Top 10 reasons why Yoda would be a terrible mentor and teacher in medicine

This is based on an article from GeekWire that lists the top ten reasons why Yoda would make a terrible teacher. Let’s see if I can make a derivation and convert these reasons as to why Yoda would make a terrible mentor/teacher in medicine.

10. Micro-manage much? 

Yoda never took into consideration the mentee’s motivations, desires, and mental states, which made for a very inefficient relationship. It also looks bad when Yoda is on Luke’s back and directing all of his moves. That level of micromanagement does not lend itself to the best situation for communication, which is a very complicated process and of essence in a learning environment.

9. Lack of transparency

It’s always important to tell your mentee what your reasoning is behind your decisions as an attending. They should learn how you go through the process of formulating answers so that they can do the same when challenged with similar problems or questions. If your reasoning is not explained, the student will never know why you arrive at a particular conclusion. Transparency also makes you more approachable.

8. The importance of goals

“Because I said so” should not really be an answer. Explain why and how the exercise/ activity/ challenge will make them better doctors. Jointly come to a decision as to what the goals of the shift are; be it seeing more patients, managing more critical care patients, working on procedures, or teaching medical students. The ultimate goal is to make of them a better doctors, take better care of patients, and be more proficient at skills. There should not be a hidden agenda. All cards should be on the table. Yoda was so secretive, and for some reason things needed to be figured out as riddles.

7. Communicate clearly

This has to overemphasized. Communication is everything. Everybody needs to be on the same page. The Geekwire article states “finding a way to minimize information friction should be job one for all mentors.” As you remember, Yoda did not communicate clearly, I mean really, who talks like that?

6. Authentic assessments

The mentor/teacher should be aware of the learner's knowledge and where that falls within the standard for that level of training. If the student hasn't met these expectations, a plan should be laid out to delineate how to get there. There should also be benchmarks to let the student know whether s/he was successful. These assessments and benchmarks were not made clear by Yoda, which I would imagine made Luke more frustrated. 

5. Authority problems
The mentee/mentor relationship is a delicate one, and all the authority should not fall on just the mentor. The relationship should be seen as a respectful collaboration going both ways. Without respect, the relationship suffers and the communication fails. Yoda was very frustrated at what appeared to be Luke’s lack of respect, but the respect did not come from Yoda either. Mutual respect leads to better communication and a conducive learning environment.  

4. Constructed learning from existing contexts
Basically Yoda did not know how to motivate Luke to learn. Criticism needs to be well directed, specific, constructive, and connected to experiences that the mentee can relate to. Sometimes criticism are more welcomed when they come from a person that the mentee can relate to culturally, chronologically, etc. The point is that there has to be some common ground beyond the mentor/mentee relationship.

3. Dispel cult auras
Mentors might be too detached from the students. When the mentee or the mentor cannot relate to each other, the learning is more difficult. I’ve heard great podcasts where the attendings sound very down to earth, and this in turn makes the students feel more comfortable to learn from them. I went to a conference where Amal Mattu was lecturing, after lecture I approached him and called him Dr. Mattu, the first thing he told was to call him Amal. After that my conversation with him felt more like I was talking to a friend even though I knew how well renown he was.   

2. Accessibility in all ways
The mentor creates a better learning environment when the mentee sees him/her as being approachable. This is much easier with technology in the present time. When we have a question, we can just go ahead and text or email someone. In contrast, Yoda was pretty inaccessible.

1. There is nothing magical about learning new things
All students should know that learning is hard, and that they need to put in a lot of work. No matter how stellar a mentor is, if the mentee does not put in the time, s/he will not get to master the skills necessary to be successful. The name of the game is repetition, there are no shortcuts. 

The mentor-mentee relationship is a very complicated one. If basic principles are followed, however, the process of learning and mentorship can be a mutually beneficial and joyful experience. Clear communication and mutual respect are the foundation in this relationship, which both parties should strive for. 

