Off service residents "cherry-picking" EM patients

[Angry Birds]

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Oh yes! got to love slacking by going to conference those residents are required to give lectures and take quizzes. No matter the IM rotation you can still go to morning report (except the ICU in some cases) and if residents didn't go to conference on off service they would miss it in intern year for more than half of the year.

There is no way that is tolerable in any specialty.

What offservice rotation does IM do? Clinic and all the other specialty would have to go to conference that time must be protected no matter the program or specialty.

Do the IM residents go to EM conference day? I never saw that at my program. Roksana please let us know if you did go to our whole day conference every week. Or do you somehow think your didactics are more important than ours?

 

[Apollyon]

EM conference is 5 hours, whether 5 on one day, or 2 and 3 over two days. To "manage their pts during lecture" - huh? If you pick up a pt, then sign them out, they definitely are not staying there for 5+ hours. That may be in IM, but absolutely not in EM.

 

[rokshana]

Do the IM residents go to EM conference day? I never saw that at my program. Roksana please let us know if you did go to our whole day conference every week. Or do you somehow think your didactics are more important than ours?

Yep…went to whatever conference was required of the rotation… so yes I did go to the all day( which ended at 3p) ED lectures.
And I went to the radiology conferences when I was on radiology… the neurology conferences when i was on neurology, etc.
And it was apparently the other way around … the EM dept felt that their conferences were the only ones that were important.
And apparently y’all think that EM residents are the only hard working residents in a hospital…personally found that the surgery residents were the hardest working residents.
maybe that’s why there were so many unfilled spots this year in EM? No one wants to work that hard anymore?

 

[rokshana]

EM conference is 5 hours, whether 5 on one day, or 2 and 3 over two days. To "manage their pts during lecture" - huh? If you pick up a pt, then sign them out, they definitely are not staying there for 5+ hours. That may be in IM, but absolutely not in EM.

You’re right… icu pts tend to stay longer than a day…the other residents on the service had to take care of their pts as well as their own pts for that one day, even though they could have seen the pt before lecture, written the note, and then come back after lectures and finish up on anything pending… maybe that happens at other programs…didn’t at mine…maybe mine was the anomaly of EM residents.

 

[turkeyjerky]

You’re right… icu pts tend to stay longer than a day…the other residents on the service had to take care of their pts as well as their own pts for that one day, even though they could have seen the pt before lecture, written the note, and then come back after lectures and finish up on anything pending… maybe that happens at other programs…didn’t at mine…maybe mine was the anomaly of EM residents.

Yeah, I think yours was an anomaly. I definitely didn't just go home after conference when I was on an ICU month, trauma or other intense rotations.

 

[Clean7795]

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?

A lot of interns don't know how your system/EMR works so usually having 1 person (senior resident or rotation supervisor) spend 1-2 hours at the start of the rotation orienting the interns and discussing expectations (e.g. seeing patients in order of acuity off the tracker board, trying to see ~X number of patients per hour, and any specific goals for the rotation) can help. Most of that is obvious to you but things might've worked different for them as a medical student, especially if they are graduates from overseas.

If you find they are always away at academic days, then it should be policy to send the rotation coordinator their academic days+vacation days a few weeks in advance so there aren't any surprises. FM programs tend to have more academic days than other specialties since they often have their own "longitudinal clinic". I would not expect any off-service residents to attend your specialty specific didactics if they already have their own, since that is just way too much time off of clinical duties.

 

[Clean7795]

Beyond that, the reality is that you don't have a lot of control over off-service interns—some will innately be disinterested. If you are treating the on- and off-service interns somewhat equally, most should be interested in the rotation.

When I was an off-service rads prelim in the ER, I would get special assignments from certain attendings to the psych cases since "I'd never see them again" while the ER interns worked off the tracker board in order of acuity. You can imagine my interest in the rotation when I was working with those attendings.

 

[Angry Birds]

Yep…went to whatever conference was required of the rotation… so yes I did go to the all day( which ended at 3p) ED lectures.
And I went to the radiology conferences when I was on radiology… the neurology conferences when i was on neurology, etc.
And it was apparently the other way around … the EM dept felt that their conferences were the only ones that were important.
And apparently y’all think that EM residents are the only hard working residents in a hospital…personally found that the surgery residents were the hardest working residents.
maybe that’s why there were so many unfilled spots this year in EM? No one wants to work that hard anymore?

Rokshana, I don't think anyone here was making the silly claim that EM residents are the hardest working (unlike your silly claim that surgery residents are the hardest working).

Rather, the only discussion being had was that we treat our off-service residents too leniently. Nobody expects them to be a fully functioning EM resident or carry that burden, so why wouldn't you expect the same for when EM residents work on the floor? Learning the EMR itself would preclude the possibility that residents from another specialty could immediately be up to the same level and not have a learning curve.

All I was saying is that we can't be too easy on off-service residents either, which applies for EM and IM. You could have easily made the respectful case that you think things could also be tightened up in IM rotations but instead you came in to insult and degrade, including your latest swipe here about unfilled spots. All I know is that when I applied to EM a few years ago it was inordinately easier to get into IM than EM, yet this did not make me look down on the specialty.

I think one thing we can all agree on here though is that you've come on another specialty's sub-forum and acted like an ass. Or do you disagree with that assessment? A little bit of self-reflection will go a long way here.

Lastly, the decision to be exempt from your conferences is due to the decision that it is not helpful to their learning for their specific specialty. I think, however, that more and more EM programs are moving to exclude IM rotations entirely.

 

[HemeOncHopeful19]

I think most off-service rotations (and rotators) are overrated in general and support any specialty that moves away from them.

TBH having been an IM chief resident and sat in on meetings with other department heads it was more about having the residents as labor and meeting whatever specialty board requirements than it was about actual education.