Last updated: Nov 5, 2020
For students hoping to go into Emergency Medicine, doing a sub-internship at your home program is a must. For all other students, the EM rotation is a great way for you to hone your clinical skills and practice for the Step 2 CS exam since you will be working with dozens of new patient cases every shift.
At my medical school, 4th-year students on the Emergency Medicine sub-internship work 15 eight-hour shifts over four weeks: 6 am-2 pm, 2 pm-10 pm, and 10 pm-6 am. On each shift, the sub-internship is assigned to work with one of the senior residents. Additionally, every week, students have the opportunity to attend a resident conference and a dedicated lecture led by the clerkship director. However, even with such a full schedule, there are definite steps you can take to succeed in EM.
If nothing else, a concise and pertinent patient presentation is crucial for success in your Emergency Medicine sub-internship. With each patient I saw, the residents and attendings were evaluating me based on my ability to create a broad differential diagnosis, hone in on a potential diagnosis, and, most importantly, rule in/out life-threatening conditions. My core clinical rotations helped me develop my SOAP presentation and physical exam skills. To help me prepare for presentations in the Emergency Department, I found some helpful example videos and read this paper to help organize my presentations.
After giving your oral presentation and discussing the diagnostics and treatment plan with your resident and attending, the most helpful thing that a medical student can do is reassess the patient. Checking the EMR regularly to see if CT or CBC results are back is a good way to keep things moving and is helpful for your team, which may be juggling a dozen patients at one time. Being proactive and visiting your patients ensures that their care is progressing efficiently and appropriately.
To give a simple example, during one of my shifts, I had a patient come into the ER for an acute allergic reaction to cashews. By popping my head in periodically and saying “hello,” I made sure that his urticaria was improving and that vitals were stable (both of which are useful updates for discharge), all the while building a great rapport with him.
Finding board-style questions for Emergency medicine isn’t as straightforward as it may seem, and some specialties may come with their own official exams. At my institution, for example, students on the Emergency Medicine acting internship take a Society of Academic Emergency Medicine (SAEM) Exam at the end of the rotation. And so, it goes without saying—especially for students hoping to go into EM—that doing well on the standardized exams will certainly help you on the rotation and for your Standardized Letter of Evaluation (SLOE). Below are the resources I thought were most helpful:
Clinical grades are an important part of the residency match process and, as medical students, we all have the goal to achieve the best scores we can. My general recommendation is to keep the focus on the patient and not on your evaluations. Once you have the right focus, you will invariably end up doing well. Enjoy your shifts!
Get on-the-go medical info with the AMBOSS Knowledge app. It works online and offline so you'll have access to the answers you need during the EM rotation and every clerkship.
Andrew Luo is a MD/MBA student at Penn State College of Medicine and Columbia Business School. In his free time, he is either working on his golf swing or watching stand-up comedy specials on Netflix. You can find him as @andrewdluo on Twitter.