New Medical Student Director solliciting advice

[beyond all hope]

Guys,

I am now faced with the very real possibility of becoming Medical Student Director at my new program. Most of my duties would involve teaching 3rd year medical students who do a six-week rotation.

Medical education is something I feel very strongly about. There is a lot of opportunity here, and I want to do it well.

Right now they get lectures every week (mostly by residents), and they follow a resident around seeing patients in tandem. They don't see patients on their own. Honestly, I think this is a good thing. I don't think a 3rd year med student is really ready to handle ED patients by themselves.

We also have 3rd years rotate at my current program. We're not very busy here so I actually have time to teach the 3rd years personally. My new program is busier so I need to streamline my teaching.

Suggestions? Anything you've seen done well or done poorly? I need some brainstorming here. Help me make this the rotation that we all wanted to have when we were med students.

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[USCDiver]

Guys,

I am now faced with the very real possibility of becoming Medical Student Director at my new program. Most of my duties would involve teaching 3rd year medical students who do a six-week rotation.

Medical education is something I feel very strongly about. There is a lot of opportunity here, and I want to do it well.

Right now they get lectures every week (mostly by residents), and they follow a resident around seeing patients in tandem. They don't see patients on their own. Honestly, I think this is a good thing. I don't think a 3rd year med student is really ready to handle ED patients by themselves.

We also have 3rd years rotate at my current program. We're not very busy here so I actually have time to teach the 3rd years personally. My new program is busier so I need to streamline my teaching.

Suggestions? Anything you've seen done well or done poorly? I need some brainstorming here. Help me make this the rotation that we all wanted to have when we were med students.

Will this be a required rotation for all 3rd years? Will you also have 4th years doing AIs and would you have a different curriculum for each of them?

For M3 students, they should do a variety of shifts; days, nights, weekends to see the differences in what we deal with depending on the situation. Lectures should be complaint focused, ie working up chest pain, differential for abdominal pain in different populations, etc as well as some of the medicolegal aspects of EM practice, EMTALA (this will be especially useful if it is required and some of these students will go on to be subspecialists).

Seeing patients in tandem with a resident is probably best for an M3, but let them see the patient before the resident, don't just have them shadowing around. I did two AIs as a M4: at one, I was truly acting as an intern, seeing patients, presenting to an attending and following their labs, and disposition. At another place I was working alongside a PGY3 and while I would see my patient and discuss it with him, I very rarely saw an attending (who would briefly discuss the cases with the R3 and then bless them all before going back to supervise interns more closely). At this second place, I felt like an M3 again; like I was on a medicine rotation and everything I did was being followed by 3 other people.

More later, I gotta run...

 

[EM_Rebuilder]

I am a recent graduate and agree with what was said above.

I think it is a big mistake to have any MS3 or MS4 medical student simply shadow a resident. That is boring for the most part and most I know honestly get very little out of it; it also may turn someone off of EM. Obviously if a major trauma comes in, then sure the student shadows the whole team and does what they can...but if its a sore throat..

I did 2 EM rotations (albeit both as an MS4); one place I saw patients and presented to a 'teaching resident/PGY3'. They would then order labs and fill out most of the paper work. I had no access to labs or films, and thus felt like all I really did was go see a patient and give the resident a heads up as to what he is going to see next. At the second place, I was an acting intern. I picked up patients on my own (of course, we were told to only pick up low acuity patients... I saw many lacs, closed fxs, some mild metabolic compaints, and OB/GYN stuff), I talked to the attendings directly, did all my own charting, ordered what needed ordered (after talking to the attending) and simply had the attendings sign off on the orders. It was an awesome experience, I learned more that month than ever, and that is where I will now start in July...


So... as a recently minted graduate that experience both sides recently... I think as MS3 year starts, and you have non-EM interested students, they should be much more closely tied to a resident (but not shadow!....just see and present to a resident), as the year progresses and as such you would expect to get more of the 'want to do EM' people towards the end of the year, then you switch to them being more tied to an attending..... You could also stress to the MS3 to pick up low acuity patients obviously, and to try to get complaints that they have seen in previous clerkships. The first group will always be the most lost, but even them you can work on the simple routine clinic type stuff..

