If you are a second or third-year medical student looking to go into emergency medicine, it can be helpful to consider how to get the most out of your off-service rotations before you have your first emergency medicine audition.
Some things to consider:
- What does the specialist want you to know about their specialty?
- What is considered an emergency in their specialty and when is it important to wake them up in the middle of the night for that emergency?
- What skills will be helpful to take away from the rotation?
- What specific knowledge will be useful for you as an EM physician?
In this episode, Andy is joined by Casey McGillicuddy, MD, and Kevin Tomecsek, MD to discuss how to get the most out of non-EM rotations by learning skills and knowledge from each specialty that will help you to become a better EM physician.
Try to learn the major possible obstetric and gynecologic emergencies that can happen (hemorrhage, ovarian torsion, precipitous delivery, etc). It is important to know what history and physical exam findings OB/GYNs are looking for so you can give them the appropriate information when you call a consult. When calling about a pregnant patient you will have to know their gravidity and parity status. When discussing a patient that presents with heavy vaginal bleeding, try to quantify the bleeding. How many pads/tampons is the patient using every hour? Is the patient actually soaking through? Are they passing clots? A specific skill set you should learn from this rotation is doing a good pelvic exam on pregnant and non-pregnant patients.
Here it is important to learn what limitations a family medicine physician has and when they need to send a patient to the ED. Also, know that there may be significant barriers to a patient getting access to primary care and what resources you can provide to the patient to avoid them being lost to follow-up. This is also a great rotation to improve your history and physical exam skills.
Big skills to learn here are again getting a good history and physical, but specifically for a psychiatric patient. How long have they had symptoms? What symptoms do they have? Etc. . This rotation is very pharmacology-heavy. It is important to learn the different toxidromes and how to tell them apart, how to treat these toxidromes, how to treat different psych diagnoses, and what medications work best in the acute setting. Also, understanding this can be hard for the patient and the patient’s family.
Know that kids are not just little adults. They are a specific patient population that presents very differently depending on age and they have disease processes specific to their age groups. Get good at performing the necessary physical exam maneuvers for each patient age group. You should learn how to identify a “sick vs not sick child” and when to do a more extensive workup.
This specialty is pretty all-encompassing and easy to get bogged down in a lot of the little details of a patient’s course. One of the best things you can do is focus on your patient’s disease process and learn all about it. Learn the pathophysiology. How do we diagnose, prevent, and treat the disease? Also, learn when the patient requires admission versus when they can be managed outpatient. Pay attention to what generally happens for a patient during an admission and how long they usually stay.
Stay tuned for Part 2 of this episode coming soon!
Post by Shannon Caliri, DO PGY2
Casey McGillicuddy, MD
PGY-3, AdventHealth East Orlando EM Residency
Kevin Tomecsek, MD
Clerkship Director, AdventHealth East Orlando EM Residency
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