If you have prelims/FM residents rotating on EM, have you guys had issues with them picking up too few patients or cherry-picking the easy ones? How have you dealt with this?
Nope, we assign patients to them.If you have prelims/FM residents rotating on EM, have you guys had issues with them picking up too few patients or cherry-picking the easy ones? How have you dealt with this?
All Off service residents/interns sucks and should be treated as med students. This included EM residents in off service too. I surely have slacked when on off service.
I did my share of hiding on OB/GYN for sure.
You guys need to toughen up with that. We've had residents have to come on their off-service months to make up shifts.My experience echos above. Our FM residents are extremely lazy. Sometimes don't even show up. Have issues finishing their charts. Have random questionable "didactics" "guest lecture" or "clinic" at odd times. We essentially just send them to the urgent care side now and they can see their 0.5pph.
During my academic attending days I honestly was annoyed by how much energy my residents put into this issue. Life ain’t fair. Sorry the psych intern isn’t “pulling their weight” etcIf you have prelims/FM residents rotating on EM, have you guys had issues with them picking up too few patients or cherry-picking the easy ones? How have you dealt with this?
Yep. I skipped a few shifts and had to make it up later on.You guys need to toughen up with that. We've had residents have to come on their off-service months to make up shifts.
This is an interesting take. One I'm sympathetic to, and I think it helps clarify the question.This partially falls upon the senior residents in the pod. A good senior will ensure that they are pushing the off service residents to see more patients, and unpleasant ones (vaginal bleeding, psych patients, lac repairs). In addition, they should be there to support/supervise/oversee them as well in addition to the attending.
When I was a senior resident, I would tell them: I'm going to pick up the next 2 patients, can you please see the new patient they slotted in room 31. You would inevitably get an eye roll or a sigh. You would watch them drowning while they were juggling the 3 patients they had on the board, but ultimately you aren't there to be their friend. It's important for them to get to see why EM is like so when they block consults/admissions as seniors they understand what the ED deals with on a daily basis.
I agree with this but I think it all goes out the window when you’re in some off service rotation that has questionable relation to your field.You don’t want easy patients in residency. You want the hardest, craziest, non-sensical, dizzy, fatigued, chest pain, altered mental status, 80 year old, pregnant, male, unicorn you can find. You’re learning on someone else’s malpractice so don’t skimp on the hard ****.
I think the point being made is that EM residents at his/her hospital had easier workloads on off-service rotations. N = 1, but my off-service experiences, especially in the ICUs, were not chill. My classmates and I were picking up the same patient volume and complexity as the other services' residents. Our seniors had q3 24s like theirs. We generally did more procedures as well (except on SICU for obvious reasons). And on MICU specifically it would be just EM folks and the MICU fellow covering during IM conference.Yeah, I'm not clear on what rokshana meant, either.
I agree if your point is that we shouldn't expect FM/IM to be excited about the ED if we can't be equally excited during our medicine ward months. Touché. However, I really don't understand your point about protected didactic hours? (Every residency has them.) I also find your ICU experience with EM residents to be very unusual. ICU is a heavily focused/desired rotation for us as it deals with critical care medicine and provides a plethora of procedures. (Hence, why we do 3-5 of them.) The only exception might be the PICU, but for different reasons. I don't remember any difference in patient load from my IM colleagues in residency. In fact, the only difference I remember is that I did the majority of procedures because they didn't want to do them which was perfectly fine with me. The only exceptions being the pulm/cc fellows.Remember this when advising the EM resident when they are off service …where I did residency the EM residents had the whole day on Wednesdays for their diadactics…but of course never attending any of the IM one… and generally had lower pt load with the easier pts in the icu… and someone else had to take their pts on their “lecture” days…sometime you get what you give…
My goal on that 4 week rotation was to get my required Pap smears and not admit anyone to medicine… ended up admitting two to nephrology…
Eh… wasn’t something I wanted to do or frankly needed to do…but noted to not use that term.Well I guess now we know why off-service residents are so slow in the ED--in addition to working up the CC, they're also providing comprehensive cancer screening.