Another thing I would mention is that obviously a sr resident is more ready to handle what is in the ED, but I have had some of my best time and best learning epxeriences with the interns.....they still easily recall what its like to be a student and often you learn something together. I do not know that tieing a medical student directly to an intern might be such a good idea as that may wear on the interns patiences and learning experience... but just make sure the interns interact closely with the students and ask them to come help out with any procedures...

Good luck.

 

[coldcoldworld]

I too am a recent grad going into EM. At our school, EM is a required course for all MS4's so I think there are definitely changes that need to be made for MS3's. You need to remember that the 1st few months of 3rd year, the students will have a hard time even knowing how to present a patient concisely, let alone knowing how to manage any medical problems.

One thing that I recommend would be requiring the students to see some core "bread and butter" EM cases as well as doing some core procedures. For us, we were required to see the following core cases: Abdominal pain, chest pain, ENT, musculoskeletal, neuro, medical code, trauma code, peds, and respiratory distress. Required procedures included a set # of ABG's, Foleys, IV starts and lac repairs. This will at least expose them to what it is that we actually see and do.

Another feature that our clerkship had was a set # of "teaching shifts". In these shifts, 2 or 3 students would be paired with a chief resident who would hand pick the rack for interesting, often complex cases and then work with the students on managing the cases that they otherwise wouldn't normally see. They would also glean many of the more subtle teaching points of the case. Overall, the focus of the shift was entirely on teaching and not moving the meat at all. In fact, in some shifts you might only see 5 patients.

As far as who to pair the student with, there are benefits to both the intern approach and the senior resident approach. Personally, I preferred the senior resident approach as I felt the teaching was better. Regardless of who they work with, I think it is imperative that they be allowed to see the patient by themselves before the resident sees them. Granted, you'll probably get one of the most complete yet largely irrelevant H&P's ever, but at least it allows them to get some patient face time. They'll hopefully pick up on what they actually needed to ask and examine when they go back and see what the resident asks. Personally, I found the pure "shadowing" rotations to be largely worthless.

Again, IMHO, I think if this is going to be a required rotation, it might be better served as being required as a 4th year instead of as a 3rd year.

Good luck.

 

[EM2BE]

Granted I am not that far yet, but have heard a few likes/dislikes. Another option is to see how much you feel the student can handle. If one student seems capable and ready, maybe they can do more than the student that seems timid or not sure yet. Even allowing the student to do more as the month goes on seems to be a reward for some (that I've heard from).

 

[emrevue]

Another recent grad here

I agree with the above posters about the more autonomy the better. My most fun rotations were ones where I got to do the most and I actually felt like a doctor, if you will. I also noticed my quality of work and knowledge improve dramatically when I was writing the H & P, giving presentations, ordering labs, etc. (not like I don't try when I'm shadowing someone...my "medical mind" just comes out more when I am doing and not watching)

Our school also requires EM now in either the MS3 or MS4 year but has medicine or surgery as a pre-requisite. I would really encourage giving students as much autonomy as possible. IMO Procedures are always good for students too, no matter how small.

And lectures- I did two EM rotations, one place where residents gave all of the lectures and another where both residents and faculty gave lectures. The faculty lectures were better by far, so maybe having a few core lectures by faculty (chest pain, trauma, abd pain) would be helpful.

I also agree that working with an intern may not be a great idea...if I start in July with a med student at my side, I don't know what I would tell them!

 

[SolidGold]

I don't think a 3rd year med student is really ready to handle ED patients by themselves.

