My first rotation was Emergency Medicine. Although I had previous experience working in an ER as a scribe, I was extremely nervous and wanted a systematic method to assess each case. Below I've included what I found to be my favorite approach to patients in order to determine the level of care they require. I also included some thoughts and tips for making your emergency medicine rotation a success.
Tools for ER rotation:
- I had a small clipboard that fit in my white coat. It was small enough to fit in my pocket, but large enough to fit a whole patient encounter on it.
- Maxwell Quick Medical Reference - this was gifted to me and I mostly used it to cover as many important ROS (review of systems) questions as possible. It is filled with a ton of other helpful information. I highly recommend this resource.
- Tape measure - this was great for measuring wounds or lesions. If you need to measure something but don't have a tape measure, check out the back of a tongue depressor wrapper - it has ruler.
- EMRA's Basics to Emergency Medicine - this was gifted to me after my white coat ceremony and coincidentally recommended to me by my preceptor. This book is formatted by chief complaint and lists differential diagnoses for each complaint with relevant questions, physical exam findings, and expected lab results.
- Vitals - I found it helpful to always check the patient's vital signs before entering the room to meet them. Vital sign assessment is a simple step that can indicate a patient's level of acuity.
- Chief Complaint - It is important to check the patient's chief complaint because it helps drive your differential diagnoses. It also helps prepare you for what you encounter, as long as you have a wide differential and consider atypical presentations of illnesses. While it is important to look at a patient's chief complaint, it is not always accurate or relevant to why they came to the ER. Because of this, a patient's initial chief complaint should always be noted, but never taken as fact.
- Medical History & Medications - If you have access to a patient's EMR, it's nice to see if patient has been filling their medications. Medical history is always important, so if it's not in the chart make sure to ask!
- Previous Tests/Imaging - If you are lucky enough to be at a hospital with access to patients' complete medical records, it will impress your preceptor to note their results in your report (if they are relevant). Ex: For a patient who comes to the ER with chest pain (which is very common), any previous stress test results and their date can help rule in or rule out differential diagnoses.
- I had a small clipboard that fit in my white coat. It was small enough to fit in my pocket, but large enough to fit a whole patient encounter on it.
- Maxwell Quick Medical Reference - this was gifted to me and I mostly used it to cover as many important ROS (review of systems) questions as possible. It is filled with a ton of other helpful information. I highly recommend this resource.
- Tape measure - this was great for measuring wounds or lesions. If you need to measure something but don't have a tape measure, check out the back of a tongue depressor wrapper - it has ruler.
- EMRA's Basics to Emergency Medicine - this was gifted to me after my white coat ceremony and coincidentally recommended to me by my preceptor. This book is formatted by chief complaint and lists differential diagnoses for each complaint with relevant questions, physical exam findings, and expected lab results.
Other tips:
- Auscultate heart and lungs on every patient, even for foot pain.
- Ask your preceptor how they prefer you to present your patients to them. There are many different styles for this and it's best to figure out what they prefer.
- Always ask your patient when their last dose of pain medication was and the dose taken. This is important to determine if someone has a masked fever or intractable pain. This will also affect how much pain medication you can administer.
- Use MD Calc to help justify your clinical reasoning and support your conclusions. They have a website and app.
- Don't be shy or wait for permission to see patients. I would often go see patients if my preceptor was running late - this demonstration of initiative impressed him and he made note of it. Be sure to ask to perform invasive procedures and physical exams instead of waiting for an invitation to participate. If you don't ask to do things, you won't be given the opportunity to practice.
- Sometimes you have to be firm with patients. It is important to stand up for yourself when a patient is behaving inappropriately towards you - whether it's an elderly lady or a young man, you have to establish boundaries.
How to study for EOR
Smarty PANCE:
à This subscription is on the more
affordable side and is very useful for both didactics and rotations. I took a
totally of 5 practice exams. The questions are straightforward and simpler than
the EOR but good practice
o
4 x
50 question exams
o
1 x
184 question exam
Rosh Review:
à Helped tremendously. They have boost exams for each rotation specialty. It was challenging, but the explanations at the end
of each question were worthwhile. So don’t freak out if you score in the 70s
but use it as motivation to study harder. At the end of the practice test it
tells you which areas you need improvement. Use this analysis to your advantage
when you study.
Blueprint of Emergency Medicine EOR on the PAEA website:
à This is a list of conditions organized by body
system and has percentages that show how much of the EOR focuses on each system.
I looked up the conditions in the more prominent systems (7% and up) on Smarty
PANCE and PANCE prep pearls.
ExamMaster, searched "emergency":
à Exam master has questions based on body
system and not rotations. I used the search engine to only include question
that contained the words emergency department or emergency room.
I hope this helps. Good Luck!
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