The data is out. Just published June 30th, 2015, in Academic Medicine (the Journal for the AAMC)(Benson, Stickle et al. 9000) is that 4th year students going into EM are much more likely to do away rotations during their 4th year than students going into other specialties. Also, the majority of 4th year medical students believe that one of the primary uses of the last year of med school is to successfully match in the residency of their choice. Well, from the EM administration side, we want the same thing… to match the students most likely to succeed in our individual EM programs. Below find some tips for success on your rotation.

  1. Work hard. This is a month-long audition, whether it is at your home institution or a visiting rotation… now is your time, so use it. You can sleep during other rotations. ☺
  2. Show up early, stay late, minimize any schedule requests. Your sister’s wedding… Dinner with your boyfriend… not acceptable. Remember, most of the time the scheduler for your rotation will have a BIG say in whether you match in that program. They are typically the Clerkship Director or the Assistant Director. If you are interviewing during your visiting rotation, be very clear about the days that you need for interviews (this is OBVIOUSLY an acceptable ask) but then offer to work whenever they want you to, to make up for multiple schedule requests.
  3. Be honest. K.A. DON’T LIE. If you didn’t check the TM’s, don’t say that you did. If you didn’t ask a smoking history, don’t say that you did… eventually you will be caught and even minor transgressions are big red flags.
  4. Listen to your patients; listen to your residents and attendings, listen for overhead pages. Everyone is different, and they will ask you to see and present patients in different ways. And then they will act like this is OBVIOUSLY the ONLY way that ANYONE could ever see this patient or make this differential diagnosis. Clearly, this is not true. There are many ways to skin a cat (which I always think is gross to imagine). Humor us, we want to teach you, and so we want you to model our behavior during the shift.
  5. Every time there is a trauma code, the clothes need to be cut off. If you don’t have shears, then BUY some and have them in your pocket. If you see your resident or attending doesn’t have shears, GIVE THEM YOUR SHEARS. Every critical patient needs an IV. Even if you can’t put in the IV, get all of the stuff together. Anticipate the needs of your team. Make yourself useful. Is some of this scut work? Sure, but someone has to collect the supplies for the foley. Make yourself indispensable, and you will get more opportunities for education and procedures during your rotation.
  6. Know where to find stuff. At your home institution this should be easy. On an away rotation, that first day of orientation… go look and find stuff. You should know where basic stuff is. If someone asks you to go get something and you don’t know where to find it, TELL THEM immediately. Offer to get help finding said object, or go with the resident/attending to see where the object is located so you know for next time.
  7. Re-check vital signs. You go to see a patient, and their heart at triage was 120, but you note during your exam that it is 85. This is important and should be part of your presentation.
  8. Re-check your patient. Are they still in pain after the medication? Has their breathing and breath sounds improved after the neb? If a patient is getting worse or needs something that you can’t provide, TELL SOMEONE.
  9. Determine pregnancy status. If you are seeing a woman between 12 years of age and 55, then chances are good that they will need a urine pregnancy test. If you have the ability to do this yourself in the ED, then do it. This should not delay your presentation of the patient, but often can occur concomitantly. Same with any rapid ED testing, urine dip-sticks, or any non-invasive point of care testing that is applicable to your patient. If you don’t have the availability of doing the test yourself, then make sure that the patient has a cup to pee in.
  10. Know your nurse’s and tech’s names. At the start of every shift, introduce yourself to the attending (duh) and the residents (double duh) and the nurses and techs. What do you think works better? “Sally, can you help me put in this IV?” OR “Hey… can ‘you’ help me put in this IV?” If you know their names, they will learn yours, and you can bet that they will let others know (in a positive way).
  11. Learn how to start an IV/draw blood from a patient, suture a simple laceration, and do an ABG ASAP. These are basic skills, but if you can reliably do them, you can bet that your team will allow you to do new and better procedures. When more complicated procedures are being performed (LP, central line, paracentesis, chest tube), ask if you can scrub in and be the assistant. Practice suturing at home on bananas, practice instrument ties and one handed ties, because those are what we use in the ED.
  12. Take ownership of your patients. You should be the FIRST to know when blood tests are back, xrays/CT/US’s are done and read. You should also know if your patient’s care has been delayed in some way (i.e. labs aren’t drawn because no one can get blood from the patient. CT head wasn’t done because the drunk patient refused to go with the transporter.)

Finally, the 4th year rotation allows the program to decide whether they want you, but it should also give you information about whether you want us. Each EM program is different and suits different types of learners. Have fun and work hard. Remember, your EM faculty and residents are excited to have you around. They want to teach you. Occasionally you will come across people who don’t love teaching, but ignore those people; they are in the vast minority. You have already made the awesome decision to join us in Emergency Medicine. Good job making excellent life choices. Now the fun begins!

References

Benson, N. M., et al. Going “Fourth” From Medical School: Fourth-Year Medical Students’ Perspectives on the Fourth Year of Medical School. Academic Medicine 2015. Publish Ahead of Print.