I disagree with that statement. Emergency medicine is a required 1 month rotation for the 3rd years here at my old med school (wow, nice to say "old"). We saw patients on our own and presented to an attending or senior resident. We even were able to pick and choose which patients to see from the rack so that we would see interesting cases which were educational (chest pain, abdominal pain, etc.) and not the useless cases like sore throat. We were allowed to carry 2 patients at a time and would see 6-8 patients on average during an 8 hour adult ED shift. If things were serious with the patient, we were told to grab the nearest resident or attending for help. I personally thought this was a great way to learn in the ED, even as a 3rd year.

We had a few peds ED shifts, as well as fast track shifts mixed in, in order to get exposed to other aspects of EM.

Whenever a procedure came up, one of the residents would come find a student to do the procedure. I did a paracentesis, tons of suturing, a chest tube, and got to do intubations as well, as a 3rd year student.

I also agree that shadowing is a waste of time, especially if its with an intern. The only time shadowing isn't a waste of time is when a trauma case or something else that is a true emergency comes along and the resident grabs a student to come along to observe. Even then, hopefully the resident will ask the student to help out with something like putting lines in, a foley, doing chest compressions, etc.

 

[beyond all hope]

Just a quick comment. I like to give med students and residents as much autonomy as possible. Yes, there are some 3rd years capable of taking care of their own patients. However, many simply aren't ready. It's not fair to patients or to the department to let a patient wait as long as an hour to be presented to a resident/attending, which is what can happen if you let some med students see patients by themselves.

I really like teaching, but just realize that 90% of med students are more work than they are help. If not it means you're just using them as scutmonkies.

I've had even MS4s disappear for an hour into a room with a patient showing subtle signs of shock. They just aren't trained to see the danger signs. In the end, we end up having to see the patient independantly anyway.

No, I'm not going to let MS3s see patients themselves. I'd like to give them a sense of autonomy but frankly it's not safe or practical. Maybe towards the end of the rotation, for a certain few, but definately not for all.

 

[StudentDoc327]

Wow. I guess this is why im so ready to be out of medical school. One of the reasons I liked my EM rotations (I did 3) so much is because I got to see patients (albeit not high acuity) by myself and present to the attending or senior resident. Everything else is a waste of time. Every rotation where I have had to shadow has ended up with me leaving early and regretting that I ever paid any tuition that day. I can not imagine an EM rotation that is strictly shadowing. To my knowlege there are no student EM clerkships where students strictly shadow, but I definitely do not know them all.

I know it's more trouble to attendings to let students see their own patients, but isn't training students part of the job of being an academic attending? I don't know how busy your ED is, but if they do it at Grady (I saw ~10 pts/shift and presented directly to the attending) i'm sure you can squeeze it in at your department.

I always hear old school attendings talking about how when they were students they were so much better clinicaly than us. I believe it. It seems like now students are either restricted from doing anything useful or educational due to medicolegal reasons or because we are too much trouble. Guess thats why 4rth year is such a joke instead of a year which truly prepares you to be an intern.

Anyway, I hope you let 4rth year students esp those going into EM see their own patients.

 

[DrQuinn]

We were allowed to carry 2 patients at a time and would see 6-8 patients on average during an 8 hour adult ED shift. If things were serious with the patient, we were told to grab the nearest resident or attending for help. I personally thought this was a great way to learn in the ED, even as a 3rd year.

What?!?! 6-8 patients? I thought you were only allowed to have 2 on the entire shift. Which, to my understanding at the time, was a paltry number.

Regardless,
Beyond, I do think that M3s CAN see patients in the ED. Albeit they should NEVER have more than 2 patients at a time. I also tell them to take a FULL H&P so that way they know everything there is about the patient. Unless, of course, the patient is writhing in pain, then I usually ran in and gave them some dilaudid, then let the student get back to work. I think the process of allowing them to create their Differential Diagnosis is key, and it really only happens in the ER, it doesn't happen when they're on the med wards!

That being said, when SolidGold was a wee M3, we started the M3 EM rotation at his medical school, and from what we heard it was a big success. (They had never had required EM months at his school).

Q

 

[EM_Rebuilder]

One more thing I thought of today....

