10 Tips For Med Students Going Into EM

1.  Join AAEM, EMRA, and ACEP. Free or very inexpensive for medical students.

2.  Go to the annual meetings. AAEM is this Feb, 2013 and in Las Vegas. ACEP is this Oct. 2013 and in Seattle. Attend the medical student components of both conferences.

3.  Get honors in your emergency medicine clerkship.

4.  If you are committed to one program, do an away rotation there.

5.  Check out www.freeemergencytalks.net and listen to these 3 lectures to start:

http://freeemergencytalks.net/2012/10/joe-lex-an-old-fogey-speaks-45-years-on-the-front-lines/

http://freeemergencytalks.net/2010/03/amal-mattu-finding-your-niche-in-em/

http://freeemergencytalks.net/2010/04/peter-rosen-beginnings-of-emergency-medicine/

6.  Go to ACEP's leadership & advocacy conference in May 2013. http://www.acep.org/LACHome.aspx?MeetingId=LAC

7.  Score well on Step 1.

8.  Get a strong letter of reference from at least one emergency physician.

9.  Identify a niche in EM (Ultrasound, EMS, Pediatrics, Hyperbaric, EKGs, Social Media)

10. Seek balance in career, life, health, family, and fun.

What tips do you have?

Emergency Haikus

What's causing the pain?
Myocardial infarct.
Transfer to cath lab.

Trouble with sleeping?
Worries and anxiety.
ER is open.

Can't move your right side?
And your speech doesn't make sense?
Head CT and then....

The spider bit you
Redness, swelling, and fever.
Here's doxcycline.

Vaginal bleeding.
What is causing this problem?
Not your period.

International Ultrasound Resources

INTERNATIONAL ULTRASOUND RESOURCES
By Dr. Sachita Shah

BOOKS : Obviously there are many within our specialty, but these are
some ultrasound books outside of EM that have pertinent info for
practice in low resource settings and/or are written for generalist
health care providers

1) Cristoph Dietrich, MD, and colleagues have published a freely
downloadable, online full color textbook, including special chapters
on US in HIV and tropical diseases. It is an in depth resource that is
made more for experienced clinician-sonographers, and written in high
level /technical english. Great work and so inspiring that it is free!
Please check it out at this link: http://www.efsumb.org/ecb/ecb-01.asp

2) Ultrasound: A Practical Approach by William Marks.  http://www.amazon.com/Ultrasound-Practical-Approach-William-Marks/d...

3) Training in Diagnostic Ultrasound Essentials, Principles and
Standards, WHO Study Group report.  http://apps.who.int/bookorders/anglais/detart1.jsp?codlan=1&cod...

4) Manual of Diagnostic Ultrasound in Infectious Tropical Disease
(covers abdomen only, available by amazon too)  http://www.wfumb.org/publications/books.aspx

5) Partners In Health Manual of Ultrasound for Resource Limited
Settings (free, electronic book in pdf, simple english, point-of-care
approach to abd/ob/dvt/skin/procedures etc)  www.pih.org/publications/c/manual


COURSES:
1)  Short Course on Abdominal Ultrasound in Tropical Disease  
http://www.tropicalultrasound.org/
This course  (YEARLY, April, Italy)is designed for clinicians who wish
to acquire basic skills in ultrasound of the abdomen and a general
overview of Ultrasound in Tropical Medicine. Imaging specialists who
want to acquire knowledge in the field of Infectious Diseases and
Tropical Medicine can benefit from this course as well. It is also
designed for MDs who plan to work in tropical/resource poor areas or
who are already experienced in field work but need to refine their
skills in this diagnostic tool.

2) Clinical Ultrasound in Tropical Infectious Diseases  
http://www.georgiahealth.edu/ems/COM/InternationalMed/Peru.html
Join the faculty of the Instituto de Medicina Tropical, Alexander von
Humboldt, Cayetano Heredia, Lima, Peru; the Center of Operational
Medicine, Section of Clinical Ultrasound, Georgia Health Sciences
University; and the University of Pavia, Division of Infectious and
Tropical Diseases, IRCCS S. Matteo Hospital Foundation as they co-host
the first Clinical Ultrasound in Tropical Infectious Diseases course
in Lima, Peru, October 21-26, 2012. Providers with experience and/or a
special interest in clinical tropical medicine or infectious disease
with ultrasound experience are invited to attend. This unique course
consists of lectures, demonstrations, and small-group clinical rounds
for live ultrasound scanning.
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Dr. Sachita Shah is Assistant Professor at UW Division of Emergency Medicine in Seattle.  She completed her US fellowship at Alameda County Medical Center-Highland Hospital.  She is the first author of "The Partners in Health Manual of Ultrasound for Resources Limited Resources." (See the link in number 5 above)

