Which electives are good to take for a 4th year going into EM

[han14tra]

I'm going into EM. I'm considering the following electives: Anesthesia, Trauma, MICU, SICU, and inpatient peds. I have 1 block that I need to fill with one of these.

I already did an anesthesia elective last year so I'm leaning away from that a little. I also did a trauma rotation, but it was at a very low volume trauma center in the middle of winter (so all I did was change wound vacs and scrub into ACS cases like appys).

Which would be good to choose?

---

Members don't see this ad.

 

[gman33]

I'm going into EM. I'm considering the following electives: Anesthesia, Trauma, MICU, SICU, and inpatient peds. I have 1 block that I need to fill with one of these.

I already did an anesthesia elective last year so I'm leaning away from that a little. I also did a trauma rotation, but it was at a very low volume trauma center in the middle of winter (so all I did was change wound vacs and scrub into ACS cases like appys).

Which would be good to choose?

Inpatient peds?
I'd have a hard time coming up with anything as low yield as that.

Anesthesia if you can get tubes. Like a bunch.
MICU/SICU if you can get procedures.

Some surgical sub-spec stuff is good, especially if you can do short like 2 week rotations.
ENT, OPTHO, Plastics. A lot to learn. Maybe not good if it's just scut.

 

[justin8818]

I did 4 weeks of ophthalmology. All I did was screw around with the slit lamp and direct ophthalmoscope. Any whisper of going to the OR and I bounced.. I thought it was pretty helpful all in all!

 

[Transmogrifier]

My MICU month was good. Check with other students about what sites are best (if you have a choice).

I didn't get tons of procedures, but the hours were pretty decent and I got to see a ton of really sick patients. It'll make my ICU months next year at least slightly less scary I hope.

 

[wobit]

Seems silly, but a month of Derm was actually great. Rashes are annoyingly variable and getting a chance to see a variety of common presentations on different skin tones and degrees of chronicity was helpful. Not a bad schedule, either.

 

[jbar]

2 week tox rotation. Sure you get tox in residency but it's nice to roll in feeling good about the basic aspirin, tylenol, TCA overdoses. And more tox rotations are like 9-3pm.

Emergency medicine ultrasound, super useful.

Selective radiology rotation. I didn't do this but would have liked to spend a week on just chest xrays and body CTs. I think it would be worthwhile if you can be selective in what you do, ie "I want to learn about this." If you just do a general radiology elective you risk spending a lot of time looking at stuff like PET scans and MRIs and breast ultrasound that don't really apply to EM.

I second anesthesia if you can get tubes.

 

[dally1025]

Ask the 4th years at your school. Rotations vary by school and location in terms of usefulness. For example, if you do you MICU rotation at the VA in my town it's a wasted month but if you do it at the main hospital it's worth your time. Unless you want to stand around listening to the residents argue about which dose of steroids to use or see a million patients with acne or female balness don't do derm at my place. The best resource is to talk to people that have done some of those rotations. Also, do something you may not get a chance to in the future or have a strong interest in.

 

[John146]

The beach

 

[RPedigo]

I think my most useful rotations were:

1. Emergency ultrasound: being comfortable with the probe even before starting residency is great to have. I would heavily recommend this to anyone going into Emergency Medicine. Plus, the rotations are typically pretty laid-back. I got to scan all day, put in some lines, and do a few lacs and paras during my rotation.

2. Anesthesiology: only if you are going to get lots of tubes. I rotated at an attending-only place and was able to get between 3 and 7 intubations a day. If you're going to be averaging 0-1 it's probably not worth your time unless you've never intubated before. Also, a good time to learn about pharmacodynamics of some of the vasopressors, learn about ventilation, etc.

3. ICU: do an ICU rotation before your intern year. My first day of intern year was overnight in the ICU from 1800 to 1000 essentially by myself (there was a 2nd and 3rd year resident as backup, but also covering other parts of the hospital; I was the only dedicated ICU resident). Having some critical care experience was definitely helpful when patients would desat on the vent or even for something as simple as "this septic patient is still hypotensive on max dose norepinephrine, what should we do?"

4. Some kind of EKG-based rotation, if available: I did an electrophysiology rotation at my home institution which was basically me reading EKGs all day. I had to round on some people, but I'd say the vast majority of my day was doing nothing but reading EKGs and going over them with the electrophysiology attendings. EP attendings tend to be "the" EKG experts, so it was a good rotation.

 

[K31]

The beach

Yeah, this. I will be done with everything required to graduate by Match. I was considering doing a couple of electives in April (was thinking 2 weeks derm or ophtho, 2 weeks anesthesia) but then realized I was stupid for considering doing a post-Match rotation when I didn't have to.

 

[Khaos]

I can tell you from experience...the last couple of months either take off or pick easy rotations. I did the harder rotations and it felt as if I had no break when I got into EM because the moment you walk in you are running. The truth is the first year of residency you don't do much EM. You are in the ED maybe 4 months if you are lucky and some programs do as little as 2 months in the ED. You are doing all of the external rotations that year.

I have recommended to all students to take easier rotations in the last couple of months to give yourself time to get your stuff together, say goodbye to the friends you made the past 4 years, and to get packed and save up money.

I know that everyone wants to go into their first year ready to go and to not feel like the one bringing everyone down. I've got a surprise for you. There will be plenty of times you will feel helpless and will be asking for help no matter how many "hard" rotations you did in medical school. Just do a search on SDN and you will find plenty of it.

Enjoy those last couple of months and have fun in something that actually interests you but gives you time. Radiology, dermatology, and anesthesia are great rotations that usually let you have a lot of time at home and such but you learn some things that you will use.