Make sure you have a place/station/chair/computer for the number of students you will have at a time. One place I was at, I had no place to 'be'. I stood around, walked around, looked over shoulders of residents at computers, and such. It often makes for awkwardness and often I felt like I simply was not doing anything. At place number 2, I had my own place (sometimes a shared place by 2 students...that was fine). I could look at my own labs, check xrays, look at the board.... check email, read the news... or even read up quick on a patient. I was much more comfortable that way and obviously that makes for a better experience..

 

[VFTW]

Just a quick comment. I like to give med students and residents as much autonomy as possible. Yes, there are some 3rd years capable of taking care of their own patients. However, many simply aren't ready. It's not fair to patients or to the department to let a patient wait as long as an hour to be presented to a resident/attending, which is what can happen if you let some med students see patients by themselves.

I really like teaching, but just realize that 90% of med students are more work than they are help. If not it means you're just using them as scutmonkies.

I've had even MS4s disappear for an hour into a room with a patient showing subtle signs of shock. They just aren't trained to see the danger signs. In the end, we end up having to see the patient independantly anyway.

No, I'm not going to let MS3s see patients themselves. I'd like to give them a sense of autonomy but frankly it's not safe or practical. Maybe towards the end of the rotation, for a certain few, but definately not for all.

Dude, you asked for advice on how to make this a cool and educational rotation for your third years, and refuse to take the most commonly presented theme in the response: give them some damn autonomy. If you are afraid they are going to kill your patients, then make some ground rules about the level of acuity that they are allowed to see autonomously. But don't take such a hard line against letting third-years see patients themselves; your attitude and beliefs about medical students' competency level will show, and knowing that your uppers don't believe in you or want to push you to learn how much you can do is the recipe for a pretty disappointing rotation.

 

[mikecwru]

Just a quick comment. I like to give med students and residents as much autonomy as possible. Yes, there are some 3rd years capable of taking care of their own patients. However, many simply aren't ready. It's not fair to patients or to the department to let a patient wait as long as an hour to be presented to a resident/attending, which is what can happen if you let some med students see patients by themselves.

I really like teaching, but just realize that 90% of med students are more work than they are help. If not it means you're just using them as scutmonkies.

I've had even MS4s disappear for an hour into a room with a patient showing subtle signs of shock. They just aren't trained to see the danger signs. In the end, we end up having to see the patient independantly anyway.

No, I'm not going to let MS3s see patients themselves. I'd like to give them a sense of autonomy but frankly it's not safe or practical. Maybe towards the end of the rotation, for a certain few, but definately not for all.

I run a third year student clerkship for our program. They see patients on their own. I would suggest a time limit, ie, I specifically tell them I don't want the hour H&P on the acute side, that coupled with pointing out I need them to present immediately for time dependent diagnoses, stroke, chest pain, etc. Finally, I give them "if they ever feel nervous" speech. It's done ok.

You could always do the reverse... if someone is having a lot of trouble, put them on restriction. I wouldn't say I would have to do this with the majority of med students.

PM me if you want more.

mike

 

[AmoryBlaine]

I would think there would be some benefit to a clear explanation of pace at the outset. The way I see it (as an M3 on his last rotation) is that the ability to be expeditious with patient encounters is a skill that is slowly separating certain students out from certain others. It's called "focusing" and some people get it, some don't.

The ability to focus seems like it should be part of evaluation in an EM clerkship, so it seems reasonable for you to say "if you are taking 45 minutes to do the H&P on a pt with diarrhea, something is not right and you are not performing adequately on our EM rotation."