Basically, don't be Yoda.
Javier Benítez, M.D.

G-Advising: Using Google Hangout to advise medical students

Get an advisor.

Don't try to climb the mountain on your own.

This is key especially during medical school as you navigate through the mounds of reading, paperwork, options, and pitfalls. If you are interested in Emergency Medicine (EM) as a career, that means getting one or several great EM advisors. Don't rely on non-EM faculty to give you any insight into EM. Inevitably, I have found that they give incomplete or slightly skewed perspectives about the pros and cons of EM.

What if you don't have an established EM residency program or established EM faculty at your school?

Be proactive in finding an EM advisor. Sometimes that means looking outside of your school. That's what a medical student at the Philadelphia College of Osteopathic Medicine, soon-to-be Dr. Rick Pescatore did. We conducted a Google Hangout with the EM Interest Group where I got to field insightful questions about EM. I was at home and the students were in a classroom. Another student in the library actually linked into our Hangout partway through. The Hangout allows for up to 10 link-ins. The video and audio worked seemlessly!

Check out Rick's account of this cool approach to advising on his blog LittleWhiteCoats.

For those looking for e-Advisors in EM, I'm working with a team, lead by Dr. Megan Fix (Utah) and Dr. Rob Cooney (Conemaugh Health Systems), who are almost ready to launch the massive program in 1-2 months. Keep a lookout for it. There will be a list of available faculty, their academic affiliation, and their interests. You can select whomever you want.

This is just my first (of hopefully many) adventures in G-Advising using Google. Here is a video on Google Hangouts.

Article Review: Formative experiences during medical school

What were your most impactful experiences during medical school?

This study surveyed 216 medical students from Johns Hopkins about a wide spectrum of formative experiences and the impact on their lives.

The goal of this study was to determine which experiences are the most commonly shared and most impactful. Because these experiences contribute to each student's emotional development and early professional competence, faculty mentors should be cognizant of these events when advising medical students.

Methodology

An online survey instrument was developed using various focus groups, which included students, residents, and faculty advisors. A list of 34 distinct events/experiences were determined. In the study, students were were asked:

1. Did you experience this event during medical school?
2. What magnitude of impact did it have on you?

A Relative Impact Score was calculated for each item based on the numeric values for verbal descriptors:

• 0 = Experienced event but no impact
• 1 = Little impact
• 2 = Some impact
• 3 = A lot of impact
• 4 = Tremendous impact

The numerical values for each item were summed across all of the student responses, divided by the total number of events experienced, and scaled to 100.

Results

Of the 216 graduating residents, 181 completed the questionnaire (84%). Anything over 70% is generally considered a "reasonable" response rate for surveys. Obviously the higher the better.

Look at this table from the article, which lists the 34 "events". For each event, there is a corresponding exposure rate (% of students who experienced the event), Relative Impact Score, % of students who ranked the event as moderate impact, and % of students who ranked the event as high impact. The list is presented in descending order, based on the percentage of students who list the event as high impact.

I highlighted the 10 events with the highest Relative Impact Score in yellow. Click table to enlarge the size.

In general, impactful experiences were grouped into one of three categories (in descending order of "impactfulness"):

1. Inspiring experiences

• Being inspired by a special patient-care related experience
• Encountering a truly exceptional role model in medicine
• Working well with a team
• Seeing a patient whose life was saved by medical intervention

2. Mortality-related experiences

• Seeing someone undergo resuscitation/intervention
• Seeing someone die
• Encountering a corpse in the anatomy lab

3. Negative experiences in the learning environment

• Seeing/experiencing mistreatment by colleagues, staff, or faculty
• Receiving genuinely inappropriate feedback
• Getting a grade very much below expectations

This list of formative experiences during medical school is extremely useful for both medical students and faculty advisors. First-year medical students can anticipate what experiences will come. And faculty advisors can be more attuned to and ask about the moderate-to-high impact experiences for their advisees.

