How to rock your ER rotation

Hello M4’s, at this point in the year, most of you are taking away “audition” rotations. The goal here is to make a good impression, such that when your application comes across the residency selection committee’s desk, they remember you fondly.

You want to do well here. So how can you do that?

  • Be professional: don’t be late, be respectful. There’s a lot of emphasis on punctuality in EM – the last thing you want to do after a tiring shift is have your replacement show up late. So, show up 10 minutes early and get the lay of the land.
  • Respect the nurses: not only have they been doing this longer than you, they know more than you. Get them on your side. I suggest you take the time to learn their names… and use their names. Keep them informed of the plan. Help them out. If a patient needs a pillow, you get it. Put a patient on a bed pan.
  • Respect the patients: same applies here. Ask their names (Mr. and Mrs. So-and-so unless they insist you use their first names) and give them yours. And most importantly keep them informed of what’s going on. Rather than getting the patient on your side, you want to get on the side of the patients.
  • Ask questions: Don’t make up questions to seem inquisitive. Instead, make an effort to find out the answer first. With Up-To-Date, Smart Phone apps, websites (CDEM) you have a lot of information at your fingertips already. If you still can’t find the answer, now ask intelligent, informed questions.
  • Make decisions: this is the time where you get to flex your decision making muscles. So don’t wait for the attending to spoon feed you the plan – get all your information, take some time to synthesize it, and then make an educated guess at a plan. You’re not going to be right every time, but it’s better to commit yourself to creating a plan and show you’ve put some thought into this than to passively accept what’s given to you.
  • Have a DDx: have this ready before you present to the resident or attending. You don’t want to be stumbling guessing when asked “what could kill this patient presenting with X?” Think this out ahead of time.
  • Do the stuff you’re supposed to do: finish your charts, complete any shift cards, go to all lectures, complete all assignments, and look up whatever anyone asks you to look up. Check on all results. Don’t leave stuff half done so you can leave your shift the minute it ends. Most of your attendings and residents will be staying late to get their work done… if they are, if you have stuff left undone, maybe you should, too. Along these lines, don’t pick up a complicated patient 10 minutes before you’re supposed to leave – you won’t be able to finish. You’ll be there for hours.
  • Set expectations early: if you’re going to be asking an attending for a letter of recommendation, ask them at the beginning of the shift. “Dr. X, I’d like to get a great letter of recommendation from my time here. I was hoping you could help me excel here. I’m open to any feedback, positive or constructive.” Now Dr. X will be paying attention to you, and looking for ways to help you. If you want till the end, Dr. X likely won’t have paid 2¢ of thought to you and will make up generic advice in the heat of the moment. If you want to learn something, bring that up at the beginning of the shift. “Dr. Y, I’ve been having trouble presenting concisely. I’d like to work on that today. I’d appreciate any feedback that can help me do that.
  • Enjoy it: I know I made it sound pretty tough, but if you are considering this as a career, it should also be fun. It is fun! Sure there will be good days and bad days, but on average you should be enjoying yourself.

I’ll add more here if I think of it.

How to rock your ER rotation

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