Advice About Applying to EM Residency Courtesy of UT-Houston’s EM-bound MS4’s EM is getting a reputation of becoming a competitive specialty as more and more people are applying. Statistics show that the ratio of applicants to spots has remained the same for years, however more and more applicants are applying to a greater number of programs leading residencies to screen out applicants based on STEP scores and even geographical regions. This is a list of tips to help you navigate through the application process. All tips have been given to us by previous fourth years going into EM, EM faculty, and our own reading. PLEASE TAKE NOTE - this document has been prepared by a multitude of MS4’s in the hopes of getting a broader scope of thought about this important process. We hope that this document is helpful for you, but make sure to take this advice for what it is.
Thoughts on 3rd year EM elective: ●
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I definitely think it’s worth it. EM has a completely different way of doing things and the three week elective was invaluable for me for learning how to present, do ultrasounds and some basic procedures. Some may say you don't want to do it before completing core content and looking bad, but It's only in the spring so it's not like you're gonna learn much else between then and it will really help a lot Only reason I would say don’t do it is I knew a girl who was like 100% EM and had shadowed a decent amount. She wanted to try something else, so she did anesthesia and ended up liking that more.
Aways and VSAS ●
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Start getting immunization records together early. ○ Go to student health in late December/Early January and tell them you need your titers drawn for VSAS. This will take them a week or so to get back. Some people will not have sufficient titers and will need to get more vaccines and then more titers. ○ Once you have titers drawn ask them to print you off a complete copy of your immunization record. You will be expected to fill out the VSAS and school specific forms and give them back to student health with your copy so they can verify. Each time this will take about a week. Apply EARLY! Most aways are on a first come first serve basis, so apply as soon as the application opens. ○ Some programs (etc. Christiana) fill up quick, requiring you to apply in January or shortly after. Figure out which programs you may want to rotate at and figure out when you have to apply. Apply to around 10 programs.
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This number will be different for everyone. If you want two, I would probably apply at least five, unless you have connections that will help you get in the door. Once you’ve accepted an away, DO NOT cancel if you receive another offer, as it looks bad on you and our program. You are, however, allowed to reject an away before officially accepting but not after. Check a program’s website as some do not participate in VSAS or require extra applications besides VSAS. ○ Some programs may require a faculty rec letter or a personal statement Email the course coordinator to see if there are spots available. ○ Beyond this, I would recommend finding a connection to the program, if you really want to rotate there. Ask the UT EM faculty if they know anybody at your desired program, and maybe they can reach out for you. ○ Also, if there’s one you want to go, specifically, I recommend emailing the program director/clerkship director and explaining to them why you’re interested in their program (etc. location, reputation). This helped alot! Recommend doing at least 1 away, 2 if possible but 1 is more than enough apart from our home UTH rotation. ○ My recommendation is to do 2, if you are able. UT-Houston is a difficult rotation to honor. Doing 2 away rotations gives you more of a chance at honoring one of them. One away will definitely suffice though. ○ Don’t be tied down to doing aways in August and September. August is an extremely competitive month for away rotations and I know a lot of us had issues finding a rotation then. While a rotation in October won’t help all that much in terms of the SLOE, you can use a rotation that month to ‘unlock’ a region of the country. If you want to leave Texas, it is more than recommended that you do an away outside of Texas so programs can see that you are willing to move out. ○ I would push this farther to say that if you’re interested in competitive places like NYC, Chicago, or anywhere in California → do an away there. If possible, do your away rotations at places where you have friends/family to stay with. Renting a place for a month is expensive. Avoid this, if possible. Applications and the trail are expensive enough. Try to do your away before November, recommended between July and October (at the latest) to get your SLOEs in before applications are due. ○ You can apply for multiple months for some programs. Say you are planning your AI here at UTH in July you can apply for an away at a place for August and Sept. ○ You may want to consider doing an away in November or December to get a third or 4th SLOE. It probably won’t make a difference at most places because most interview invites will have gone out by then, but you can at least get an interview at that place (especially if it’s a competitive place that was going to be a reach for you) and it’s another excuse to email places updating them and expressing interest. Its also probably an easier time to get an away at a competitive place.