References
Murinson BB, Klick B, Haythornthwaite JA, Shochet R, Levine RB, & Wright SM (2010). Formative Experiences of Emerging Physicians: Gauging the Impact of Events That Occur During Medical School. Academic medicine : journal of the Association of American Medical Colleges, 85 (8), 1331-1337 PMID: 20671460

*

Article review: Career in Academics

What should I do after finishing residency training? What, there's no more training?!

Traditionally, graduates enter one of four traditional areas -- academia, community practice, industry, and the military. With the increased financial and research pressures of academic medicine, a study reviewed why physicians pursue a career in academia.

Specifically, the authors conducted a literature search of the term "career academic medicine". Articles published during 1986-2006 were included. From the 480 relevant articles, there were 41 identified, which were highly relevant. The following themes were noted in the literature:

Opinion and editorial pieces
One editorial commented on the decline of the academic physician pool and that efforts should focus on medical students, who should be encouraged to pursue academia.

Issues and obstacles
There are many obstacles that residents face when considering a career in academia. Issues include:

• Competition for decreasing pool of funding sources
• Long patient care hours
• Heavy administrative responsibilities
• Busy teaching schedules
• Lower salary
• Medical school and residency debt payments
  
• Uncertainty for success
• Number of years of training necessary to join academia
• Lack of effective mentoring and role modeling
• Undesirable location and practice environment
• Challenging work-life balance especially for women in academia

Financial considerations
Because of the general lower pay of academic faculty compared to community and private practices, personal debt may negatively incentive residents from academia.

Role models and mentoring
There are not enough great role models for students and residents interested in pursuing academic medicine. Without strong mentors, especially for women and under-represented minorities, it is a leap-of-faith for undifferentiated residents to choose a career in academics.

Academic physicians as teachers and/or researchers
Gone are the days of the "triple-threat" academic physician, who excels in patient care, teaching, and research. Now there are two academic models: clinician-educator and clinician-scientist. The clinician-educator has a niche in teaching and scholarship. The clinician-scientist has a niche in research.

Publication and research activities
Exposure to research experiences during medical school is associated with medical students pursuing academia as a career choice. Exposure to research during residency is also worthwhile to help foster continued interest in research and publications.

Gender
As a broad generalization, two studies suggest that men and women select an academic career for different reasons. Female physicians chose academia for the "perceived quality of life, earnings potential, and organizational reward". Being recognized nationally and being perceived as a leader are less important than for the male physicians. Both genders, however, value the intellectual challenges in academia.

Career development/choice
Students from research-intensive medical schools and those with advanced degrees tend to pursue an academic career more than other students. Those with mentors comment that mentors played an important role in their career decision to enter academics.

Values
Intellectual stimulation is a major factor in a physician's decision to pursue a career in academia. Generating and translating new knowledge is an extremely attractive draw for many physicians (including myself!). Future research will have to to determine exactly how individual and generational values differ for the Baby Boomers, Generation X, and Generation Y physicians and how they affect the decision to pursue an academic career.

The authors propose a call to action to the Association of American Medical Colleges (AAMC) and Society of Directors of Research in Medical Education (SDRME) to build a structured approach towards understanding who enters academic medicine and why.

For me, I kind of fell into academia. I attended Harbor-UCLA for EM residency, which is one of the powerhouses of EM academia. My role models were doing academics, and I just assumed that I was going to do it as well. I felt that I easily fit into the clinician-educator model, because of my interest in teaching. Boy, am I lucky to have had such strong role models.

Question to the reader:
Why did or didn't you pursue a life in academia?


Borges NJ, Navarro AM, Grover A, & Hoban JD (2010). How, when, and why do physicians choose careers in academic medicine? A literature review. Academic medicine : journal of the Association of American Medical Colleges, 85 (4), 680-6 PMID: 20354389

Top 10 tips when making your rank list

"How do I decide how to order the
residency programs on my rank list?"

On Feb 24, 2010, every residency applicant will have a brief moment of panic as their rank list is submitted and officially certified.

