In our commitment to keeping posts up-to-date, this post was updated by Eve Purdy in December 2014.
You’re a bright-eyed young medical student and you think you want to be an emergency doctor. You haven’t made life easy for yourself. While it may not be the case in other parts of the world, Emergency Medicine in Canada has become a highly sought-after specialty. The stats from our matching service indicated that last year 88 students ranked emergency medicine as their first choice while there were only 65 spots available. Closer to home, my residency program received a whopping 76 applications for our 2 positions this year. With all of this competition, one of the questions I am asked is: what should I do to prepare? In partial response to this I always tell them that it’s important for them to rock EM clerkship. How? Here are my Top 10 Ways. (Note: Updates since this was originally posted are in italic and now include a #11).
EM Clerkship Tip 1 – Find Mentors
I think this is probably the most important thing you can do for yourself as a medical student. Much has been written about the importance of mentorship in medicine, but you won’t get it until you’ve experienced it for yourself. The doctors that are willing to invest in you by taking you under their wing, teaching you, supporting you, and opening doors for you are the ones that are going to make the biggest difference in your success. They’ll make you a better doctor, prepare you to impress on electives, and write your best reference letters.
Of course, finding a mentor and developing this time of a relationship is sometimes easier said than done. If there was a physician that spurred your initial interest in emergency medicine, they might be one. Give them credit, ask for their advice, and see how it goes. If that doesn’t work, try to meet up with the doctors that win the med student teaching awards – they love to teach and are likely natural mentors. If even that doesn’t work, just keep hanging around the ED and enjoying yourself. If you’re right for this job, you’re bound to hit it off with someone soon.
When you find a mentor make sure that you set the agenda. Come with questions for them and know what you hope to get out of the relationship.
EM Clerkship Tip 2 – Read blogs
I know you’re busy and have lots of other stuff to read, but this one of if not the best way to know what is happening on the cutting edge of the specialty. Getting this “education on the side” will broaden your perspective, give you fodder for tons of intriguing and educated questions, and help you to get more out of your on-shift learning. Most of the bloggers are some of the best educators in the world so the content they put out is damn good.
The easiest way to follow blogs is to amalgamate them with an RSS reader, a process that Lauren Westafer describes brilliantly here.
Additional tips:
There are so many great blogs it’s hard to recommend only a few, but some of the ones I started with were:
lifeinthefastlane.com – The content on this site is unbelievable. Explore, read, follow. Its weekly reviews will lead you to many other awesome blogs.
alien.com – This is another one of the originals and also has tons of helpful content. Check out her PV cards and get them on your iphone/android/whatever – they’re super slick.
shortcoatsinem.blogspot.com – This one is the most popular ones written by a med student. She teaches me things regularly.
emergencymedicineireland.com – A sweet Irish dude puts out this one. His anatomy videos are something to behold.
EMBasic.org– a bootcamp guide to emergency medicine. Make sure you know the basics.
EM Clerkship Tip 3 – Listen to Podcasts
The same points I made for blogs apply to podcasts. This free education is generally better than the one you’re paying for.
You can follow these by following their blogs in the same way I mentioned in 2, but if you want to just get the podcasts the easiest way to start following them is:
-Get itunes
-Go to the podcast’s website and find the itunes button
-Click on it, click open in itunes and then click to subscribe to their blog
-You can sync these with your iphone/ipad just like music and, if you really want to get crazy, the iphone/ipad can play them at double speed.
Again, there are too many good ones to name. Some of the ones I’d recommend starting with are:
emcrit.org – Scott Weingart is a legend. I have a total mancrush on him. This one may a bit over your head to begin with.
empem.org – Great reviews of the peds stuff
embasic.org – More review than cutting edge, but its great for background
thesgem.com – This one has some in-depth content but seems to be very accessible to students/residents.
EM Clerkship Tip 4 – Learn to present patients
This is a harder task than it first appears. Presenting a solid history and physical in a way that your attending can follow is super important. Getting good at it will help you to appear more competent and confident while making you more fun to work with.
How can you get good at it? Read about how to make a good presentation (Updated links – start with ALiEM’s great post on this located here and here), remember that the emerg presentation is slightly different than what you’d see/here working in other areas, eavesdrop when junior residents are presenting (the senior ones will be much too concise), ask for feedback on your presentations, and practice by running through the most complicated presentations that you’ve seen.
Another great article is “The 3 minute emergency medicine medical student presentation: a variation on a theme“.
EM Clerkship Tip 5 – Join Twitter
There’s a lot of Doctor conversation going on there. It’s emergency medicine’s “digital watercooler” (as per @M_Lin) or your “finger on the fem pulse of EM” (as per @ERMentor). Add them, @sandnsurf, @EMCrit, and us (@boringem). @FOAMstarter is also a great resource for beginners with lots of good suggestions for who to follow and @FOAM_Highlights provides a regular rundown of FOAM that’s on fire. Once you get started you won’t be able to stop!
EM Clerkship Tip 6 – Get the ERRes or PalmEM Apps
They both cost a few bucks, but they are super fast and EM-specific references for things we need to look up very commonly in emerg such as the decision rules (Ottawa foot/ankle/knee, PERC, Wells, CT Head, Canadian C-Spine, NEXUS, PECARN, Strep, etc etc), common medications, ALCS/PALS algorithms and more. The time saved on shift is worth the $3-5!
EM Clerkship Tip 7 – Read the cardinal presentation chapters in Rosen’s
The start of this emergency medicine textbook goes over some common presentations. Either buy it (you’ll need it down the line anyways!) or read it online for free. I believe Canadian med students have access through the CMA Clinical Resources website. It is quite a bit of content, so it might help to match the presentation with your rotation (ie – read abd pain on gen surg, chest pain on cardiology, vertigo on neuro, etc).
EM Clerkship Tip 8 – Read 12-Lead ECG: The Art of Interpretation by Garcia and Holtz
It is important to know ECG’s, find a book and approach that works for you, then go with it. This book has tons of interpreted examples and it will take you from “I vaguely remember something about that” to confidently reading them better than some of the junior IM residents. ECG’s come around frequently in the ED and knowing them well as a med student is impressive.
EM Clerkship Tip 9 – Make a learning goal each shift and let your staff know
It is so unbelievably awesome to have a student come on to shift and let me know what they want to learn about. Something as little as “I’d really like to work on my ECG interpretation skills” gives me something to work with. I will always want to teach you something, but I want it to be something that you are actually interested in. If you tell me what you want to learn about I guarantee that I will go out of my way to teach about it. So give me the opportunity! As a learner myself, I find it hard to force myself to do this, but it will make the teaching you get better and you’ll be that much smarter for your next shift.
Taking this one step further, make learning goals for the elective. Share those with your elective coordinator and they are usually more than happy to help you make them happen. Document how you have, or have not, met those learning goals.
EM Clerkship Tip 10 – Read The Emergency Medicine Clerkship Primer
About a week after publishing this post I found this book being discussed in posts on ALiEM by Michelle Lin and LITFL by Chris Nickson. It sounds like a stellar addition to the “How to Rock EM Clerkship.” While I have not yet had the opportunity to read it myself, it sounds like a spectacular addition. Check out the reviews at LITFL and ALiEM.
There is a lot of room to expand on many of these Ways to Rock EM Clerkship so I will be discussing many of them in this section over the coming months.
For any resident/attending readers, what advice would you give to a med student that wants to rock their clerkship rotation? Any other references that I should add?
Thanks for reading!
Brent Thoma
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