 

[SolidGold]

What?!?! 6-8 patients? I thought you were only allowed to have 2 on the entire shift. Which, to my understanding at the time, was a paltry number.

yep. the rule was no more than 2 patients at any one time. you could see another patient if one had been dispositioned. with that rule, i'd see up to a dozen patients in fast track in a shift, same with peds if it was busy. but, we had a list of required procedures, so some students may have seen 2 patients and then spent the rest of the shift looking for procedures to perform.

we were told from orientation and many times during a shift by some residents and especially attendings to not take longer than 15 mins for an H and P and to have a focused presentation ready soon after seeing the patient. being focused with presentations and not taking long for an H and P was part of our evaluation.

we were also told to immediately grab an attending or resident if there was anything seriously wrong with the patient. it doesn't take a med student to know if a patient is sick, plus the nurse keeps tab on the patients condition while a doc is not around anyways, no different if a med student is there or not.

the required 3rd year rotation has been at usf for 2 years now and I'm positive that there has not been any patient that received sub-standard care. the residents and attendings were always on top of everything. just because a student went to see a patient first doesn't mean that the student is soley responsible. the residents or attendings would also do their own quick evaluation and were responsible. its not any different than having a patient during a medicine rotation.

its funny to see how others do it and relieving to see that many places do let 3rd years see patients. if i'm not mistaken, the SAEM website has articles on med student education and the 3rd year required clerkship at usf was modeled from what SAEM suggests.

 

[met19]

Just a quick comment. I like to give med students and residents as much autonomy as possible. Yes, there are some 3rd years capable of taking care of their own patients. However, many simply aren't ready. It's not fair to patients or to the department to let a patient wait as long as an hour to be presented to a resident/attending, which is what can happen if you let some med students see patients by themselves.

I really like teaching, but just realize that 90% of med students are more work than they are help. If not it means you're just using them as scutmonkies.

I've had even MS4s disappear for an hour into a room with a patient showing subtle signs of shock. They just aren't trained to see the danger signs. In the end, we end up having to see the patient independantly anyway.

No, I'm not going to let MS3s see patients themselves. I'd like to give them a sense of autonomy but frankly it's not safe or practical. Maybe towards the end of the rotation, for a certain few, but definately not for all.

Current grad here. During my MS3 and MS4 EM rotations, if the patient was triaged with a complaint that could be life threatening, the senior resident or attending would see the patient first. However, students were still involved. Often they would say see the patient in room 6. Then you come out, after a focused H and P and get pimped. What's the diff diag, whats your plan, what labs, procedures, etc. So even if the studies were already ordered, the student could still follow the case and gleam inportant educational points from them.

However, for a majority of my rotations I saw patients on my own. If a student has problems with a focused H & P perhaps they need a talking. To be completely honest, a couple shifts I had an attending who did not allow students to see their own patients and it was a glorious waste of my time. And the main reason I am going into EM is I had amazing attendings who taught and piqued my interest in the field.

I would argue then that ground rules for your MS3 and MS4s are perfectly legit. E.g no more than 2 patients at a time, let the attending know who what patient/chief complaint you are picking up, focused history, attendings might eyeball the patient prior to you, if you are nervous get help, etc.....Ground rules need more enforcement early during MS3

 

[beyond all hope]

Well, I'm glad I started this poll, because it's clear what students want: autonomy. Believe me I understand. I went around the rules and did an ED rotation as a SECOND YEAR seeing my own patients.

We have 3rd years rotating in my ED where I currently work. Some are good, but the bad ones have actually caused significant delays in care for patients. It's not their fault, but it is a problem. What I do for those students now is I just see the patient entirely independently of the student. This is a lot of work but it's the only way I've found to protect both patients and education.
The last time I did this I had to teach EKG reading almost from scratch. Remember M3s have significant differences in their level of competency, and I feel that it's my job to get them up to par.

I'll have to come up with a hybrid system. I'd like to have a teaching resident, or more likely the senior resident, oversee all of their cases.

Okay, I get the autonomy thing.

What else?

 

[met19]

Well, I'm glad I started this poll, because it's clear what students want: autonomy. Believe me I understand. I went around the rules and did an ED rotation as a SECOND YEAR seeing my own patients.