Next week, I'll be joining a group podcast with Dr. Rob Rogers (Maryland) and Dr. Dave Manthey (Wake Forest) for the next installment of EMRAcast. This new podcast series was created by Rob for EMRA for the specific purpose of providing advice to medical students. I still find it fascinating how much you can get done virtually. We'll all be using Skype from our respective offices and recording our conversation.

I feel sorry for Rob because getting the 3 of us together will probably need a LOT of editing. We end up joking around most of the time.

The podcast theme
Making your rank list - pearls and pitfalls

Off the top of my head, my top 10 list of tips in making a residency rank list is:

1. Don't try and game the system. The match algorithm is weighted towards the applicant. Rank your first choice as #1. There's no logical reason to rank a seemingly more competitive program (but that you aren't as excited about) higher to improve your chances of getting in the program.
   


2. Go with your gut. Where did you feel that you fit in best? Where would you be happy? Each program and its residents has a unique "personality". Don't just select a program for its name or reputation.
   


3. Do your homework. Make sure you have the facts about each program. Don't go by the interview trail rumor mill. Don't base your facts on anonymous forums. I'm constantly shocked by how wrong some rumors are. The best ways to find the truth are from the residents in the program. Just fire an email off to them.


4. Find a program which matches your interests. Some applicants already know that they want to pursue a particular area of EM. This may be EMS, global health, hyperbarics, toxicology, ultrasound, or public health. Be sure there is a faculty member there who can help mentor you in developing your niche. Contact that person to ask about their ability to mentor residents.
   


5. Factor in a support system. Residency, especially internship year, can make it hard to live a balanced life. Having friends or family (who you like) in the area can be important in having a life outside of residency.


6. Look at the trauma, pediatric, and ICU experiences. Determine how important each of these experiences are for you. For instance, if you want to do a pediatric EM or critical care fellowship, a strong pediatric or ICU experience during residency would be ideal. Although there are required minimums for each of these 3 aspects of training, residencies can vary widely in how much exposure there is.


7. The educational culture. How are the residents taught? In the required weekly residency conferences, are the conferences high quality? Are they taught by the residents or faculty? Are the faculty good bedside teachers? Does the educational curriculum fit your learning style?


8. Long-term geographical consideration. If you already know that you would really like to live in [your perfect city], it helps to do training somewhat nearby. You will be able to more easily network into a job. During residency, I was offered a job where I moonlighted.


9. Don't shorten your rank list because you got a "we love you" call or note. Be cautious about phone calls or emails from programs who tell you that they were really impressed by you. You have to remember that year to year, a program goes down a different number of ranks on their list before filling all the slots. For example, if a program gives a call to their top 50 applicants and goes down to 70 on their rank list, all 50 applicants have a great shot of matching there. Then next year, however, the program only goes down to 20 on their rank list, after having made their usual top-50 phone calls. You can do the math. Don't be the one to fall through the cracks.
   


10. Only list programs that you would be willing to attend. It reflects extremely poorly on you if you were to match at a program and refuse the position. It's essentially a breach of contract and this unprofessional action will follow you whereever you go (especially if you try to apply again next year). That being said, for first-time applicants from U.S. allopathic medical schools who have passed their USMLE boards on the first attempt, I would list AT LEAST 10 programs to prevent having to enter the Scramble.

Thanks to RxnMan comment below, I uploaded the 2009 NRMP Charting Outcomes for the Match (pdf, EM relevant sections only) in case you wanted to read how you would have stacked up to last year's match class.

Can you share with me your suggestions? I'd be happy to share the best ones on the podcast (and credit you, if you leave your name in the comments).

Hot off the press: Free EMRA Casts

It is mid-December and residency interview season is in full gear. 'Tis the season of black and dark blue suits walking through hospital halls.

• How have you prepared your interviews?
• What are the classic types of questions that you'll be ask?
• What should you do about your Twitter and Facebook accounts?

