So I start my intern year in the ER, which I'm excited about because I think I will have the opportunity to learn a lot. However, I'm also terrified because I struggle in the trauma and code setting. I'm more of a quiet, laid back person and the whole ER trauma setting gives me a lot of anxiety (not incapacitating, just the feeling if being really uncomfortable). I think a lot of this anxiety comes from not knowing what my role should be. I don't want to jump in and do something I shouldn't but I also don't want to stand back and look uninterested or clueless. If anyone has any advice on how they deal with the stress of a trauma, what an intern's role should be, etc. I would greatly appreciate it. Thanks
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Non EM intern needing advice
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If you are an off service intern, especially at the beginning of the year, the expectations for you will be very low. Nobody is going to expect you to run a code or a trauma. Just be there and jump in when you see an opportunity to do something that you know how to do, i.e. CPR, and learn. If they ask you to do something, just be honest about your ability to do it and go accordingly.
So I start my intern year in the ER, which I'm excited about because I think I will have the opportunity to learn a lot. However, I'm also terrified because I struggle in the trauma and code setting. I'm more of a quiet, laid back person and the whole ER trauma setting gives me a lot of anxiety (not incapacitating, just the feeling if being really uncomfortable). I think a lot of this anxiety comes from not knowing what my role should be. I don't want to jump in and do something I shouldn't but I also don't want to stand back and look uninterested or clueless. If anyone has any advice on how they deal with the stress of a trauma, what an intern's role should be, etc. I would greatly appreciate it. Thanks
First do not worry! You will always have an attending there with you. An intern shouldn't be running any codes or traumas. Your role as an intern should be to get as much hands on learning as possible. You should watch, then perform under guidance any procedures ( central lines, chest tubes, etc...) I'm not sure who else you have with you as far as residents, EM residents/ interns etc, as EM residents / interns usually do these procedures and run codes ( EM residents)
Thanks for the reassuring words. What you guys have said makes sense. For whatever reason, I just envision myself showing up for a trauma the first day and an attending or nurse turning around, looking at me and saying "Um...why aren't you doing anything?"
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At the beginning of the shift introduce yourself to the attending, let him or her know that you're an off-service intern and say something like "I've done my orientation, but I was hoping you could tell me how you would like me to function during our shift?"
You might do this every time you work with a new attending, as we often have different expectations.
No one is going to expect you to run codes or traumas as an off service intern.
You might do this every time you work with a new attending, as we often have different expectations.
No one is going to expect you to run codes or traumas as an off service intern.
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The expectations of a new (especially an off service) intern are going to be pretty low. As was mentioned earlier, ask the attending and more senior EM residents about their expectations and how they'd like you to operate in the ED. You'll make the biggest impression by helping out as much as you can and being a team player. Your responsibilities in a code or trauma are going to be close to zero so just lend a hand where you can help (i.e. holding the ET tube for someone intubating, helping log roll the pt, etc.).
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I'd like to hijack this thread and ask any tips for a new fourth year student about to do my first sub I with no previous EM rotations. What should I do/not do? Ay tips appreciated..
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The above also applies to students. Ask the attending/senior residents what the expectations are. Be involved and a team player. Most importantly, if you go see somebody first and they're truly sick, let somebody above you know immediately.I'd like to hijack this thread and ask any tips for a new fourth year student about to do my first sub I with no previous EM rotations. What should I do/not do? Ay tips appreciated..
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I'd like to hijack this thread and ask any tips for a new fourth year student about to do my first sub I with no previous EM rotations. What should I do/not do? Ay tips appreciated..
Be there, be interested, be aggressive about picking up new patients (but don't carry too many to keep track of), have a good way to keep trak of your patients, ask to do procedures but don't be put off if someone above you on the totem pole takes it instead.
And read this article.
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I second everyone's advise and I think the cardinal rule as an intern is when you need help, ASK for help. I can't stress that enough. Don't sit on the GI bleeder that you can't get IV access or walk away from a patient that is barely breathing. Just ask for help. It may look like we're annoyed or busy when you interrupt us, but we will never fault you for grabbing us when you see a sick patient that needs help that you can't provide.
I have had many moments as an intern or student where I was like, do I want to look like an idiot and bother the attending..... but that is the exact moment when you should. You're there to learn and do the right thing for the patient.
I have had many moments as an intern or student where I was like, do I want to look like an idiot and bother the attending..... but that is the exact moment when you should. You're there to learn and do the right thing for the patient.
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Patient's with severe traumatic injuries can be complicated, but the trauma systems that are in place ensure that an OB intern never gets left alone with a guy with a Bowie knife sticking out of his neck. So when you're starting out, don't worry about trauma. Ditto with cardiac arrests - if they come in with CPR in progress, no one is going to pull the medicine intern and expect them to be in charge. There will always be seasoned attendings and nurses around.
What you should be worried about are the old people with vague, nonspecific complaints. Every day there are a few of them who, instead of having nothing wrong like most of them do, are actively trying to die and make you look bad.
What you should be worried about are the old people with vague, nonspecific complaints. Every day there are a few of them who, instead of having nothing wrong like most of them do, are actively trying to die and make you look bad.
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Off service interns/rotators seem to have responsibilities to their home programs at our institution. There's nothing worse than wondering what's going on with their patient and realizing that they've left to go to morning report/noon conference/ etc without dispositioning their patient or signing them out to someone to follow the relevant pieces of information. If you're expected to leave the area try to remind the attending or supervising resident for the area at the beginning of the shift and also discuss what you should do for your patients during that time.
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To do well in EM
1. Be calm. No one knows everything 100% of the time. We all make mistakes and luckily 99% of the mistakes are correctable. Making a mistake is not a big deal if you know how to correct it.
2. Act interested. Act like you want to learn. Ask the attending to grab you with any interesting cases/procedures. I you act interested, I will stop everything to find you if someone cool comes by.
3. DONT be LATE. DONT ask to leave early
Running a code - this is what my upper level told me when I was an intern. THis is a valuable advice. If you are running a code, you make ALL of the decisions. If you think its Vtach, call it. Sometimes the rhythm is hard to discern, so be assertive and just make the best decision you can. Stay calm and everyone will follow. If it starts to become chaotic, Stop everything and tell everyone to calm down.
1. Be calm. No one knows everything 100% of the time. We all make mistakes and luckily 99% of the mistakes are correctable. Making a mistake is not a big deal if you know how to correct it.
2. Act interested. Act like you want to learn. Ask the attending to grab you with any interesting cases/procedures. I you act interested, I will stop everything to find you if someone cool comes by.
3. DONT be LATE. DONT ask to leave early
Running a code - this is what my upper level told me when I was an intern. THis is a valuable advice. If you are running a code, you make ALL of the decisions. If you think its Vtach, call it. Sometimes the rhythm is hard to discern, so be assertive and just make the best decision you can. Stay calm and everyone will follow. If it starts to become chaotic, Stop everything and tell everyone to calm down.