We have 3rd years rotating in my ED where I currently work. Some are good, but the bad ones have actually caused significant delays in care for patients. It's not their fault, but it is a problem. What I do for those students now is I just see the patient entirely independently of the student. This is a lot of work but it's the only way I've found to protect both patients and education.
The last time I did this I had to teach EKG reading almost from scratch. Remember M3s have significant differences in their level of competency, and I feel that it's my job to get them up to par.

I'll have to come up with a hybrid system. I'd like to have a teaching resident, or more likely the senior resident, oversee all of their cases.

Okay, I get the autonomy thing.

What else?

My ED dept conducted suture labs, EKG and CXR reading seminars, phlebotmy training (for MS2), 3 hours of lecture/wk (e.g. headache, chest pain, abdominal pain, etc. They also made sure we had a chance to rotate thru all areas of the ED dept (critical, main, in/out service). They are big on teaching procedures (obviously more attempts for students occur later in the year- suturing, foleys, IVs, ABG, LP, arthrocentis, etc).

Though my program does not have one, I like the idea of a teaching resident. A dedicated senior who only works and can spend some time with the students and is not there to "move the meat".

Let your MS3s know the rules prior to starting and assume that the rules are for the weakest type of MS3. Rules can be bent for stronger MS3s (more than 3 patients, sickier patients, etc). For example, set a certain number of procedures to be done in 2 or 4 weeks (foleys, ivs, abgs)- very simple procedures. More competent students get more rewards in terms of doing more cool stuff and seeing more patients- and of course a better grade than average students.

 

[Janders]

I'm not sure how your ED is set up, but at my school different areas had different levels of autonomy:

"Flex Care"--aka Urgent care, shoulda gone to see the PCP-- You could pick up as many patients as you could handle, and you presented to an attending. Anything that looked suspiciously mis-triaged, you notified someone. If you were slow and annoying and had too many patients, you were told.

Main ED-- Things that might be urgent. Stable patients with apparent ACS, BRBPR, etc. This is where there was a lot of leeway. Usually you saw patients in tandem with a resident. Not shadowing, unless the patient was very ill, but not taking an hour on your own. The residents were responsible to do all their own charting in this area, but encoraged students to see new patients before they got to them, and come up with their own DDx/Plans.

Trauma/Resus-- You shadowed the resident assigned to this area. As they got a feeling for your skill set, you were allowed more or less autonomy. You might be allowed to help do procedures, or if multiple minor traumas came in, you might be allowed to lead the primary/secondary survey. These patients were sick enough that you didn't mind shadowing.

Peds-- Mostly like the "Flex care" area, as most kids just weren't that sick. If a sick kid came in, you usually saw them in tandem with the senior resident or attending.


As for other ideas with lectures, etc. I had a good experience with an additional hour-2 hours of instruction just for med students after the weekly resident conference. We'd get an hour of specialized MS3-4 level lecture from an attending about bread-and-butter issues, and usually got to play with some of the procedural toys, like fake airway dolls or central line kits. That way we felt connected to the resident coferences, but still got some specialized instruction that was more at our level.

 

[bartleby]

In our system, the med studs rotate as 4th years. EM gunners and slackers alike get the same low down from me when we first meet:

1) If you see a patient with markedly abnormal vitals (HR >110 or <60, high or low bp, tachypnea) or someone who just looks sick (even if you can't explain to me why), your job is to get out of the room and find me. Unstable or patients who make you feel uncomfortable require no presentation . You get points for knowing when to tap out, but you get a major demerit if I catch you taking a social history from someone who's in the process of infarcting his left ventricle.

2) If you spend more than 15 minutes in the room with a patient in the ED as a student, you're doing something wrong. Get in, best HPI you can get in 10 minutes, high points of the exam, and get out. I don't want to know what is on the med list of the patient's great uncle twice removed. All you're doing by spending an hour in the room is slowing down the care of the patient.

 

[kiterunner]

Have to agree with previous posts. If you remember at all what is like to be a medical student, you remember how painful it is to be shadowing beyond the 2nd year. Not just because you want to be in on the action but because you get to actively learn.

