Residents/Attendings with Answers

[makesomerheum]

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I thought it would be cool and helpful if residents and attendings would be available to give advice and answer specific questions on programs they have information about either from current training, past away rotations, or their own medical school rotation. Medical students may also participate, but I think our info would be lower yield. Please only volunteer if you do not mind the occassional private message in your SDN inbox.

 

[Powder]

3rd year EM resident ... happy to help if you have questions. 😎

 

[DrQuinn]

I thought it would be cool and helpful if residents and attendings would be available to give advice and answer specific questions on programs they have information about either from current training, past away rotations, or their own medical school rotation. Medical students may also participate, but I think our info would be lower yield. Please only volunteer if you do not mind the occassional private message in your SDN inbox.

I would think if you asked a specific question about a program, you would get a lot of participation from the residents/attendings here. The EM forums are chock full of helpful people!!!!

Q

 

[sleepymed]

I would think if you asked a specific question about a program, you would get a lot of participation from the residents/attendings here. The EM forums are chock full of helpful people!!!!

Q

I have one!! I have one!!! My step one score is a 287, I'm AOA, and I have honored every course since high school, but I 'm really concerned... Do you think I have a chance!

 

[joeG]

Ask what you want about Bellevue/NYU

 

[TysonCook]

There are 5 of us on here from Carolinas Med, ask away as I'm sure one of us will be able to help out 🙂

 

[Hard24Get]

I thought it would be cool and helpful if residents and attendings would be available to give advice and answer specific questions on programs they have information about either from current training, past away rotations, or their own medical school rotation. Medical students may also participate, but I think our info would be lower yield. Please only volunteer if you do not mind the occassional private message in your SDN inbox.

I like it, especially as it serves as an opening to ask about specific programs, etc. There is also the Mentor thread, which does not necessarily overlap with this thread

 

[sleepymed]

Ask what you want about Bellevue/NYU

How is the toxicology student rotation there. I am debating between that rotation and an EM U/S rotation.

 

[joeG]

How is the toxicology student rotation there. I am debating between that rotation and an EM U/S rotation.

Unrivaled - you'll be very pleased with what you learn. You are taught by EM attendings who all went through Tox fellowships. You'll be quite inspired. Good hours.

 

[shortbread9]

here to help as well...im the token DO at hopkins now. pgy 1

 

[brucecat]

I'm on my medicine rotation now as a MSIII. When I've expressed my interest in EM to IM residents, many have told me that EM docs lose their medicine knowledge. They start out well, but over time they invariably become most concerned with getting patients in and out as quickly as possible--they either don't have the time or lose their interest in making diagnoses, history taking skills, etc.

I have come to see that every specialty likes to talk some smack about other specialties, so I know to take this with a grain of salt. But it does concern me that if I choose EM, I will be checking off boxes on standardized admissions forms and taking 2 minute histories, and instead of practicing good medicine, I will be relegated to herding people through the system as fast as possible. I am concerned that as an EM doc, I will be judged primarily on my ability to be efficient, without concern for the best care of the patient.

I know I really have to do my EM rotation before I can make any commitments to my career choices, but unfortunately I can't do an EM rotation until 4th year, and that leaves little time to change directions if I find out that EM isn't for me. Any comments from those currently in the field would be greatly appreciated.

 

[EM_Rebuilder]

I'm on my medicine rotation now as a MSIII. When I've expressed my interest in EM to IM residents, many have told me that EM docs lose their medicine knowledge. They start out well, but over time they invariably become most concerned with getting patients in and out as quickly as possible--they either don't have the time or lose their interest in making diagnoses, history taking skills, etc.

I have come to see that every specialty likes to talk some smack about other specialties, so I know to take this with a grain of salt. But it does concern me that if I choose EM, I will be checking off boxes on standardized admissions forms and taking 2 minute histories, and instead of practicing good medicine, I will be relegated to herding people through the system as fast as possible. I am concerned that as an EM doc, I will be judged primarily on my ability to be efficient, without concern for the best care of the patient.

I know I really have to do my EM rotation before I can make any commitments to my career choices, but unfortunately I can't do an EM rotation until 4th year, and that leaves little time to change directions if I find out that EM isn't for me. Any comments from those currently in the field would be greatly appreciated.

You are correct in that efficiency is a HUGE thing in EM as we progress to attendings. However, the key is to be a top notch clinician with as little information about a patient as possible. That is simply the nature of EM. IM tends to be very in-efficient and those guys may spend 3 days watching K+ and talking about a patient at noon conferences and looking stuff up until they deduce they have this ultra rare case of such and such... they pride themselves in that and there is nothing wrong with that.