(@rokshana, this is just a pet peeve for many of us, referring to pelvic exams as pap smears. It's annoying when nurses and patients do it, but it's inexcusable for physicians. We're not checking for cervical cancer, we're checking for PID)
I think most of us on here are attendings, right? This issue seems more like one of those petty things that residents get all peeved about but is inconsequential. Frankly, I think if it matters at all what off service residents are doing then the program is staffing wrong (although if they're cherry picking procedures, that's f'd up and needs to be addressed). Imho, they should be scheduled as extra help rather than essential.
EM off service rotators on medicine services are no different than the FM/IM off service rotators in the ED.Yeah, I'm not clear on what rokshana meant, either.
I didn’t turn over my patients to the other residents when i went to noon conference, but they weren’t required to manage their pts on their didactic day.I agree if your point is that we shouldn't expect FM/IM to be excited about the ED if we can't be equally excited during our medicine ward months. Touché. However, I really don't understand your point about protected didactic hours? (Every residency has them.) I also find your ICU experience with EM residents to be very unusual. ICU is a heavily focused/desired rotation for us as it deals with critical care medicine and provides a plethora of procedures. (Hence, why we do 3-5 of them.) The only exception might be the PICU, but for different reasons. I don't remember any difference in patient load from my IM colleagues in residency. In fact, the only difference I remember is that I did the majority of procedures because they didn't want to do them which was perfectly fine with me. The only exceptions being the pulm/cc fellows.
You sure you did Paps in the ED? I've never even heard of someone doing a Pap smear in the emergency department much less seen one. We don't even stock that stuff for our OB/GYN consults.
EM off service rotators on medicine services are no different than the FM/IM off service rotators in the ED.
Literally everything in medicine relates to EM. From being an embryo to dying at 105, we see it all, we treat it all.I agree with this but I think it all goes out the window when you’re in some off service rotation that has questionable relation to your field.
If you're unhappy with certain posts, you can always report them.I love how this thread started with a fellow EM colleague asking his own on how to deal with off service rotators (in the EM forum mind you....) and the IM attendings feel the need to rush to the rescue of these nameless FM/IM rotators while criticizing EM rotators in the process. My eyes rolled so much catching back up in here that I felt like I was having an oculogyric crisis. Talk about a thread derail.
I'm not one of those forum cancel culture types. It would take a really egregious post to make me report it for anything. Although I don't like/agree with some of the posts in here, there's nothing remotely report worthy about them. After all, it's the bickering on SDN that makes reading the forum so much fun. Imagine if we always agreed on everything in here? Talk about boring. Plus, I like rokshana. I'm just snarky this morning. I'm only half way through my coffee.If you're unhappy with certain posts, you can always report them.
I'm not saying this to be flippant, we often do take action when people stir up trouble in other specialties forums.
Heh, fair enough.I'm not one of those forum cancel culture types. It would take a really egregious post to make me report it for anything. Although I don't like/agree with some of the posts in here, there's nothing remotely report worthy about them. After all, it's the bickering on SDN that makes reading the forum so much fun. Imagine if we always agreed on everything in here? Talk about boring. Plus, I like rokshana. I'm just snarky this morning. I'm only half way through my coffee.
I think they just use that to vet people. I doubt you'd get 100% EM attendings on the ACEP train though you could probably get 90% if it was ACEP and/or AAEM.Heh, fair enough.
FWIW to join the anesthesia private forum you have to be an ASA member. Everyone here up for paying dues to ACEP to get a private forum like they have?