How to Succeed on Aways: ● Be active and participate while on your aways; NEVER show up late to a shift and stay late if necessary. It’s a tough month but it will serve you well when it comes times for your SLOEs. ○ Depending on the culture of the program, I would recommend emailing a small learning issue after some of your shifts on your rotations. This helps show that you’re interested in active learning. However, don’t go overboard with this. If the culture seems to frown on it, as one of my places did for some reason, I wouldn’t recommend it. Be eager, but be respectful of other students. ○ Get solid with EM-styled presentations. Having concise/sweet presentations with a good differential and plan will help you succeed on your away rotations. (https://www.saem.org/cdem/education/online-education/medical-student-present ations-video) ● Rule: 15 min early is on time, and on time is late!
Application Process ● ● ●
Start as soon as ERAS opens. Apply to a mix of competitive, mid level, and back up programs. Ratio of applicants to spots appears to be staying the same, just the same amount of applicants are applying to more places.
How many programs do I apply to? ● If stellar applicant, I still suggest applying to at least 40 programs; have a good mix, don’t be overzealous and apply to only competitive programs. ● If average applicant, then I suggest applying to at least 50 or more; it used to be less back in the day, but unfortunately more applicants are increasing their application pool so we all have to keep up. ● The rule of thumb is the 30/40/50 application rule, based on your competitiveness. If you’re ultra competitive, you can get away with applying to 30 programs. If average, 35-45 should be enough. If you’re not too competitive, more than 50 is likely recommended. ● Keep in mind that you can apply to 60 programs and still not apply ‘broadly’. You can get to 60 programs by just applying in competitive locations, meaning those programs are likely more competitive or it’s like NYC where they like to keep their own people. Applying broadly needs to be done with the number of applications sent out and the type of program/location of program. Van Meter was helpful on this front. Tell me everything I need to know about SLOE’s: ● You can submit 4 letters total. At least two should be SLOEs, though you may not have both by the time Sept 15th rolls around. A “complete application” is three letters. So if
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you only have one SLOE on Sept 15th you can submit two faculty letters and have a “complete application” the day ERAS opens. Then you can submit your second SLOE when it comes in. According to Dr. Van Meter, most places will pull the trigger on an interview invite with just one SLOE, but I’ve also heard that some places (no idea where or how many) won't look at the application until ERAS tells them the app is complete. So having two faculty letters accompany the one SLOE is a way around that. On the other hand maybe you don’t want to have a complete application until you get your second SLOE in so they know a second SLOE will be coming. In the end, the quality of your SLOE will be a bigger factor than the number of SLOE’s you have. I know it is hard to predict how good your SLOE will be, so I recommend setting yourself up for three SLOE’s, such that you will likely be an EM-master by your third rotation. My recommendation is 3 SLOE’s and 1 LOR by a UT faculty member, if possible.
Random Thoughts: ● I see 4 tiers. At the bottom is just wanting to match anywhere including brand new programs and programs in really undesirable places. Then there are the vast majority of programs which are solid programs (many community) but maybe only known in that region. Then there are the places somewhat more known around the country but still reasonable for most applicants to apply to. At then at the top are the 10-15 really, really competitive places like LAC, Denver, Vanderbilt etc. ○ I think it's important to know what you are going for and get advice tailored to that goal, which can wildly differ based on what your going for (for example doing research, which I actually think may be important for those top places) ● Your personal statement, while important, it will not make or break you. Program directors just want to make sure you are “normal.” ● Most programs won’t start looking at applications till October 1st so don’t freak out if your last SLOE is not uploaded till early October. Rule of thumb though is to have everything uploaded as early as possible. ○ From what I’ve heard most places won't even look at the application until early Oct when the MSPE/Dean’s letter comes out, so don't freak out about not having two SLOEs when Sept 15th rolls around. That said interview invites will start to roll in a few days after Sept 15th from some programs for some people. ○ You can use this link from ACEP to compare information about each program. https://webapps.acep.org/utils/spa/match#/search/map ● Who gets what interviews where doesn’t make a lot of sense. You may get an invite at a place that your classmate gets rejected from and your classmate may get an invite at a place you get rejected from. You may get invites from your reach schools and get rejected from your safety schools. Unfortunately, EM students are applying at more and more places and this means you should too in order to get the number of interviews you want. All other things being equal it’s going to look better that you applied to a school