In EM, your goal is to make the most likely diagnosis with the small time and small information you have. Unforuntatly, someone like IM may admit a patient with XYZ diagnosis given by EM, 3 days later they figure out he doesnt have XYZ but ABC.... and then its flame the EM people... forgetting EM made that diagnosis in 5 mins, and did not have the luxury of 'sleeping on it'. You will not always be right on yoru diagnosis, oftentime you will have no diagnosis, and remember that IM and every other specialty is wrong sometimes too.


As far as practicing good medicine, that is something that is specialty dependent, and your choosen career needs to fit the goals you desire. If you can see LOTS of patient with practically no serious cases passing through your crack (i.e. you admit what needs admitted and send home what needs sent home) then you are practicing awesome medicine by Emergency Medicine standards....

 

[Halaljello]

I'm on my medicine rotation now as a MSIII. When I've expressed my interest in EM to IM residents, many have told me that EM docs lose their medicine knowledge. They start out well, but over time they invariably become most concerned with getting patients in and out as quickly as possible--they either don't have the time or lose their interest in making diagnoses, history taking skills, etc.

I have come to see that every specialty likes to talk some smack about other specialties, so I know to take this with a grain of salt. But it does concern me that if I choose EM, I will be checking off boxes on standardized admissions forms and taking 2 minute histories, and instead of practicing good medicine, I will be relegated to herding people through the system as fast as possible. I am concerned that as an EM doc, I will be judged primarily on my ability to be efficient, without concern for the best care of the patient.

I know I really have to do my EM rotation before I can make any commitments to my career choices, but unfortunately I can't do an EM rotation until 4th year, and that leaves little time to change directions if I find out that EM isn't for me. Any comments from those currently in the field would be greatly appreciated.

spending 35 minutes in a patient room doing an H+P doesn't make one a good physician. Plus what is this "medicine knowledge" do the residents speak of? if it involves breaking down electrolyte minutia or chasing after social work and home health on hospital day #13, then personally, I would rather not have that knowledge. The fact that we happen to be efficient in no way (and im sure there are exceptions) compromises what's best for the patient. You will see that there are some medicine people who will lose their "emergency knowledge" some of the ones i work with don't know how to recognize a "sick" patient, dont know when or how to intubate, have weak procedure skills and Pan-consult, and barely do anything for the patient themselves. At least in the ED, we do the diagnosis we start the treatment, and neatly package patients before they hit the floor.

You should spend a couple of hours just shadowing in the ED while you're on call as a 3rd year. I did that a few times and I learned more in 4 hours than I did in a whole week on medicine. Plus it confirmed that the ED was the place for me.

 

[bulgethetwine]

I'm on my medicine rotation now as a MSIII. When I've expressed my interest in EM to IM residents, many have told me that EM docs lose their medicine knowledge. They start out well, but over time they invariably become most concerned with getting patients in and out as quickly as possible--they either don't have the time or lose their interest in making diagnoses, history taking skills, etc.

I have come to see that every specialty likes to talk some smack about other specialties, so I know to take this with a grain of salt. But it does concern me that if I choose EM, I will be checking off boxes on standardized admissions forms and taking 2 minute histories, and instead of practicing good medicine, I will be relegated to herding people through the system as fast as possible. I am concerned that as an EM doc, I will be judged primarily on my ability to be efficient, without concern for the best care of the patient.

I know I really have to do my EM rotation before I can make any commitments to my career choices, but unfortunately I can't do an EM rotation until 4th year, and that leaves little time to change directions if I find out that EM isn't for me. Any comments from those currently in the field would be greatly appreciated.

SSSSSSSSssssssssssssssnnnnnnnnnnnnnnnnnaaaaPPPPPPPPPPPPPPPP!

 

[GeneralVeers]

I have come to see that every specialty likes to talk some smack about other specialties, so I know to take this with a grain of salt. But it does concern me that if I choose EM, I will be checking off boxes on standardized admissions forms and taking 2 minute histories, and instead of practicing good medicine, I will be relegated to herding people through the system as fast as possible. I am concerned that as an EM doc, I will be judged primarily on my ability to be efficient, without concern for the best care of the patient.

Each specialty should stick to their own, and not give advice on the others. I'm not going to speak poorly of medicine, surgery or radiology, and likewise it's inappropriate for them to comment on EM.

One could argue that EM physicians have more "knowledge" than any other specialty. We have to know most of general adult medicine, plus pediatrics, ortho, radiology, general surgery, trauma, sports medicine, pain management, and OB\GYN. When the medicine residents master all of those specialties, then they can look down on EM.

 

[The White Coat Investor]

When I've expressed my interest in EM to IM residents, many have told me that EM docs lose their medicine knowledge. They start out well, but over time they invariably become most concerned with getting patients in and out as quickly as possible--they either don't have the time or lose their interest in making diagnoses, history taking skills, etc.