I briefly thought about not doing emergency medicine when I rotated through my home school because I was given little responsibility as a fourth year aside from taking the history. When I did an outside A-I, I was able to juggle up to 5 patients at a time, ordered my own labs, discharged my patients. Attending asked me for updates. I often left exhausted and I loved it. That's how I knew I wanted to do EM.

I understand your reservations considering it would be a a 3rd year elective as opposed to 4th year acting internship.... but I really think that having ownership of the patient is one of the best ways to learn. Otherwise you are setting up the rotation to be a classic one that med students skip out on.

Low expectations. Low yield.

 

[leviathan]

What about airway skills? ET intubation, or alternative devices like LMAs, combitubes, etc?

 

[MacGyver]

My thoughts:

1) EM is a waste of time as a required clerkship for all med students. It should be left as an elective. The topics that are covered in EM and the patients you see are better left for a different setting.


2) Med students will be hating life with just shadowing. I would seriously sneak away to go read if thats all I was allowed to do. Tell the med stud they have 15 mins to go see a patient and do an H&P and come up with a plan, then present. That way you will avoid the hour long waiting times.


3) Procedures in EM are a waste of time unless you actually want to go into EM. All of the big stuff like LPs or chest tubes are going to be taken by residents/interns regardless of what the med student wants to do anyways. I guess you could let them practice IVs and routine venipunctures, maybe a couple of simple lacs.


4) LET THE MED STUDENT ASSIST WITH CODES! Out of all the rotations in medicine, this is the absolute biggest waste of a good teaching opportunity. Give the med student a specific defined role PRIOR to the code and make sure they know how to do it. Teach them how to use the defib machine and get lots of practice first. Then if/when a real code comes, THEY get to use the defib on the pt. Of course this does require some work on your part. MOst of the nruses and suppport staff will jsut shove the med student out of the way during a code, so you need to communicate to them that the MS is expected to participate. After all these support staff probalby do dozens of codes per year each, it wont hurt to let the poor med students assist with a couple here and there.

 

[MacGyver]

What about airway skills? ET intubation, or alternative devices like LMAs, combitubes, etc?

Not going to happen for med students unless they rotate at an insanely busy ED where intubations are a common place everyday occurrence and all the interns/residents are tired of doing them.

 

[met19]

My thoughts:

1) EM is a waste of time as a required clerkship for all med students. It should be left as an elective. The topics that are covered in EM and the patients you see are better left for a different setting.


2) Med students will be hating life with just shadowing. I would seriously sneak away to go read if thats all I was allowed to do. Tell the med stud they have 15 mins to go see a patient and do an H&P and come up with a plan, then present. That way you will avoid the hour long waiting times.


3) Procedures in EM are a waste of time unless you actually want to go into EM. All of the big stuff like LPs or chest tubes are going to be taken by residents/interns regardless of what the med student wants to do anyways. I guess you could let them practice IVs and routine venipunctures, maybe a couple of simple lacs.


4) LET THE MED STUDENT ASSIST WITH CODES! Out of all the rotations in medicine, this is the absolute biggest waste of a good teaching opportunity. Give the med student a specific defined role PRIOR to the code and make sure they know how to do it. Teach them how to use the defib machine and get lots of practice first. Then if/when a real code comes, THEY get to use the defib on the pt. Of course this does require some work on your part. MOst of the nruses and suppport staff will jsut shove the med student out of the way during a code, so you need to communicate to them that the MS is expected to participate. After all these support staff probalby do dozens of codes per year each, it wont hurt to let the poor med students assist with a couple here and there.

I disagree about the procedures (maybe not chest tube and real biggies), but stuff like LPs, lacs, etc. Procedures attracts med students to EM and are fair game for the student if its THEIR patient. Residents at my hosp have no problems getting number so if the students presents the HPI and exam, manages the patients labs and tests, its only fair to let them do the procedure- assuming the pt is ok with a med student doing it and of course the stuent has appropriate supervision.