Most useful elective rotation for a future EM resident?

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boulux

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Simple question, but I'd like some opinions on this.

My med school's curriculum starts its clinical rotation with 3 electives (before the core rotation). I'm already dead set on EM, I've had enough clinical exposure to make my choice.

Well, if you were to choose 3 electives that would be the most useful (regardless of the application process for residency), what would you choose? I already have a 6 weeks rotation in EM this summer. One of those 3 electives can actually be a EM one. BTW, those electives are 4 weeks long each.

Thanks for the input!

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Anesthesiology, Radiology, Cardiology, ICU. I'm sure you can't go wrong with any of those.
 
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Thus far I was thinking about rads, EM and maybe anesthesiology. But I'm thinking about not doing EM and doing something else because I'll do a plenty of EM afterwards. It's very hard to find a trauma elective. It would be high on my list but I'm not confident I'll find one. I'd have to go somewhere in ontario or in the states but my english isn't good enough to fully benefit from it (unfortunately).
 
Thus far I was thinking about rads, EM and maybe anesthesiology. But I'm thinking about not doing EM and doing something else because I'll do a plenty of EM afterwards. It's very hard to find a trauma elective. It would be high on my list but I'm not confident I'll find one. I'd have to go somewhere in ontario or in the states but my english isn't good enough to fully benefit from it (unfortunately).

Toxicology?
 
Most of the EPs and 4th years I have spoken to say that you can't really go wrong with any elective because of the scope of EM.

Obviously, as others have pointed out there are some that may be better. I have heard different takes on how to set up your 4th year.

1. Try to schedule clerkships to prepare you for your desired specialty
2. Try to sample the more esoteric rotations, since this is the last time you may have the opportunity to do so
3. Make your schedule as easy as possible, because no matter what you take you will still not be ready for the major change of intern year

I hedged my bet and went with alittle of 1 and 3
 
scheduled 4 different 4th year electives today..

1 away EM rotation, 1 home EM rotation
1 CT/US radiology rotation
1 "understanding your patient's needs" rotation.

probably will add an anesthesia and an EKG elective, maybe a few weeks of medical spanish in a central american country close to the endless, tropical surf of the pacific ocean. we'll see. I'm definitely trying to combine 1 and 3 from the list above. :)
 
I think above anything else, anesthesia is the most essential elective rotation in med school for EM in the future--there's a reason that managing an airway is the first part of the ABCs. You really want to learn on many uncomplicated, NPO cases in the OR rather than the drunk combative guy vomiting or the GSW.

My elective rotation ranking would be:

Tier 1:
-anesthesia

Tier 2:
-cards
-radiology

Tier 3:
-optho
-ortho
-ICU (only down here because you'll get a lot of experience in residency)
-ultrasound
-trauma
-tox
-peds surg if you can do it provides a great experience in dealing with sick kids
 
I think above anything else, anesthesia is the most essential elective rotation in med school for EM in the future--there's a reason that managing an airway is the first part of the ABCs. You really want to learn on many uncomplicated, NPO cases in the OR rather than the drunk combative guy vomiting or the GSW.

My elective rotation ranking would be:

Tier 1:
-anesthesia

Tier 2:
-cards
-radiology

Tier 3:
-optho
-ortho
-ICU (only down here because you'll get a lot of experience in residency)
-ultrasound
-trauma
-tox
-peds surg if you can do it provides a great experience in dealing with sick kids

Thanks a lot! That's the kind of input I was hoping for...

Thus far, this is what I had in mind. 1st elective is going to be anesthesia in a rural area, where we're given lots of responsibilities and exposure. I've heard there's so resident and they treat medical student very well and they actually like giving us lots of exposure. This is going to be my first elective. As for the second one, I really want to do rads. I'll have to find a place where they'll actually do a lot of teaching. I'll speak with a few rads resident here if they have any idea.

As for the third one, I have a hard time making my choice. I'd like to do trauma. Unfortunately, trauma and toxicology electives are way too hard to have for us here. If it's possible, I'll try to get a trauma elective with this elective. If not, would cards be a much wiser choice than let's say ortho? There's also a possibility of doing a peds-EM rotation. If ever it were to be an available option for me, would you advise in doing this instead of cards?
 
now that i think about it, one of the more high-yield rotations for EM is optho--most residencies don't have any formal rotation and the only teaching occurs when pts come in with optho complaints.

i did a month of it towards the end of 4th year and it really helped to become familiar with the slip lamp and some common optho stuff.

yesterday, i ended up calling the optho resident on call for a non-emergent thing so a pt could get follow-up and he actually said he was impressed with the thoroughness of my work-up
 
now that i think about it, one of the more high-yield rotations for EM is optho--most residencies don't have any formal rotation and the only teaching occurs when pts come in with optho complaints.

i did a month of it towards the end of 4th year and it really helped to become familiar with the slip lamp and some common optho stuff.

