The EM Mentoring Thread

[WorkinEM]

Hello, I'm a 3rd year who's pretty much set on going into EM. I got 120 on Step 1 and I'd appreciate advice on whether I should risk taking Step 2 in time for my residency applications. I know 120 is a good enough score to match somewhere, but I'm concerned about being poorly competitive and getting stuck doing residency somewhere I don't want to be. To frame my situation, I go to one of the more highly regarded med schools, but I don't stand out in my class in terms of grades or extracurriculars.

Thanks in advance.

I think this comes down to how well you think you'll do on Step 2. If you have been doing well on your shelf exams and you've been keeping up with your reading you can go for it. Step 2 is more clinical than Step 1 and most people who are more clinically oriented feel more comfortable withe the material. If you don't feel comfortable with it then you can stick with your existing scores and see what happens.

Bear in mind too that your scores get you the interviews. Your interviews determine you place on the rank list.

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[WorkinEM]

I am 6th semester college student still considering medical school. Nevertheless, I am wondering how much a role does death play as an EM physician? Is it something you have come to terms with? Or do you not really experience it too often (ie. other doctors handle it)?

It's a daily occurance in EM. We have to deal with grieving families almost every day. Most of us don't mind it because if you do it well you can actually make a big difference for people in a bad situation. It's not fun but it can be rewarding.

 

[WorkinEM]

I've just found out my fourth year rotation schedule. The powers that be, in their infinite wisdom, have scheduled my core EM rotation in the last month of my 4th year. I'm doing what I can to try and switch it to an earlier month, before I take off for EM electives. There's a chance that it may not happen. I'm worried that I'm going to end up on my elective rotation being clueless in front of the attendings. Am I screwed? Is there anything else I can do to deal with this? Any suggestions would be welcome.

That's bad. They should really give you priority since you will be applying into EM. Change it if you can. If you can't I would see if you can spend some extra time shadowing in the ED to pick up some experience for your audition rotations. Try to get a mentor at your school's ED. Often having a faculty member pulling for you can get these things change and if not then they can try to get you up to speed for your electives.

Good luck.

 

[WorkinEM]

No idea if anyone reads this thread anymore, but I just found it. I had a question.

I'm about to begin my first year of medical school. Recently I've been consistently shadowing an EM physician in my community. I've come to look at him as a mentor and he's told me that anytime I have a break I'm welcome to come back and shadow him for as long as I want.
Would maintaining an activity like this be something that a residency program would look favorably upon? Or would they even care? Even if it doesn't really affect anything, I really enjoy doing it, but its just made me curious as to whether this could benefit me in the future.
Thanks.

Sorry it has taken me so long to respond to this. I'll send you a PM to let you know there's an answer.
I don't think you'll get any additional benefit to your residency app by doing more shadowing. You've already done it, more won't necissarily be better for your app. You also should know that most academic docs are a bit snobbish about community docs and what we have to say. That said if you enjoy the shadowing I think you should continue to do it when you can. It will provide you with some great insight into EM that will help you as you go forward in your career.
As I've said before mentors are crucially important. The fact that you have one is terrific. Now you will need to get an academic mentor as well for the all important SLOR and the academic connections but your mentor can continue to help you. You ought to ask him about additional opportunities in your area to get involved with research, admin, EMS, education, etc. Those things would be new entities you could add to your app.
Good luck.

 

[pepes1lv1a]

Thanks for answering all these questions!

I took a year off after graduating to get my EMT license, and I've been working in an ER as a technician. I absolutely LOVE my job.

I have a few questions:

1) What do you think about the #FOAMEd (Free Open Access Medical Education) movement? Do you follow any of the blogs or podcasts (EMCrit, ERCast, resus.me, Dr. Smith's ECG Blog, The Chart Review)?

-If so, do you have any good ones you'd suggest that I haven't listed?

-Also, is this something I should bring up about during interviews/in essays? I love learning about emergency medicine and I spend a lot of time outside of work keeping as current as I can, but I also have zero medical background to inform my perspective.