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Sept 1 rather than halfway through Oct, when it’s obvious you are only applying now because you didn’t get enough interviews. Sending letters of interest. This can definitely help. I got one interview this way. I even met one person on the trail who got rejected from a really good school, sent them a letter of interest anyways because his wife had gotten an interview there, and then he got an interview! It’s hard to say when to send the letters. Most people will advise to send it in October after the first round goes out, but I would say if you really know you want to go somewhere send it in September or even Oct 1 (especially if its in another region of the country). That’s what the couples matching people do and it seems to help. Programs get so many applications they are looking for anyway to stratify people and showing serious interest really helps. That’s why there is such a regional bias – they think people from that area will want to stay. If you know a resident there ask them to put in a good word for you. Look back through our previous match lists and reach out to UT Houston alumni to get thoughts on the program. Updating programs with Step 2, or additional SLOEs can be a good excuse to email them. Also for letter of interest I suggest emailing the PD and cc’ing the program coordinator. For emails only updating the application, maybe just email the program coordinator. Find an ER mentor who can help you decide what programs are a reach for you and which ones can be back ups or good fits. ○ Networking can be a HUGE help in getting you where you want to be. Ask the UT faculty if they happen to know anyone where you would like to go. They can really help you get your foot in the door. I, honestly, believe this was the only way I got an away rotation at what is now my number one program, which helped my get the interview as well.
All things STEP 2: ● When to take CK depends on how well you did on STEP 1 and when you desire to take it. I took it immediately after my family med shelf at the end of third year and was glad that I had taken it then. It was nice to be able to focus on away rotations and not have to worry about STEP. If your STEP 1 score was decent, though, you could likely get away with taking it at some point before December. You really want to have the score back in time for programs to rank you, as I believe most want to see this. However, this mainly just applies to CK, as opposed to CS. ● How to study for CK. I finished one pass of UWorld by the time I had finished third year. Therefore, the month of my family med rotation I nearly completed all of Rx for Step 2, went through all the questions I had gotten wrong on UWorld, and read Step 2 secrets 1.5 times. I found these resources to be helpful and relatively successful in helping me prepare. ● All other things being equal, it’s better to have Step 2 in by the time you submit, or at least by Oct 1. Doing well on your rotations is more important, but having that in really helps. And can even help with a great Step 1 score.
Interviews General Thoughts about Interviews: ● ● ● ●
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Don’t freak out when your peers applying to pediatrics or internal start receiving interviews early since ER won’t start inviting till late September at the earliest. Most interviews are given out in October and November, mainly mid October. The busiest interview months this year were November and December, but January can be a busy month if you want it to be. As people start cancelling interviews another wave tends to happen around early November. ○ Three of my top five programs gave me interview offers in December. Keep this in mind after the initial wave rolls through. If by early November you don’t have enough interviews, around 10, then I would suggest talking with Van Meter or your ER advisor to come up with a back up plan. Aim for 12-15 interviews, although given past numbers the magic number tends to be 12 for an almost 100% match rate. I suggest you do not do more than 15, as interviewing is costly, time consuming, and tiring ○ To further evaluate this info for yourself, I would recommend checking out the “Charting Outcomes” data for the 2016 match. It is a helpful document. If you need to cancel or reschedule an interview, do it at least 2 weeks in advance so programs have enough time to extend more interviews out. ○ DO NOT be a no show! People say to schedule interviews depending on location proximity. I found this was not always possible as interviews come in and fill at different times. Try your best to schedule based on location proximity but be aware that this will not work most of the time; you have to be flexible sometimes flying across the country back and forth. Scheduling will depend on your rotation schedule and when you get invites. Some people will place interviews they aren’t as excited about early to use them for practice. I placed ones I wasn’t excited about at the end hoping I could cancel them if I got better interviews. You will meet some people on the trail who get all their interviews basically done in November and others who are interviewing mostly in December and January. When you schedule the interview won’t affect how they rate you.
