An intern's perspective: Doing well on your EM clerkship

It's that time of year again. When medical students interested in EM are stressing over doing well on their EM rotation.

Here's a very insightful guest post from Dr. James Connolly, who is a new PGY-1 resident at Hahnemann Hospital in Philadelphia, and hosts his own blog at: www.erjedi.com. I'll write my personal top-10 list next week, from the perspective of a faculty member.

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Many MS4 interested in emergency medicine will be starting their EM Sub-I's in the next few weeks and are naturally wondering what to expect, and how they can be successful, both in terms of getting a strong letter of recommendation, and all while still having a fun and enjoyable rotation. With that in mind, I'd like to present a unique "Top Ten" list, written with the aim of helping the student succeed on his or her upcoming rotation. The list is my own, based on my experiences during three EM rotations last year as a medical student.  I've also asked a few of my fellow interns for their input on the list, so the list really reflects thoughts of a handful of people who recently successfully matched into emergency medicine. 

1. Case files or a similar book will cover 99% of what you need to know.  But remember, this is not like a medicine rotation where you can go home and read about your patient at night and then use what you learned the next day on your patient.  Avoid UpToDate if you need to look something up as it will give you WAY more information that you probably need. Instead, there should be a copy of Tintinalli's Emergency Medicine or even better "5 Minute Emergency Medicine Consult" laying around to look up something quick if you need to.

2. If you had to know three cases cold, know about chest pain, belly pain and asthma, the differential and basic treatment of each. You will probably see each of these on every shift. There are also a few "rules" that if you know them, you'll be on your way to all-star status. The ones I was asked about most were rules for head CT imaging, C spine clearance, and PERC scoring for pulmonary embolism.

3. Don't worry about trauma, no one has expectations for you to know much, if anything, about what to do when a trauma patient rolls in.

4. Despite that, still gown up for trauma. You might be able to get involved, you might not. But if you don't wear your uniform, the coach can't put you into the game.

5. Keep a pair of trauma shears in your back pocket. Helping to cut clothes is a great way to get up to the table during trauma cases, and you'd be surprised how often you'll need a pair of scissors during your shift.

6. Practice your instrument ties and simple interrupted sutures ahead of time and feel confident knowing how to do them.

7. Before presenting your patient, take 2 minutes and practice it to yourself.  Remember that these presentations are different than your medicine presentations. What the patient had for breakfast or the last time they pooped probably don't need to be included.

8. Practice your presentation. Its worth repeating. In the busy ER, the amount of "face time" you get with those who will be evaluating you largely consists of you presenting your patients, especially during a busy shift.  This is the best opportunity to show your stuff, so if you can appear polished, it will only help. If you present to the attendings, try to run it by your third-year resident first for an additional practice run.

9. When you present, be prepared to answer the question "So what do you want to do?" In other words, have a plan in mind of how you want to proceed with this patient.

10. Review the basics of normal EKGs. You will likely be asked to interpret several EKGs, most of which will likely be normal. Thus,  know what makes an EKG normal (ie Sinus rhythym, regular rhythm, correct intervals and timing etc etc)

Bonus point: Enjoy the rotation. In all of med school, no other rotation will let you be an independent thinker (and often worker) like your EM rotation will. Use this as a chance to apply all that great knowledge you've been building up over the years.

Read more on tips for success from a faculty perspective.