Dr. Rob Rogers (Maryland), who constantly is coming up with cutting-edge educational projects and of EM-RAP Educator's Edition podcast fame, is starting a new podcast series called "EMRACast". This series uniquely focuses on giving advice to medical students interested in EM.

Link: EMRA Podcast

In this inaugural podcast for EMRACast, Rob talks about how to succeed in residency interviews. He covers the classic pitfalls and pearls, along with a list of common questions, which each applicant should be prepared to answer.

I have been informally polling applicants over the past 3 years while they are touring San Francisco General's Emergency Department. It sounds like this season's questions are pretty mellow. Basically programs want to know if you fit the their mission and if you'll be a fun, hard-working person, whom the nurses and other housestaff would love to have on shift at 3 am. This is known as passing the "night shift test".

Some quirky questions that I've heard about are:

• If you were on an island, what 3 things would you bring?
• What song would you like to listen to? I'll play it for you right now.
• Draw a picture representing yourself on this index card. We'll be posting and re-ordering these cards on rank day. I heard someone wrote "#1" and their name on their card. Pretty quick thinking!
• What is NOT in your application?
  

Work in progress: Advising EM students using Google Wave

There has been a lot of press about the much-touted Google Wave platform. It will be a major culture-shift in how we communicate electronically. I foresee it replacing traditional email. At a minimum, it is an email, wiki, and real-time collaboration tool all rolled into one. There is also a Playback feature, where you can see how the document was built over time. Often it's hard to follow what happened based on seeing only the most updated version, and it helps to see the evolution. Currently user-access is invite-only, but I have some invites to give out!

I am officially announcing a new "wave" or discussion thread that I am starting, which is open to the public (or at least those with Google Wave accounts). It is called "A career in emergency medicine: Advice from emergency medicine faculty".

This Wave will be a living document where faculty can answer students' questions and post their thoughts about commonly-asked questions about EM. It is so real-time that you can actually see the user typing letter-by-letter, if you catch them at the right moment. As I build the site, you'll see links, graphics, documents, videos, polls, and other cool gadgets.

Here's a screenshot of the initial layout. I may need to break out into several sub-"waves" if the main page gets too long and unwieldy. Each section is editable by the public. Questions/comments can be posted under each chapter within indented boxes. (An example can be seen just under the video.) Click on the image below to see more detail.



If you would like a Google Wave account, please email me at michelle.lin@emergency.ucsf.edu, and I'll give you one of my remaining 19 invitations.

If you have an account already, you can search for and join the Wave by typing "with:public career in emergency medicine" in the home page's New Wave box.

Come and join the fun. I'd love your help. With some help and hard work, I think this virtual EM advising site may really take off.

My prior post on Google Wave and a link to the introductory video from Google.

Hot off the press: Review of "EM Clerkship Primer" book

In an upcoming issue of the Academic Emergency Medicine journal, there is a glowing review of a collaborative project that I was involved in. If you are a medical student about to do an EM rotation, or serve as a faculty advisor for an EM medical student, feel free to distribute this EM Clerkship Primer (FREE book!) for them to read. This was the first official project to come out of the Clerkship Directors in Emergency Medicine (CDEM). It was written by 22 established medical educators in EM, led by our fearless leader/ editor-in-chief, Dave Wald. Go, Dave!


EMERGENCY MEDICINE CLERKSHIP PRIMER: A MANUAL FOR MEDICAL STUDENTS. Edited by David A. Wald, DO. Free for students and educators; 108 pp; download PDF at http://www.saem. org/CDEM (look under "Resources for Medical Students").

The Emergency Medicine Clerkship Primer is a unique and authoritative introduction for medical students entering the specialty of emergency medicine (EM). It has been prepared by physicians who are nationally recognized for their dedication to medical student education. The guide provides a thorough, yet succinct, primer that introduces the steps to not only have a successful clerkship, but also to understand issues central to the practice of EM.