Things to do (or not do) on your interview day: ●
Always carry your suit/interview outfit in your carry on. Never check in your suit as there’s always a chance the airline may lose your luggage. You do not want to be scrambling to find a suit in a new city the day before your interview!
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Your interview starts from the time you land till you depart, be nice to people, be polite! Try to attend the pre-interview dinner, as it will give you a sense of the residency and especially the residents. Many of them will be your future colleagues, so it’s important to figure out if you will be happy there working with them. ○ One question I tended to ask residents at the pre-interview dinner was if there was something that the program could improve on. This will give you a sense of the programs openness to change and what the resident might not like about the residency without being to direct about it. ○ To me a red flag was if they answered that nothing needed to be improved on or changed as no residency is perfect. There’s usually something that residents may not like about the program that could be changed for future classes. Do not drink more than 2 beers/glasses of wine. You’d be surprise how often people forget that what goes on at the pre-interview dinners is not a secret. Do not curse and be nice to the residents and fellow applicants. The pre-interview dinner is part of your interview as well. Arrive 10-15 min early for your interview. There’s always logistics as far as finding parking or the building you will be starting your interview at so plan ahead. If you can, check out the city the day before or after if you are staying an extra day. This is the place you will be living at for at least the next three years so it’s important that you like it. ○ I highly recommend renting a car when you can and driving around the town. Look at neighborhoods you might live in. See what traffic is like. What kind of fun things are there to do, what is outdoor recreation like. Spend two nights there if you can afford it. Look at Airbnb in addition to hotels
Below is a list of interview questions to consider: ● Shift length and amount per month? Number of EM months? ● Number of critical care months? Are you senior on critical care months? Are there EM/CC attendings on ICU rotations ● Number and types of off service months? Are the off service months useful or are they scut work? What is the best offservice month and what is the worst? What is ortho and similar months like? (Sometimes they are just ED consult). Is EM considered one of the stronger programs at the hospital? ● How many elective months are what electives are available. International electives? Do you get electives 2nd year or just 3rd year. ● What kind of patients are you seeing? County? Tertiary/Quaternary? Community? What kind of trauma do they get (blunt vs penetrating vs farm equipment) ● What fellowships are there and what kind of fellows do you work with? ● What do the residents feel weakest about when they graduate? ● How is the program administration/Program director? Do residents feel supported? How responsive is admin to suggested changes? Any examples? ● What changes in the program are coming down the pipeline? What changes have been made recently
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Do residents moonlight? Internally or externally? Are shifts stratified by acuity? Is the program a graduated responsibility program or are you thrown in to the mix from day one? Are there any rotations you have to complete before you can run codes/resus patients. ● Do interns present to senior residents or only to attendings? Do you work with one team or present to multiple attendings? ● How are traumas done? Who runs them, who does airways, primary and secondary survey, how are procedures divided up? ● What EMR charting system do they use? Can you dicatate? Scribes? ● How is relationship with nursing? Do they hang out outside of work? How much scut do you have to do yourself? Is there a social worker there at all times? ● How much boarding is there? How often do you get a patient checked out to you that was checked out to the resident before you? How long do patients sit in the ED after getting admitted? ● How much do you have to fight to get someone admitted? ● Do they have someone paging consults for you or do you have to figure it out? What consults are not available? (Some places may not have ENT or Optho so you have to/get to do things yourself?) ● Is pediatric EM shifts separate months, longitudinally integrated into EM months or both? ● Who is faculty in the Ped ED? EM attendings, PEM faculty, Pediatrics faculty. If PEM faculty are the mostly EM->Peds EM fellowship or Peds à Peds EM fellowship? ● How are psych patients handled? Is there a separate Psych ED? ● Do residents think conference is useful? Is conference mostly done by residents or attendings? ● What is expected out of you research wise? What kind of support is there for research? What kind of research are they known for? ● Where do alumni go? What percent do community vs academic vs fellowship? ● What do most residents pay for rent, where do they live and what is traffic like? What kind of jobs are available for significant others? ● How is EM represented in the leadership of the hospital and the medical school? How long has the program been around? ● What kind of teaching is there on shift with regards to medical students, PA/NP students, pharm students? ● What benefits are there? CME money, cafeteria money, health care benefits, what is parking like? ● Resident class size? What happens if someone get sick and has to miss shifts? Do attendings pick up patients on their own to help throughput and keep up skills? Do they run their own pods? And of course – how happy are the residents? Are they your type of people? Do they hang out with each other? Do significant others hang out with the group and each other. Do different classes hang out?