2) At my ER, it's expected that the techs interact mostly with nurses and stay out of the doctor's way. I need to ask for a letter of recommendation at some point, but it's frankly extremely intimidating to approach an attending.

-Do you have any advice for how to go about doing this, or getting to know them better, without interfering with their work?

-Is it reasonable to ask them if they know of any colleagues who would be willing to let me shadow them?

 

[Birdstrike]

Do you follow any of the blogs or podcasts

You need to follow drwhitecoat.com

The wealth of free information there is incredible.

 

[KinesiologyNerd]

2) At my ER, it's expected that the techs interact mostly with nurses and stay out of the doctor's way. I need to ask for a letter of recommendation at some point, but it's frankly extremely intimidating to approach an attending.

-Do you have any advice for how to go about doing this, or getting to know them better, without interfering with their work?

-Is it reasonable to ask them if they know of any colleagues who would be willing to let me shadow them?

Really? Maybe my experiences as a scribe are different (we spend the entire shift with the doc), but our docs are absolutely the most down to earth/approachable docs I've met. Just talk to them. They're people too.

Also, yes talk about how you love learning about EM, but maybe try to spin as loving to learn about medicine. I talked about how I keep a collection of interesting EKGs and love talking through scans/results/MDM with the doctor. I do think my desire to go EM/trauma hurt me at a very primary care focused school, however.

 

[HunterGatherer]

-Also, is this something I should bring up about during interviews/in essays? I love learning about emergency medicine and I spend a lot of time outside of work keeping as current as I can, but I also have zero medical background to inform my perspective.

It is good to find a niche in EM at least I keep hearing this. Seems like you may have found yours early on. You need to find those who are in charge of sim lab, protocol training, anyone offering free educational resources online, etc. Hopefully, someone is doing one of these things at your shop and they are an EM doc.

Also find out which doc does training with the EMTs and early on express your interest as a future EM physician. This would avoid the culture that seems to discourage doctor-tech interaction.

2) At my ER, it's expected that the techs interact mostly with nurses and stay out of the doctor's way. I need to ask for a letter of recommendation at some point, but it's frankly extremely intimidating to approach an attending.

If you've been there at least 3 months I'm sure you've built a rapport with one of the doctors so approach that person. Maybe I misunderstand what you mean but I find it odd that a tech can't approach a doctor other than to hand them an EKG.

If there really is some bizarre barrier that prevents you from approaching a doctor and you are still preferring to do this where you work you can:
1. Do this via the hospital volunteer department
2. When you see someone shadowing in the ED pull them aside and ask what you need to do.
3. Ask a nurse or colleague which doc you would be able to approach.
4. Use your own school's counselor for pre-meds to set something up.
5. Go somewhere else since it should not be this complicated.

-Is it reasonable to ask them if they know of any colleagues who would be willing to let me shadow them?

Seems reasonable but also seems like you are stating you are unable or reluctant to approach the docs for some reason. Maybe we are both complicating something that requires a simple, "Hello, my name is Pepes..."

.

 

[HunterGatherer]

1) What do you think about the #FOAMEd (Free Open Access Medical Education) movement? Do you follow any of the blogs or podcasts (EMCrit, ERCast, resus.me, Dr. Smith's ECG Blog, The Chart Review)?

-If so, do you have any good ones you'd suggest that I haven't listed?

Nice list. Along with drwhitecoat.com perhaps we could make a sticky for this. I never heard of one the sites you mentioned so thanks. Looks like you are already spreading the word.

 

[pepes1lv1a]

Really? Maybe my experiences as a scribe are different (we spend the entire shift with the doc), but our docs are absolutely the most down to earth/approachable docs I've met. Just talk to them. They're people too.