Ummm... The EM residents are attending their conferences on Wednesdays (not going on vacation)... Why would they then attend both IM and EM conferences?Remember this when advising the EM resident when they are off service …where I did residency the EM residents had the whole day on Wednesdays for their diadactics…but of course never attending any of the IM one… and generally had lower pt load with the easier pts in the icu… and someone else had to take their pts on their “lecture” days…sometime you get what you give…
My goal on that 4 week rotation was to get my required Pelvic exams ( which I never did again)and not admit anyone to medicine… ended up admitting two to nephrology…
At my residency we were allowed to in-house moonlight picking up unfilled “off service” shifts .. my nocturnal self would pick up as many of the overnights as possible .. I could see the visible relief on the PGY2’s face when they got an EM PGY-3 instead of a psych intern LOLThis is an interesting take. One I'm sympathetic to, and I think it helps clarify the question.
Should I make off-service rotators see patients they don't want to in the ED?
If your goal is to give the best patient care - hell no.
If your goal is to serve their education - depends on the patient.
If your goal is to teach the senior EM resident how to run an ED - maybe.
If your goal is to show them what working in the ED is like - yes, and better make 'em interpret an ECG while they're arguing with Radiology to do a CT that you don't really think is EMERGENTLY indicated, but you need to get to admit this patient and possibly will (in some way) serve the patient.
If your goal is to be fair - let me tell you this now, Medicine isn't fair.
Yeah where I trained EM residents run whatever off service they are on. I think the only other rotation where other residents work as hard was probably Trauma/SICU because the surgery residents were great. But certainly we were known as the hardest workers in the hospital and I think that’s not uncommonI think the point being made is that EM residents at his/her hospital had easier workloads on off-service rotations. N = 1, but my off-service experiences, especially in the ICUs, were not chill. My classmates and I were picking up the same patient volume and complexity as the other services' residents. Our seniors had q3 24s like theirs. We generally did more procedures as well (except on SICU for obvious reasons). And on MICU specifically it would be just EM folks and the MICU fellow covering during IM conference.
Oh i did! Never wanted to do the EM rotation…so i stayed out of the way and stayed in the D pod.Ummm... The EM residents are attending their conferences on Wednesdays (not going on vacation)... Why would they then attend both IM and EM conferences?
As for lower patient load and easier patients in the ICU... That's a good one. EM off-service residents have the exact same patient loads when rotating in EM or ICU... As for not admitting anyone to medicine, this shows that you really slacked off in your EM rotation.
Because EM residents are the best residents where ever they rotate?I love how this thread started with a fellow EM colleague asking his own on how to deal with off service rotators (in the EM forum mind you....) and the IM attendings feel the need to rush to the rescue of these nameless FM/IM rotators while criticizing EM rotators in the process. My eyes rolled so much catching back up in here that I felt like I was having an oculogyric crisis. Talk about a thread derail.
I think you like many others don’t understand how our specialty works and the different mindset it takes to be an EP. You work harder than most when you are on, and when you are off you are off.Oh i did! Never wanted to do the EM rotation…so i stayed out of the way and stayed in the D pod.
And not where I trained…they were treated like all the other off service rotators…we had psych residents rotate as well and they had lighter loads and easier pts as well.
And they should have attended the IM conference and not the EM ones…they were on an IM rotation…I went to the conferences of whatever rotation I was on as was required.
Again, I applaud the EM leadership… they protected their residents…to not have to manage their pts during lectures… it didn’t give them much good will amongst the other residents though…on and off service rotators alike.
Oh, good grief. It wasn't a thread to dump on off service rotators. The OP simply wanted advice from FELLOW EM DOCS on how to deal with lazy off service rotators. How that turned into a DEFCON SDN alert for you , I have no idea... Why on earth are you sticking around to argue so much and defend your experience with what you perceived as "overly coddled" EM residents? Ok, we get it....you weren't that impressed with them. Who cares? It has zero to do with the original topic. Start a new thread if you want to argue about EM vs IM residents on off service rotations.Because EM residents are the best residents where ever they rotate?
If an echo chamber is what you want…so be it.