Ways to make the process cheaper: ●
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Sign up for Southwest/Chase credit cards for the 50k southwest points, if you’re able. By signing up for one of these cards (Chase sapphire preferred, Southwest Plus card, Southwest Premier card) and spending a certain amount (~2k) on it within the first few months, you will get 50k southwest points. Paying for step 2 CS is an easy way to rack up money on the card. A round trip flight can cost anywhere from 10k – 40k points, depending on how soon the flight is from when you schedule it. Therefore, if planned well, these points can go a long way. If you are just signing up for one card, I would recommend the Chase Sapphire preferred card because you can redeem your points for either cash or for southwest points, which is nice if you plan to keep it after the interview trail. If you want to sign up for two, keep in mind that when you get 110k points, you are able to get a southwest companion pass for a year, which is pretty sweet. The 50k points per card count toward that. ○ If you rent a car do it through Southwest special deals and when you pick up the car at the desk, give them your SW rapid rewards number to get more point I know this will not work for everyone, but try to plan interviews in such a way that you can avoid a ton of flights. If you’re able to do a string of interviews, it will save you extra flights back to Houston in between. I did a lot on the east coast and had family there. Therefore, I scheduled those for the same time period and used my family’s place as a home-base during that time. It helped a lot.
Post-Interview and Rank List ●
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Sending thank you notes/emails depends program to program. I recommend sending at least a thank you email to all of the programs you interview at and sending handwritten thank you notes to your top 2-3 programs no later than a week after the interview. It is just good manners unless a program tell you NOT to send thank you notes! As far as compiling your rank list, many students have some sort of algorithm or excel sheet that they use…. My biggest advice is to FOLLOW YOUR GUT! You will get great training no matter which residency program you decide to go to as training is standardize. The most important thing is to go to a place where you will be happy! No excel sheet will help you out with that one detail. Email your #1 program telling them so, only if you are 110% sure they are your number one! DO NOT send multiple number one program emails, as EM is a small community. Programs will know if you tell them they’re your number one and you don’t match there when you were in a rank position. ○ Do not feel like you have to send “number 1” email! It does not guarantee a match; it may help you in certain programs, but it will not hurt you.
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Only send “highly ranked” emails if a program contacts you post interview season and they are in your top 5. Otherwise “highly ranked” means nothing to programs. This is our perspective based on EM-based podcasts and such. Feel free to do any extra research on this because opinions on this subject vary. Do not worry if you don’t get any post interview emails or contact, many programs do not contact applicants. DO NOT ask where you are on a program’s rank list and don’t expect programs to tell you. Each party can offer this information, but it is not expected.
Couples Match ● ● ● ●
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Plan to apply to many more places and spend a lot more money on interviews depending on how competitive you both are for your given specialty From personal experience, I would not include NYC or California programs in your count of places because of regional biases If you both love a program or region, you should both do aways there (if applicable) Send emails to program coordinators on behalf of your partner if you receive an interview and he or she does not- this is not guaranteed to do anything at all, but most of my emails were at least met with a “we’ll see what we can do” ○ The same goes for number one emails- my email was met with a positive reply and I was told by multiple places that coordinators will meet and discuss all of the couples matchers Schedule your interviews later on in the season so you can cancel them with plenty of time in case your partner does not receive an interview at that program or nearby Look around at close places that may not be in the same city, but within one or two hours driving distance Specialty specific- ask for advice (peds/EM combo is very different from ortho/EM, etc) ----------------------------------------------------------------------------------
Great Resources for Succeeding During 4th Year Basic Podcast Resources EM Basic - http://embasic.org/ - Probably the most well known podcast for learning the EM basics for med students. Make it through (most of) this once before your first Sub-I shift and it will go a long way. Most are about 20-40 mins or so, faster if you put it on 1.5 speed. Towards the end he gets a little bit out of core content when other are submitting episodes. The website has pdf summaries. EM for Students - http://emclerkship.com/ - Covers the basics. Check out the summary PDFs for one-pagers.