Agreed. I tried to get optho for next year, but it was full. Will try to waitlist it.
I think medical students in general, probably aren't doing many true optho exams, so our skills aren't as sharp.

But again, still can't go wrong with many
 
What about Derm? It serves 2 purposes:
1. 6000 different rashes, zits, and nevi can shorten a bunch of ER visits with a new rash.
2. Chill elective
 
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Optho, derm, and rads are traditional high-yield subjects. Learning how to talk to an opthalmologist can save fruitless minutes over the phone while your consultant is trying to decide if you're describing retinal detachment or conjunctivitis. Derm, in theory, should be useful since we see a lot of rashes that we can't identify by sight. If you can take a 2 week elective I'd recommend that, I think a month would be relatively low yield.

Radiology is going to depend on the set-up. I was told at the beginning of my rotation that there was nothing they could teach me in only 1 month and they fulfilled that bargain.
 
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Radiology is going to depend on the set-up. I was told at the beginning of my rotation that there was nothing they could teach me in only 1 month and they fulfilled that bargain.

Definitely true. My med school had a very well regarded Rads elective for 4th years that was 4 weeks long and consisted entirely of looking at CXRs (except for the last 3 days where they started on chest CTs).

You'd be better off finding a good teaching radiologist to shadow for a couple of weeks. Or better yet, if your hospital has a radiologist assigned to reading ED films (like ours does), hang out with that person. That way you'll get a chance to see things in the "likely to kill them" context you'll be exposed to in the ED.
 
scheduled 4 different 4th year electives today..

1 "understanding your patient's needs" rotation.

What the hell is an "understanding your patient's needs" rotation?

Are you going to suddenly become addicted to crack, develop fibromyalgia, and acutely become allergic to all pain medication that doesn't start with a d... d... d... Deeeee??? (That was my attempt at stuttering in chat form...)
 
What the hell is an "understanding your patient's needs" rotation?

i have no idea but i've heard it can be done pretty much online (essays about meeting your patient's holistic, psych needs) which means i'm doing it during interview season, write the papers at the airport, and get more vacation during the rest of the year. :)
 
Radiology is going to depend on the set-up. I was told at the beginning of my rotation that there was nothing they could teach me in only 1 month and they fulfilled that bargain.

I did 8 weeks of radiology as a 4th year medical student. I think I spent a combined 8 hours in the rads suite over those two months. It was a waste to learn radiology, but at least I got to do lots of stuff related to my own research.
 
As of right now, I don't have a cards rotation on my 4th year schedule.

I got a lot of this on medicine and I have a medicine sub-i where I should get a bunch more.

Is this a mistake?

I do have a lot of stuff that should be pretty useful for EM.
 
i have no idea but i've heard it can be done pretty much online (essays about meeting your patient's holistic, psych needs) which means i'm doing it during interview season, write the papers at the airport, and get more vacation during the rest of the year. :)

The extent of understanding my patient's psyc needs involves a petition and certificate
 
Here's what I did in the order of usefulness:

Anesthesiology
Toxicology
Trauma ICU
Radiology
Infectious Disease
 
The best advice was mentioned earlier - ask your classmates about which rotations are particularly good. The 'ideal EM rotation plan' is squat if the teaching is poor or if you are stuck behind fellows and residents to learn.

That being said, here's my advice on rotations:

I agree that anesthesia is great. My residency (and I assume most others) have a dedicated anesthesia block where your sole responsibility is to intubate. I worked with anesthesia attendings and often they asked how many tubes I had done before they handed me the blade. Since I had some under my belt as a student, this really helped facilitate my experience.

I did a derm rotation and found it to be helpful. That being said, there's very few derm emergencies and they usually are pretty obvious.

My residency doesn't have an ortho rotation and I think more experience with that field would be helpful. Be careful not to wind up spending too much time in the OR or on post-op rounds b/c that won't help you.

