent to moonlight on their own, hence why you need to be cleared by your PD in the first place. In the end, I still think it’s really good experience. There’s a degree of polish that’s easily observed from graduating residents with moonlighting experience vs brand new grads who’ve never worked autonomously.
I’d be kind of curious though....would most IM and/or FM PD’s clear their residents to work in the ER on their own? I’d be honestly surprised if they did... As I said earlier though, VA ER might be a decent place. I remember that a lot of our residents couldn’t moonlight over there because it was fiercely protected by the IM residents and in hindsight...it’s not a bad place for someone with limited emergency experience. No OB, no peds and lots of backup a phone call and/or quick jog down the hallway away.