I have come to see that every specialty likes to talk some smack about other specialties, so I know to take this with a grain of salt. But it does concern me that if I choose EM, I will be checking off boxes on standardized admissions forms and taking 2 minute histories, and instead of practicing good medicine, I will be relegated to herding people through the system as fast as possible. I am concerned that as an EM doc, I will be judged primarily on my ability to be efficient, without concern for the best care of the patient.

Ahhh...the infamous "medicine makes the diagnoses" argument. Never mind that I can't get anyone admitted until their work-up is entirely done in the ED and the diagnoses made.

And what's wrong with 2 minute histories? Just because I can do in 2 minutes what takes them 2 hours doesn't mean the history is inferior.

 

[Hard24Get]

Each specialty should stick to their own, and not give advice on the others. I'm not going to speak poorly of medicine, surgery or radiology, and likewise it's inappropriate for them to comment on EM.

One could argue that EM physicians have more "knowledge" than any other specialty. We have to know most of general adult medicine, plus pediatrics, ortho, radiology, general surgery, trauma, sports medicine, pain management, and OB\GYN. When the medicine residents master all of those specialties, then they can look down on EM.

I think it is fair to say that each specialty loses some of their knowledge of other specialties as they get better at what they do and drift away from medical school training. I'm sure radiologists lose some H&P mastery, medicine guys forget how to suture and work with kids, surgeons forget how to manage outpatient diabetes, pediatricians forget geriatrics, etc, etc, etc.

Likewise, I am certain I will forget some knowledge about preventative medicine and disease that take 1 week work-ups to diagnose, but I will become better and better at my field, which includes the initial diagnosis and treatment of all urgent and emergent conditions in an efficient manner. In the house of medicine, EM docs may not have the deepest knowledge but clearly they have the broadest. 😎

 

[bartleby]

I have great respect for my medicine colleagues, some of whom in my hospital are personal friends. But our approaches to a situation are sometimes different. In EM, our approach requires some guessing. We don't have a crystal ball. Take pneumonia in a febrile 73 year old with chronic renal insufficiency who looks otherwise well...initially. Will the IM resident who comes to the admission roll their eyes and ask why the person can't just be discharged on PO abx and be sent home? Perhaps. Look up the PSI. Is there a good chance that the patient will do well and be d/c'ed without incident? 90% of it. The right thing to do isn't to send a 73 y/o home who has a 10% change of getting profoundly ill in the next couple days. But part of being an advocate for your patient means doing the right thing even when its unpopular.

I'm on my medicine rotation now as a MSIII. When I've expressed my interest in EM to IM residents, many have told me that EM docs lose their medicine knowledge.

 

[makesomerheum]

Thanks for all those who have offered to give advice about particular programs. I have applied to many of your programs and hopefully will receive some interviews. Since most of what I know is from websites, it is hard to know how to choose which programs to apply to and interview at.

For example, some programs have more ICU mos (Indiana?), more on call mos, fewer EM mos (Carolinas?), fewer vacation weeks (Vanderbilt?) etc. What do you guys find to be significant in your training, or are many of these things superfluous?

 

[Hawk22]

For example, some programs have more ICU mos (Indiana?), more on call mos, fewer EM mos (Carolinas?), fewer vacation weeks (Vanderbilt?) etc. What do you guys find to be significant in your training, or are many of these things superfluous?

I think that most of these things are going to be highly variable due to individual personalities and preferences. What may be viewed as a positive my me may be viewed as a negative by my fellow residents or people at other programs. We all have different learning styles, different perspectives, etc. I would ask specific questions from your point of view because asking broad questions about things we individually feel are significant will give a wide range of answers that aren't likely to be that helpful to you in the end.

 

[zinjanthropus]

In EM, your goal is to make the most likely diagnosis with the small time and small information you have. Unforuntatly, someone like IM may admit a patient with XYZ diagnosis given by EM, 3 days later they figure out he doesnt have XYZ but ABC.... and then its flame the EM people... forgetting EM made that diagnosis in 5 mins, and did not have the luxury of 'sleeping on it'. You will not always be right on yoru diagnosis, oftentime you will have no diagnosis, and remember that IM and every other specialty is wrong sometimes too.

I might just modify this a bit to say that the goal of EM is to r/o the most likely diagnoses that can kill your pt....part of the game is knowing that sometimes you won't make a dx at all - as the previous post points out - and that the lack of a dx may be enough for you to feel comfortable sending your pt home to not die

 

[DelawareEMIM]

As I am clearly biased in taking the 5 year track, if you are truly interested in IM and EM there are 11 programs out there that can satisfy your needs.

As a side note, do I think I am better emergency physician because of my medicine training? Absolutely. Does one need medicine training to be an outstanding EP? Not a chance.