FOAMcast - 20 min episodes with a mix of core content and some newer information. One of the hosts also does/did http://shortcoatsinem.blogspot.com/ EM in 5 - https://emin5.com/ - Not so much a podcast as 5 min youtube approach to type videos. Maybe better for visual learners CDEM Student podcast - https://cdemcurriculum.com/category/student-blog/ - Podcast on topics like applying to EM, ERAS, SLOEs, etc. More Advanced Podcast Resources (I actually wouldn’t use any of these yet but you may hear people saying you should) EM:RAP - https://www.emrap.org/ EMRA’s podcast series. More for resident/attending level. Going back to 2001, each episode is over an hour long, discussing trials and controversies. It’s free with EMRA membership EM Crit - http://emcrit.org/ - Scott Weingart podcast/website - Again probably too advanced but you may hear people discussing it. Website has good reference info though. Other more advanced podcasts/websites you may see out there but probably too advanced. Can be good for answering specific questions http://rebelem.com/, http://thesgem.com/, http://socmob.org/ , http://emupdates.com/ , http://www.emlitofnote.com/ (Author associated with UT Houston), http://www.emdocs.net/ - http://crackcast.org (Some residents in Canada trying to do summaries of Rosen’s chapters) Don’t take my word for it - EMRA’s take on it: https://www.emra.org/resources/Recommended-Blogs-and-Podcasts/ Websites For Use in ED Wiki EM - http://www.wikem.org - Also an app - Go-to place to look when walking back from seeing a patient to help develop your plan. MDCalc - http://www.mdcalc.com/ - Also an app. Great for any clinical decision rule (NEXUS, Wells, HEART, Perc, LRNIC, etc). Its what will come up in google if you search for any decision rule. Also sometimes has some small discussion about how to use each one under info. DDXof - http://ddxof.com/algorithm-browser/ - A website by a resident with algorithms for approach to and ways to think of various CC and DDX. Also has some case reports Uptodate - Obviously EM Medscape - http://emedicine.medscape.com/ - Great website for information about specific diseases. Free access from google but if you want to navigate around in the website you have to make a free account and log in. Academic Life in EM PV cards - https://www.aliem.com/category/clinical/pv-card/ - You can get the ALIEM app and have these cards on your phone For use at home
Rosh Review Question bank- https://www.roshreview.com - UWorld like question bank set specifically for Emergency Med. About 500 or so questions. Easier than UWorld. Can get a month subscription for about 50$ if you are studying for the NBME. CDEM Curriculum - https://cdemcurriculum.com/m4/ - PDFs on the MS4 currriculum put together by the clerkship directors organization. EM Fundamentals - http://emfundamentals.com/ - Probably more intern level. Great starting place when you want to really fully learn a topic with its evidence. Divided by diagnosis, procedure and chief complaint. Mostly a bunch of curated links to trials and discussions for each topic. Life in the Fast Lane - http://lifeinthefastlane.com/ecg-library/basics/ - Especially ECGs but all sorts of good reference info EMRA - https://www.emra.org/students - Emergency Medicine Residents Association Sign up as a student and get access to EM:RAP, get some cool free books in the mail and get newsletters. EMRA board review questions http://www.emresident.org/category/features/board-review-questions/ - Can use to prep for NBME EMRA procedure video links - https://www.emra.org/resources/video-procedure-database/ - A large list of curated videos on how to do procedures. Worth watching the ones you might do as a sub-I including US-guided peripheral IV, Arthrocentesis, Central line, Intubation, paracentesis, catheter, IO, basic splinting, dislocation reduction, digital and other nerve blocks, slit lamp, lateral canthotomy, ABI, lac repair, nail trephination, nasal packing, dix-hallpike. EMRAPs video channel https://www.youtube.com/channel/UCxwzhuYyeejWW1MIwIXi1Iw - Mostly procedures but also discussions about exam findings, tips and tricks. EM Topics email - https://www.emtopics.com/ - Sign up to the email to get