The primer has 24 chapters, including introductions to EM and the clerkship, unique aspects of EM and ED workups, complaint-directed history taking, formulation of differential diagnoses, enhancing oral case presentation skills, diagnostic testing, whether obtaining a diagnosis is important, and appropriate disposition and discharge instructions. There are also helpful chapters on topics such as ED documentation pearls, interacting with consultants, meeting patient expectations, and procedural skills.

This primer has been prepared for all medical students rotating in EM, regardless of their chosen specialty. It begins by providing some background into EM and then transitions into how to perform well in an EM clerkship. The medical student, by reading these well-organized and concise chapters, will develop an understanding of the skill set that is utilized by emergency physicians. In addition, the medical student will learn that the presentation and assessment of an undif- ferentiated patient in the ED is distinct from that of the patient with a known diagnosis in the inpatient ward.

For the medical student planning a career in EM, the Emergency Medicine Clerkship Primer provides a single, inclusive resource that contains references for articles that are essential to emergency physicians. It also provides insight into the background of EM residency education via a review of the core competencies required for residency training.

Overall, the Emergency Medicine Clerkship Primer is an exceptional guide for medical students. Its concise style and valuable content make it a distinctive and irreplaceable resource. Reading it is a highly recommended first step for a successful entrance into a career in EM.

Kapil Dhingra, MD, MBA
Erik Laurin, MD (eglaurin@ucdavis.edu)
University of California, Davis Medical Center
Sacramento, CA

Trick of the Trade: The defensive arts against pimping

Thanks to Dr. Rob Roger's podcast on EM-RAP Educator's Edition series, I learned of one of the funniest publications EVER in a medical journal. It was published on April 1, 2009 in JAMA. The article focuses on teaching medical students the essential skill set-- how to survive "pimping".

Pimping traditionally occurs when an attending physician poses a difficult question to a learner in a public forum, such as board rounds or in the operating room. As a student or resident, you know that this will happen during your training, and you should be prepared. If you think of pimping as a form of battle, you will need a good defense, and you should mix it up to be successful.

Which of these techniques have you used in the past?

Avoidance

Don't make eye contact with the teacher. Stay very still. Lower your head as if you are deep in thought. But don't look like you are sleeping and not paying attention. Bottom line is to not draw attention to yourself while appearing to listen. It's a fine line to walk.

The Muffin
Hold a large muffin in front of your mouth, as if you are going to take a bite. If you don't know the answer, take a big bite. If you still get called on, pretend to choke. I would go one step further and say - If desperate, syncopize.

Hostile Response
The best defense is a good offense. Take a tone and body posture of hostility. Say "I -- DON'T -- KNOW." Personally, as a teacher, I'd be afraid of asking this student questions -- ever --again.

The List
If asked to contribute to a list of answers, you can repeat a response from earlier pretending that you didn't hear it, because you were busy with patient care responsibilities (answering pages, working on your medical charting).

Honorable Surrender

Tell the teacher that you are uncomfortable with the open forum of questioning.

Pimp Back
Another version of - the best defense is a good offense. Ask questions in a subspecialization which the teacher may not be as familiar with. Careful - this technique may totally backfire, since pimpers often know and don't appreciate when they are being pimped back.


Politician's Approach
Don't answer the question asked but rather answer a question you would have preferred to answer.







Use Personal Digital Assistant
Use your handheld device to find answers in real-time.





Don't Sulk or Cry
Pimpers rarely remember who gave incorrect answers - this happens all the time. But sulkers and weepers definitely are memorable. Whatever you do, don't be labeled as one who loses composure. I feel like Emergency Medicine trainees do well in this area. We are constantly barraged by stressors, and it takes a lot for us to lose our composure.

Reference
Detsky AS. The art of pimping. JAMA. April 1, 2009; 301(13): 1379-81.

