EM-Bound Medical Students: EM Clerkship and Away Elective

W. Gannon Sungar, DO
Denver Health

Michael Gottlieb, MD, RDMS
Rush University

Originally published in May 2023 EM Bound newsletter

The opportunity to complete at least one away rotation is exciting for both students and educators. While exciting, these away rotations can also be stressful for students who find themselves in a new environment with a short duration of time to make a positive impression. In fact, multiple studies have shown that performance on an EM rotation is one of the most important factors considered by EM program directors in resident selection. Given the importance of performing your best on these rotations, how do you succeed? Or just as important, how do you NOT fail?

Below we provide a list of Dos and Don’ts for ensuring your success on your EM rotations. These words of advice have been compiled over years of experience working with rotating medical students, feedback from the ALIEM Chief Resident Incubator, and surveys from senior residents and faculty. While some of these tips may seem simple or even obvious, every year across the country students still fall victim to the pitfalls and fail to capitalize on the opportunity to truly differentiate themselves. Heed this advice to maximize your rotation.

Dos

• Do Perfect Your Presentations. You can be certain that you will be presenting every patient you see to someone who will likely be evaluating you. Studies have shown that the majority of a supervisor’s impression of a student is linked to how well that student gives a medical presentation. Stick to the script and present it in an organized and consistent manner. Highlight pertinent positives and negatives to craft your differential diagnosis during your presentation. Know all the necessary details, but process the information and only present what you feel is relevant. Take some time prior to your rotation to practice your presentation skills.
• Do Commit. In addition to providing a thoughtful and organized presentation, push yourself to commit to a plan for each patient. Again, you are not expected to always be right, but an assessment and plan, even a bad one, helps your supervisor to understand your thought process and identify potential learning opportunities. Avoid trying to guess what your attending or senior residents might be thinking, and instead, consider asking yourself “What would I do for this patient if I were all by myself?” Not only will you impress them with your willingness to commit to a plan, but your learning will also be accelerated.
• Do Take Initiative. Being proactive on your rotation not only demonstrates situational awareness, which is a critical skill in emergency medicine, but often puts you in a position to be more involved in activities within the emergency department. Spend some extra time in the department early in your rotation to familiarize yourself with common supplies and gain an understanding of the flow in the department. Gather the equipment you need for a procedure on your own, and look for ways to make yourself useful without being pushy. Demonstrating your ability to identify and meet the needs of the department further exemplifies your ability to be a team player.
• Do Have A Goal. Prior to your rotation, consider your strengths, weaknesses, and opportunities for growth. Asking for help or direction in a certain area of your practice is not an admission of incompetence, but quite the opposite, as it shows insight into your own education and a commitment to lifelong learning. Define a goal for each shift and for the rotation as a whole to direct your learning efforts and guide supervisors on areas to focus on. This will result in stronger and more specific evaluations as well as maximize your benefit from the rotation.

Don’ts

• Don’t Be Late. Arriving late to a shift demonstrates a lack of respect for your patients who are waiting to be seen and for your colleagues who are waiting to go home. In short, it is unacceptable. Don’t let the thousands of hours of work you have put into your medical education suffer because you show up ten minutes late to a shift. Consider doing a trial run of your commute prior to starting your shifts to ensure there will be no missteps and consider arriving to shifts a little early to allow an ample time cushion prior to your shift time.
• Don’t Lie. Reading this, you may say to yourself, “I would never lie”, but the temptation may present itself – and given the stakes of these rotations, it may be stronger than ever before. Don’t do it. Whatever element of the history or exam that you fabricate will be immediately revealed when your supervisor evaluates the patient themselves. More importantly, even a simple lie calls into question your trustworthiness and integrity and invalidates all of the other work that you are doing. As a rotating medical student, we don’t expect you to know everything, but we do expect you to be honest and to have a growth mindset, which requires a willingness to acknowledge and reveal your deficiencies so that you may improve.
• Don’t Be a Jerk. Again, this seems like simple advice, but recognize that you have the potential to be evaluated by everyone with whom you come in contact during your rotation. As such, don’t put your best foot forward for your attending to only then be disrespectful to the clerkship coordinator. Be prompt and professional in all of your interactions and communications. Be collaborative in how you interact with other students. Remember, EM is a team sport and it is critical to your success to be able to interact collegially with a broad group of people.
• Don’t Forget Why You Are There. While it is easy to think that the goal of your EM sub-internship is to impress faculty members to cement your place on a program’s rank list, remember that first and foremost you are there to take excellent care of your patients and to learn. Too often students waste their time on shift trying to make ultimately meaningless connections with faculty members or residents. If you really want to impress, devote yourself to spending that extra time with your patients, following up on results, communicating the plan, and ensuring their comfort – this will not go unnoticed and is the heart of why we all went into this field.

Lastly, remember that an “audition” rotation is just as much a program auditioning for you as the other way around. Reflect on your experience and think about what kind of learning environment you need to thrive. Your sub-internships are an amazing opportunity to see how emergency medicine is practiced at different institutions. Embrace every learning opportunity and it will build a strong foundation for your residency training.

The above is based on an ALIEM Article entitled 8 Tips on How to Succeed in Your EM Sub-Internship. Also check out this great infographic from #EMOttowa and their 12 Tips for Success.