a daily pearl delivered to your inbox. Anki EM - http://canadiem.org/the-ankiem-project/ A bunch of Anki EM resources for those Anki-ers Apps Uptodate - Obviously. Wiki EM - Free with registration. Also an website - http://www.wikem.org - Go-to place to look when walking back from seeing a patient to help develop your plan. MD Calc - Free with registration. Also a website. Every clinical decision rule, calculator you could want MedCalcX -$5 - Similar to MD Calc. Different interface. Probably not as good as MD Calc. I think I bought it cause MD Calc wasnt working at the time. ALiEM app – as mentioned above you can download the app and access the PV cards. Great for quick learning issues. PalmEM - 20$ but some people really like the info it has. Ortho Traumapedia app - $10 – pretty good resource for all things ortho
Google Translate - For help with your Spanish patients. Has a talk to text feature which can be useful. Medspanish is also an ok option. 1min US – Free from the guys who do the podcast. Good to have on your phone for one minute video of how to do different Ultrasounds if you get forget. Epocrates - I think there is a free version. Drug dosing. Some basic things that are just different and worth knowing Be able to rattle off the top of your head the differential for chest pain, shortness of breath, syncope/dizziness, back pain, abdominal pain (male and female), and headache. This will also help you as you walk into the room to figure out how you’re going to evaluate the patient. Know the headache cocktail options (Reglan, Compazine, Benadryl, fluids, Zofran, ketorolac etc) Know some more ED specific labs - VBG and lactate, Coags, UPT get ordered a lot and when to order. Know the Nexus and maybe PERC rule by heart and at least what the following scores are used for/that they exist and you can use them: Ottowa knee and ankle, HEART score, Canadian C-Spine, New Orleans Head CT, LRNIC, San Francisco Syncope, Well’s. Know the ultrasound measurements for gallbladder and AAA and where to measure them. Know the basics of how to do a FAST exam and bonus points know how to look for pneumothorax Understand the basics of sepsis resuscitation and the evolution of how we treat it – SIRS/Sepsis bundles, Early goal directed therapy and recent changes, and be familiar with the new qSOFA and SOFA scores. Understanding how we manage potential ACS and PE by risk stratifying can be hard at first. If you can, try to understand how we risk stratify, and how we treat different risk categories will go a long way. Some drug dosages I have been pimped about: Ibuprofen/Tylenol dosing for kids, Albuterol/(Ipatropium) and prednisone for asthma attacks, morphine for pain, Labetalol, Etomidate/Ketamine/Propofol/Roc/Succ for RSI and procedural sedation, Zofran, Insulin for DKA, Reglan/Compazine for headache, Status Epilepticus pathway. Orthopedics isn't something you get taught, but it’s a big part of EM, so good to read up on at least the basics ahead of time. Reasonable resources: ortho traumapedia app (10$) , intro PDF: https://www.medschool.lsuhsc.edu/emergency_medicine/docs/Ortho.ppt, overly inclusive but thorough is https://www.med.unc.edu/ortho/mededuc/medical-students/minitext.pdf Work on your presentation. Best way to get good evals. Tell a story and use your judgment in what you put in and what you leave out. Always try to make it to the plan and give a plan even if you don’t feel comfortable with it. As one resident told me “If you don't make it to the plan, you fail.” This may be an exaggeration but I think it helps to keep in mind. Figure out a system to how you are going to present and follow it. “3 min EM presentation” Actually worth reading http://www.ncbi.nlm.nih.gov/pubmed/18691216 “Presenting in the ER” - SAEM - https://vimeo.com/132865332 - Tongue-in-cheek video based on above PDF
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http://www.emdocs.net/developing-em-mindset/
Books to study Not sure on this, everyone will have different ideas but EM Secrets, Case Files and EM Pretest seem to be the main ones. Can also try blueprints. Rosen’s and Tintinalli’s are the big textbooks but not worth getting these while in med-school, if ever.
