What it’s like
Emergency medicine is it’s own beast. It’s very different from all the other rotations I had. Having 12-hour shifts, working overnight, seeing patients who had no health insurance, seeing patients who are baker acted, and literally saving patients lives makes emergency medicine a unique specialty. It’s different getting used to this schedule, but once you adjust, you will actually enjoy it, at least for me. I quickly realized during the days I worked, there was no energy or brain power left to study. Instead, I tried to recover, and I used my days off to study for my EOR exam, which I will talk about at the end. My schedule varied over time, but I mostly worked 3-4 days and had 3-4 days off, which was kind of sweet. I only worked two shifts overnight, but that can vary depending on where you are doing your rotation.
The True reality
Here are some things I will like to share about emergency medicine that most people don’t really talk about.
1. It has become a form of family medicine for those who are underserved and have no primary care provider. Unfortunately, a lot of homeless people use the ER for this so be prepared and in the look out.
2. CT scans are given like candy in the ER. Emergency medicine is so focused on diagnosing an emergency “things that can kill you” that sometimes, other essential components of patient care are not practiced here. Instead of focusing on a good physical exam and history, you will quickly see how CT scans, labs, and other tests are the main way of diagnosing here.
3. Shortage of Psychiatric institutions is a thing and some ERs have become the place to take unstable individuals until a spot opens. You will get a lot of experience with psychiatry conditions believe it or not.
4. Opioid epidemic and overdoses in the US are a pandemic. You will see this more than you want to here.
Go look for it
My best advice for you to be successful in this rotation is to be very nice and friendly to all of the staff. Be willing to jump in to help and also be out of the way when needed. Seek out opportunities for you to learn, so much can happen in one Emergency Room. You can be as busy as you want or as bored as you want. Follow a nurse to get experience with IVS, ask physicians and others if you can help intubate, if a patient is coding, ask if you can practice CPR. Most providers will quickly realize you are highly motivated, and they will call you when some cool cases come up. Suture the face laceration, insert the IV, perform chest compressions, splint an arm, give the Toradol injection, you name it. The emergency room is the place to learn as much as possible, but it’s up to you to go out there and find it.
Mistakes happen, ask for help!
What I never expected to happen to me during rotations, happened to me during this rotation. I had an incident, the incident we were always warned about as students. I pricked myself with a needle while suturing a patient. It was the scariest moment of my entire medical career. I thought I was going to get HIV, Hepatitis C, you name it. Luckily the patient was hospitalized and they were able to test the patient and everything came back negative. I’m not sure how this occurred, but I think the independence I was given as student had a lot to do with it. Make sure you ask questions, if you don’t know how to do something, let them show you first and don’t be afraid to ask for help.
You are on your own
To be honest, this was the first time I felt so independent during my rotations. I really enjoyed seeing patients on my own, presenting them to my preceptor and coming up with a differential and explaining what tests and labs I wanted to order and why. I loved the independence I had during this rotation and this helped me tremendously over the four weeks. Don’t be afraid to ask for help if needed and if you forget something or do not know it, don’t be scared to speak up, you are a student after all.
Studying for the EOR
This exam is a beast. Emergency medicine has so many topics to review. I remember looking at the NCCPA topic list and thinking “OMG 5 pages, how will I ever review all of this?” It was also a four-week rotation compared to my other rotations which were six weeks. It was very intense, and I remember getting close to test date and feeling so stressed about it. This was Probably the EOR I was stressed out the most.
I will give you some advice on how to study for it. I studied all of the topics one by one using the PANCE Pearls book. I also focused on the larger sections like cardiology and pulmonology and things I had no covered or seen in the ER. I also did a lot of ROSH cardiology questions which included all of the arrhythmias to practice EKGS. More than that, focus on emergency topics and big picture things. For example, if a patient has right lower quadrant pain, what could it be and what’s the best test to perform. I think knowing the labs and tests are key for this exam as well. This may not be the exam you kill because to be honest it’s a pretty complex one and they can throw anything in it, but you will get through it if you start studying since day one.
POST EXAM CELEBRATION: DESTIN FL
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