Meditation for Physicians

When stepping into a new patient's room, I must clear my mind completely.  To make a diagnosis, it's crucial to listen with 100% attention.  If I think about the patient I saw before, or what lab result I need to look up, my focus becomes divided.  One way to be more aware of the present moment is through meditation practice.

During medical school, Jon Kabat-Zinn lectured at the U. of Rochester and led us through various awareness exercises.  One exercise was to eat a raisin very s - l - o - w - l - y, savoring the taste and texture.  I still remember how potent the single raisin tasted.

Now, I've re-discovered him on the EM Tutorials Podcast  (By Drs Chris Cresswell, Qasim Alam and Andrew Dean-Ballarat, Australia and New Zealand)
http://itunes.apple.com/nz/podcast/emergency-medicine-tutorials/id441003312

I highly recommend you download # 7 Breath Meditation and give it a try for a week.  It's also FREE.

Axioms for Community Medicine

I've been a community MD for a few months and I recently came across Dr. Rob Orman's ERCast.  This is a great podcast that's supremely relevant for community ED docs. One of his recent podcasts had a discussion on academics vs. community medicine (including Drs. Scott Weingart and Rob Rogers). Dr. Orman ends the podcast with these powerful axioms:

1.  When first starting out (6-12 months) think of it as doing an EM fellowship in community medicine.

2.  Give service to the group.  Devote a chunk of time to group practice by adding value, i.e. develop U/S, clinical pathways for PE, A.fib.

3.  Remember, proximity to a CT scanner (or MRI) is not a reason to order the test.

4.  You can only see ONE patient at a time.  The patient in front of you is the only patient you have.  If you focus on the waiting room, the last patient, you might end up spinning your wheels.

5.  Be nice to the nurses.  They can help and teach you or really HURT you.

6.  Take an advanced airway course early on.  This will reap huge dividends throughout your career.

7.  You are always a student FIRST.  Keep on learning and staying current, in addition to LLSA/CME.  Be the best emergency physician you can be.

8.  Be gracious with your consultants and be congenial.  These are people you will be working with for a LONG time. “Seek first to understand, then be understood.” ~ Stephen Covey

9.  Go to the monthly meeting.  Although you may think they are optional, they are not.

10.  The silent chief complaint is anxiety. In addition to the chief complaint, alleviate the anxiety of their symptoms.

11.  Always advocate for the patient.  When in a bind, ask yourself, “Self, what's best for my patient?”

Listen to ERcast by subscribing on iTunes!

Emergency Medicine from THE ULTIMATE GUIDE TO CHOOSING A MEDICAL SPECIALTY

On Emergency Medicine from THE ULTIMATE GUIDE TO CHOOSING A MEDICAL SPECIALTY, by B. Freeman, 2003. 

What makes a good emergency physician (EP)?

-Likes working with hands
-Adventurous, action-oriented leader, and team player
-Can make logical decisions during rapidly changing situations
-Likes the variety and unexpected
-Is capable of juggling multiple tasks at once
-Comfortable with broad knowledge base


2.8% of ALL physicans are EPs
70% are in private practice, 25% are in academics
EP's work an average of 38.7 hours per week
75% report that their salary is equal or higher than expected

2002 Match Statistics
-1,564 applicants for 1211 positions
-992 US seniors and 600 IMGs ranked at least on EM program
- 98% of all positions were filled in the Match

90 residency programs are a THREE-year program, 14 are a FOUR-year program, and 20 require three years of EM residency after a separate internship year.

EM residents also complete rotations in medicine, critical care, anesthesia, cardiology, and OB/GYN.    The bulk of their training consist of monthly rotations in adult and pediatric emergency medicine, trauma, surgery, toxicology, emergency medical services, and ultrasound. Many programs require research:)

Check out SAEM's website for detailed information about residency programs HERE.