Ophtho could be a big plus. If you get some structured learning with the slit lamp that would be a bonus. On my community ED rotations, I see eye complaints just about every shift and I still feel it is one of my weaker areas.

Not so sure about cards. I read ECGs every shift in the ED and after my ward month as an intern (at the VA with tons of rules outs, CHF exacerbations, etc) - I feel very comfortable managing basic cardiology in the ED and knowing their path as an inpatient. Also, learning the gazillion stress tests and indications for them probably isn't super high yield since that's an inpatient work up (and also very institution dependent).

I feel a ICU rotation would be more useful (particularly if your med school didn't require one). One of our intern year ICU rotations has a ton of autonomy and I was very happy to have some ICU experience as a student before walking into a 30 hour call by myself.

Rads - a vacation rotation at my med school. I'm not sure if anyone got much education but it was a great time for step 2 or interviews.

Trauma - you'll get plenty experience during residency. I would wait on this. Plus, unless you are somewhere absolutely insanely busy or without any residents, you probably won't get any procedures.

Tox - My residency has a dedicated month for this so I don't think I needed extra time. However, if we didn't have this month I would have liked more time.

ID - Probably low yield. My experience with inpatient ID is that you had something that crazy come through the ED, ID will be consulted as an inpatient and the ED will be giving broad spectrum abx anyway. My personal thought is just to consult your PDA or EMRA abx guide and call it good. I can never remember what covers what (even though medicine folks love this topic)

Good luck!
 
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The best advice was mentioned earlier - ask your classmates about which rotations are particularly good. The 'ideal EM rotation plan' is squat if the teaching is poor or if you are stuck behind fellows and residents to learn.

That being said, here's my advice on rotations:

I agree that anesthesia is great. My residency (and I assume most others) have a dedicated anesthesia block where your sole responsibility is to intubate. I worked with anesthesia attendings and often they asked how many tubes I had done before they handed me the blade. Since I had some under my belt as a student, this really helped facilitate my experience.

I did a derm rotation and found it to be helpful. That being said, there's very few derm emergencies and they usually are pretty obvious.

My residency doesn't have an ortho rotation and I think more experience with that field would be helpful. Be careful not to wind up spending too much time in the OR or on post-op rounds b/c that won't help you.

Ophtho could be a big plus. If you get some structured learning with the slit lamp that would be a bonus. On my community ED rotations, I see eye complaints just about every shift and I still feel it is one of my weaker areas.

Not so sure about cards. I read ECGs every shift in the ED and after my ward month as an intern (at the VA with tons of rules outs, CHF exacerbations, etc) - I feel very comfortable managing basic cardiology in the ED and knowing their path as an inpatient. Also, learning the gazillion stress tests and indications for them probably isn't super high yield since that's an inpatient work up (and also very institution dependent).

I feel a ICU rotation would be more useful (particularly if your med school didn't require one). One of our intern year ICU rotations has a ton of autonomy and I was very happy to have some ICU experience as a student before walking into a 30 hour call by myself.

Rads - a vacation rotation at my med school. I'm not sure if anyone got much education but it was a great time for step 2 or interviews.

Trauma - you'll get plenty experience during residency. I would wait on this. Plus, unless you are somewhere absolutely insanely busy or without any residents, you probably won't get any procedures.

Tox - My residency has a dedicated month for this so I don't think I needed extra time. However, if we didn't have this month I would have liked more time.

ID - Probably low yield. My experience with inpatient ID is that you had something that crazy come through the ED, ID will be consulted as an inpatient and the ED will be giving broad spectrum abx anyway. My personal thought is just to consult your PDA or EMRA abx guide and call it good. I can never remember what covers what (even though medicine folks love this topic)

Good luck!

Thanks for the great advice!

I have the possibility to make to choice of where I do my rotations and choose the one with the best comments for previous students about teaching quality. I've already done my homework on this ;)

Trauma and tox will be very hard to have as a student though, I don't think I'll do any of them.
 
BTW whoever said ortho and trauma.. Ugh maybe ortho but def not trauma. If you train at any half decent residency you will see enough trauma. The electives are a time to get good at critical procedures like lines and tubes and to learn about things we dont get formal training in. Ophtho, rads, and a bunch of the others mentioned. The big list with tiers is about right but much of this will depend on whats good at your school.
 
I liked the suggestions thus far, thanks again :)

Still, I'm bumping this thread :D
 
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