Work in progress: Advising/teaching using videoconferencing technology

It is not every day when I get to give my "Tricks of the Trade in Emergency Medicine" talk in a new environment. I've given lectures in super-small groups (5-10 people), workshop settings (25-50 people), and large groups (>100 people). I given it in a variety of places ranging from Boston to Barbados.

Yesterday, I gave a 30-minute virtual talk on this topic to the Emergency Medicine Interest Group at Loma Linda School of Medicine. I gave the talk from home on my couch! The audience comprised of preclinical and clinical medical students, who are all interested in EM as a career choice.


Logistically, how did we coordinate this?
With the help of Chad Van Ginkel, a tech-saavy third-year medical student at Loma Linda, we were able to pull this off. Using iChat on the computers at both ends, I was able to "share my desktop" with the audience. Whatever was on my desktop could be viewed by the students. This allowed me to run through my Powerpoint slides. Additionally, I opened the PhotoBooth application to allow me the audience to see me talking in real-time with my slides.

My desktop screen, which was projected
onto the projector screen at Loma Linda.

Afterward the talk, we de-activated the desktop sharing and held a Question&Answer session using the videoconferencing feature of iChat. I could see the audience, and the audience could see me. I fielded questions about EM, applicant competitiveness, and common (and uncommon) interview questions.

My thoughts on videoconferencing
Based on this pilot project, I think this is a great tool to help faculty, who are interested in advising, to reach out to medical students outside of their home site and vice versa. I was able to chat with medical students and (in a small way) help guide them during their exciting journey into residency and beyond. This is a valuable, novel option for "virtual advising" in the future. If you belong to an EM Interest Group, I'd be happy to virtually visit with you as well!

The view on my desktop of the left half of
the videoconferencing room at Loma Linda.

Question: Has anyone used videoconferencing for medical purposes yet?

Free EM clerkship primer for medical students

Emergency Medicine as a specialty approaches patients in a slightly different way from other specialties. We first look to rule-out emergent, life-threatening causes of each patient's presentation. Is the headache a subarachnoid hemorrhage? Is the shortness of breath from a pulmonary embolism? Emergency physicians need to be especially skilled in a broad range of clinical knowledge in addition to multitasking, communicating to patients and consultants concisely, and overall efficiency.

So why hasn't there been a specific reference book addressing the unique aspects of EM for the medical student? It seems a bit unfair to ask the medical student, who is new to the Emergency Department setting, to acclimate to the chaotic environment and not get lost in the shuffle.

Thus about a year ago, the Clerkship Directors in Emergency Medicine (CDEM) group put together an EM Clerkship Primer to address these very issues. We wrote a reference manual called "Emergency Medicine Clerkship Primer: A Manual for Medical Students", which is available for free. The project editor was Dr. Dave Wald (Temple), and I was fortunate to be one of the Associate Editors. There are lots of notable contributing authors.

The chapters include:

1. Intro to the specialty of EM
2. Intro to the EM clerkship
3. EM clerkship goals and objectives
4. Unique educational aspects of EM
5. Differences between the ED, the office, and the inpatient setting
6. Undifferentiated and differentiated patients
7. Performing a complaint-directed history and physical exam
8. Data gathering skills
9. Developing a case-specific differential diagnosis
10. Diagnostic testing in the ED
11. Developing a plan of action
12. Diagnosis: Is it possible? Is it necessary?
13. Disposition of the ED patient
14. Discharge instructions
15. Documentation
16. Enhancing your oral case presentation skills
17. Interacting with consultants and primary care physicians
18. Patient satisfaction - meeting patients' expectations
19. Providing anticipatory guidance
20. Procedural skills
21. Suggested reading and other educational resources for med students
22. How to get the most out of your EM clerkship
    

If you are a medical student interested in EM or a faculty advisor, you should download and read this FREE resource. Yes, I said it's free. We received a generous donation from the University of Rochester to hire a copy-editor.