This is a good point. Just by virtue of the fact that getting into medical school WILL be a tremendous struggle for me (2.9 sGPA, 34 MCAT), being around the people who are "living my dream" so to speak can be intimidating, and I am sure that some of this is just in my head. I have made small headway by just asking some of the doctors questions about some of the things I come across online, and they are almost always happy to answer.

talked about how I keep a collection of interesting EKGs and love talking through scans/results/MDM with the doctor. I do think my desire to go EM/trauma hurt me at a very primary care focused school, however.

Do you have any resources in particular you'd recommend for EKG interpretation?

I've used LearntheHeart because of their fantastic library of abnormal EKGs, but (and I know this is reasonable; I'm obviously not a med student) I get frustrated by my inability to intuitively grasp the pathologies behind some of the weirder EKGs I see. Bundle branch blocks, for example, are wonderfully straightforward -- bundle branch blocks causing the "bunny ear" morphology because of differential conduction times on each side -- but other things, like a STEMI, are difficult for me to visualize even when I know the associated ST-elevation/"tombstone" morphology.

You need to follow drwhitecoat.com

This appears to be the consensus

Nice list. Along with drwhitecoat.com perhaps we could make a sticky for this.

Yes!! My big reservation with FOAMed is that I don't really have the background knowledge to evaluate the clinical legitimacy of what I'm reading. Having a sort of crowdsourced test of legitimacy through SDN would certainly help.

Emergency Medicine Updates is another good one, and for the residents out there, EM Res Podcast (and blog)

Also, there are some pretty cool compilations of EM-related material out there:
EMCHATTER is an RSS feed neatly organized by subject, and @EMSblogs is more of an EMS summary of trending Twitter articles

 

[winkleweizen]

Not to be a dick or anything, but are you still premed? If you are, you really dont need to be studying emergency related stuff. Just worry about getting in first.

 

[pepes1lv1a]

Yes, still pre-med. I've got a 4 post-bacc GPA but I need to retake a few more classes before I'm really competitive. I'm applying (DO and MD) this year because I'd rather not pay for an extra year of post-bacc coursework if I can avoid it.


I'm not really teaching myself how to diagnose or treat anything. I just like having a better idea about what's going on when I see it happening. The EM residents and attendings are kind of living my dream, so I think it's reasonable to want to watch and understand how they operate.

 

[winkleweizen]

Yes, still pre-med. I've got a 4 post-bacc GPA but I need to retake a few more classes before I'm really competitive. I'm applying (DO and MD) this year because I'd rather not pay for an extra year of post-bacc coursework if I can avoid it.


I'm not really teaching myself how to diagnose or treat anything. I just like having a better idea about what's going on when I see it happening. The EM residents and attendings are kind of living my dream, so I think it's reasonable to want to watch and understand how they operate.

Well good luck!!! I just figured your time would be better preparing for interviews and studying your courses then EKGs and stuff.....personally, I love Birdstrikes blog and ACEP and EMRA send me a magazine every month or so thats pretty enlightening.

 

[pepes1lv1a]

Well good luck!!! I just figured your time would be better preparing for interviews and studying your courses then EKGs and stuff.....personally, I love Birdstrikes blog and ACEP and EMRA send me a magazine every month or so thats pretty enlightening.

Thanks! If I get any interviews this time around...we'll see. I'm in-between courses right now (spring and summer) so I have time to pursue interests like this. When summer session rolls around I'll be back to the grind :/

I also go on twitter too much to procrastinate, and that's how I discover some of these and squirrel them away for later. Found another interesting one yesterday -- DrGDH. I really like the multimedia format he uses -- see "Why ED docs are backwards". Never heard of Prezi before.


Also, Cliff Reid retweeted me once and it made me swoon.

 

[Birdstrike]

Well good luck!!! I just figured your time would be better preparing for interviews and studying your courses then EKGs and stuff.....personally, I love Birdstrikes blog and ACEP and EMRA send me a magazine every month or so thats pretty enlightening.

It's not my blog. It's "Whitecoat's" blog. He just lets me guest post from time to time. Anyone can, actually. I'm glad you like it, though. He does a great job. There's a lot there.