Ok, I'll bite. Having worked in multiple settings that have "unopposed" other-services rotate through the ED, I will propose that you are most likely in a community setting, in a hospital with an academic bent via an FM residency but realistically still a community hospital with a community, private-practice, metrics driven ED. If these assumptions are accurate, some percentage of your ED physicians simply do not want to teach. Even for the presumed majority who are happy to teach, you are unfortunately an intern out of your turf in a busy, time-sensitive environment. IMHO, interns in community hospitals are woefully underprepared to optimize their learning or patient care despite potential general awesomeness, and such rotations should be explicitly limited to the 2nd and 3rd years of residency. There is a huge advantage to knowing how to enter orders - I can't tell you how many times I have had fix orders because they were entered on the inpatient side - and knowing the system and knowing the attendings. At this point, I enter orders while the resident presents because it gets done quickly and right. Your attendings likely know the difference between IM, FM and ED residents and, most importantly, what needs to happen in the ED. If you want to optimize your learning experience, communicate concisely but often & often before actions. I want to know who you are going to see -- and yes, I may be in and out of the room before you even finish preparing your note sheet, because I have to see the patient anyway -- but I don't mind you signing up on the board and going to see a new patient if you can't tell me right away. Focus your presentation, hit the pertinent positives, have a clear differential that is mentally organized by "worst first" while simultaneously knowing what you think is really going on, don't minimize abnormal vital signs. If you can do all those things, then you may propose appropriate treatment and a focused workup as indicated to rule out badness. If not, at some point I'm going to focus you to try to teach you some of those skills, and you are going to feel like you have lost autonomy because you have. Keep ahead with labs, and it might be "CBC is back, BMP pending still"; if you see the potassium of 1.9 before I do and say so then your next words should be, "I can order supplemental K" (and Mg for absorption, though that's often a teaching point). It does help to follow the basic rules for learning, like having goals, communicating goals concisely (to each attending, sorry), etc. I will set some rules for you as part of my standard introduction. Some of your attendings do not want to teach. Some love to. Some will try to teach, and it will be secondary to appropriate ED care.