Link: http://www.saem.org/saemdnn/Portals/0/NTForums_Attach/ED%20Primer.pdf

Hot off the press: Outcomes of 2009 Residency Match

For senior medical students and those of us advising them, we all know that the Electronic Residency Application Service (ERAS) opens on September 1. This is currently the time when students reflect about who they are, what they are going to write about in their personal statement, and how competitive they may be in the residency match.

It is always difficult for me to say how competitive each student will be, based on his/her credentials. My starting number is to tell students to apply to 30 residency programs. With each added solid accomplishment (honors grade in 3rd year and EM rotations, research experience, publications, work experience, community service, and board scores), I then recommend that they apply to fewer programs. Remember that you can always cancel interviews, but you can't really add more programs to apply to late in the game. Overall, students should have 10-12 programs on their rank list, after interview season is over.

To help students determine how they would have compared in the 2009 match, the National Resident Matching Program (NRMP) and Association for American Medical Colleges (AAMC) just released: "Charting Outcomes in the Match: Characteristics of Applicants who Matched to Their Preferred Specialty in the 2009 NRMP Main Residency Match". Download the document.

Some interesting statistics for U.S. seniors who matched (unmatched in parentheses):

• Mean USMLE Step 1 score = 222 (207)
• Mean USMLE Step 2 score = 230 (209)
• Mean # of research experiences = 1.8 (1.5)
• Mean # of volunteer experiences = 6.1 (5.1)
• Percentage who are AOA members = 11% (4.3%)

Interestingly having an advanced graduate degree or PhD did not seem to improve the applicant's chances to match.

I'm glad I don't have to apply in the increasingly competitive world of the EM residency match. I'm not sure I would have fared so well... Students are increasingly doing amazing things.

Sneak Peak: CDEM e-Advisor Program almost ready

The Clerkship Directors in Emergency Medicine (CDEM) group is about ready to officially launch the e-Advisor Program!

The e-Advisor program will be replacing the successful but unfortunately retired SAEM Virtual Advisor Program. The first phase of the program is to target medical schools, which do not have a home Emergency Medicine (EM) residency program. Students from such medical schools are traditionally thought to be at a slight disadvantage compared to students from other schools, because they do not have easy access to EM faculty who are intimately involved with the residency application, screening, interview, and rank-listing processes.


Each school will have a team of 2-5 geographically diverse CDEM faculty advisors who will be available to advise students potentially interested in EM. Students can think of them as their own personal "A-Team" (remember that great TV series?). They can help students figure out such questions as:

• How many residency programs should I apply for?
• How competitive am I, given my CV and application?
• Who should I get letters of recommendations from and what's a SLOR?
• How should I plan my 4th year?
• What is interview season like?
  

Here's a sneak peak at the first 10 medical schools, which were selected for the e-Advisor Program. The Emergency Medicine Interest Groups (EMIGs) from these schools have all expressed interest in being part of the pilot group.

• Baylor College of Medicine (Houston, TX)
  
• Dartmouth School of Medicine (Hanover, NH)
  
• Meharry Medical College (Nashville, TN)
  
• Rush Medical College (Chicago, IL)
• Sanford School of Medicine of Univ of South Dakota (Vermillion, SD)
  
• Touro University College of Osteopathic Medicine (New York, NY)
• Tufts University School of Medicine (Boston, MA)
• University of Miami School of Medicine (Miami, FL)
  
• University of Missouri School of Medicine (Columbia, MO)
• University of Vermont College of Medicine (Burlington, VT)
  

Phase 2 will provide e-Advisors to another 10 medical schools. This time, schools with or without home EM residency programs, will be eligible. Medical schools will be chosen based on those who request the CDEM e-Advisor service. For those schools with residency EM programs, out-of-state e-Advisors will be provided.

Kudos to Dr. Megan Fix (Maine Medical Center), who has been leading the charge to make the CDEM e-Advisor Program a reality.

Questions: Would you like for us to consider your medical school as part of Phase 2 of the e-Advisor program? If so, email me at Michelle.Lin@emergency.ucsf.edu.