EM Bound Newsletter | August 2020

**A newsletter for medical students pursuing a career in Emergency Medicine**

August 2020

Congratulations! You’re one month into the new academic year. How did your first rotation go? Were you able to apply the tips we provided last month on how to ace your EM clerkship? We understand that the breadth of EM can be overwhelming, with an abundance of resources at your fingertips making it a challenge to know where to start. Bridge to EM (https://www.aliem.com/bridge-to-em/) is designed to help you through this 8-week guide to provide structured preparation that is free for students. It contains vetted up-to-date information to help you shine on your ED rotation.

TOP NEWS

Mentorship in Medical Education:
Why you shouldn’t do it alone

No doubt the COVID-19 pandemic continues to affect this year’s recruitment cycle. For the 2020-2021 applicants, by now, you’ve heard about the many changes in The Match cycle including restrictions on away rotations, eSLOEs, oSLOEs, virtual interviews, and many more. It’s confusing for us all and residency leaderships across the country are also learning and adapting along with you. It is because of these changes that mentorship really matters.

Mentorship offers a unique perspective on the challenges in today’s application cycle. Specifically, you may be worried about the lack of research in your application. However, the summer that you’re applying may not be the best time to start new research. Your mentor can offer you guidance that truly highlights your strengths. I’m often surprised when a mentee shares a sparse CV only to realize there were so many things not listed simply because they did not think these should be included. Conversely, it’s also not uncommon to see CV’s with so much padding and “fluff” that reviewers are very keen at noticing. With guidance, you can successfully avoid both extremes.

So how do you effectively structure your mentorship?

Have clear goals: Just like any successful meetings, having a clear agenda is helpful. During your first meeting, share with your mentor what you aspire to achieve, your dreams (yes, dreams!), your motivations, and what you need in order to get there. Mentors do not have all the solutions but they can be very creative in connecting you to someone who may help get you to where you want or need to be. Consider a mentor-mentee agreement (example).
Schedule regular meetings: Mentorship is not a one-and-done thing. It is a relationship (https://onlinelibrary.wiley.com/doi/epdf/10.1197/j.aem.2004.06.013) . Given the complexity of the application process, it’s important to break each step down into smaller chunks, which lends itself to several sessions with your mentor.
Develop action items AND set deadlines: Your mentor is busy, just like you. Offering a mutually-acceptable and realistic deadline allows for clarity of expectations and deliverables. By being explicit with the tasks, you can identify and anticipate roadblocks, and even role-play intimidating conversations such as asking for a letter.
Set reminders: Send a calendar invite to yourself and your mentor along with calendar reminders.
Schedule your next meeting: Especially with certain tasks–finishing your personal statement, letters of recommendation, CV, final review of your application, it’s best to put these tasks in your and your mentor’s calendar.
Clarify: Mentors may forget that from your perspective, some things may be so foreign– remember the eSLOE/oSLOE/nEMSLOE?
Ask questions: It’s better to clarify while you’re in the meeting than trying to do a task then realize you don’t really understand what you’re supposed to do.
Show up: Nothing irks mentors more than mentees not holding up to their end of the relationship. We’re all busy. Let us know if something has come up. This is not the time to ghost your mentor. See the mentor-mentee contract above.
Thank you: This is simple, yet often forgotten. Remember, mentors have choices on who their mentees are. They’ve chosen you. A quick acknowledgment of this goes a long way. For me, one of the best thank you’s is a quick update email highlighting what my mentee has been doing. It reminds us that what they do matters.
Goodbye: This can be awkward. Your needs may not be something that your mentor is able to meet, or that you may have outgrown them. Similarly, thank them for what they have thus far offered you. This is a great time to check for compatibility and best suit for a mentor vs. a coach vs. a sponsor. If it’s an assigned mentorship and you are not able to switch, look for shared interests and see if you can further develop a skill or obtain a relevant connection to someone else. Whatever you do, be kind.

The process of getting into your dream EM residency is daunting and overwhelming. You don’t have to go through it alone. Your mentors are there to guide you, recalibrate expectations, celebrate your successes along the way, and be there with you to strategize for when unexpected things happen. The best mentors are the ones who are able to tell you when you are astray. Each of us needs more than luck in our journey–we all need guides who can help direct us to the right path.

SPOTLIGHT

Standing out with Ultrasound: Tips for the Student UltraFUNographer

Benjamin Karfunkle MD
Assistant Professor
McGovern Medical School at UTHealth, Houston TX

As medical students auditioning in EM departments this application cycle, you are facing a different experience than before. You may be limited in what patients you’re allowed to see. You may feel as though you are shadowing instead of contributing to the team. We are all frustrated by the COVID-19 reality. Don’t forget that your attendings and residents want you to gain real knowledge and skills from these months and they want to set you up to succeed despite the challenges.

The same things that made you successful in third year rotations will keep you successful today! Many things can go on the ‘what makes a student successful’ list, but let me guide you in my favorite – point of care ultrasound. Here are some tips to make you a stand out as an ultraFUNographer:

Bring the ultrasound into the room with you during your first encounter: Nothing ensures neglecting a quick, sensitive scan like having to leave the room to get the machine. Abdominal pain, chest pain, dyspnea, and back pain are chief complaints that should get an ultrasound in the room, every time. They won’t always get a scan, but if you have to go out to get the machine, they may not get it at all!
Learn how your department enters patient data into their machines: It may be as simple as putting the patient’s MRN in the Patient ID field, but it may not be. This can allow you to shine in helping your team set up for the exam.
Have the machine set up, cleaned, and ready to go: Doing these initial steps (especially if your resident or attending is following close behind) and the clean-up steps can really help your team out.
Know what pathologies can be quickly screened for using point of care ultrasound (POCUS): If your patient is complaining of upper abdominal pain, have your right upper quadrant images ready to show your attending to rule out biliary pathology. If it’s lower abdominal pain, quickly rule out urinary retention. Even if your images were not great, you’re showing your appropriate thought process. Practice being versed in which POCUS exams can be used for which chief complaint.
Don’t end your exam once you are done scanning: Your resident or attending may want to add a few more images if they weren’t convinced. Don’t take this as a sign that you aren’t trusted. It’s our job to assess the patients too! Ask questions and show engagement in interpreting the results your team gets to help you learn and contribute to the diagnosis.
Once you are done scanning, clean the machine and offer the patient a towel to clean themselves: In COVID-19 times, cleanliness is more important than ever.

For most of you, we know that this is your first month in the department. We don’t expect you to be perfect. We expect you to work hard, to help the team however you can, and to follow through on tasks. Showing us that you can acquire and interpret ultrasound images, or even that you can facilitate us getting these done, will go a long way.

Resources:

SonoDoc: Online POCUS Game
SAEM: Introduction to Bedside Ultrasound

COVID-19 UPDATES

Until a vaccine exists and treatment options become more widely understood and available, our battle with COVID-19 will continue to grow. Currently, the United States is leading in cases, topping over 4 million with over 146K deaths. Summer weather has created hotspots around the country as many travel on vacation to beaches and resorts. As students interested in EM and even rotating in EDs around the US, it is important to be systematic in donning and doffing your PPE. PPE fatigue is a real concern and threatens to compromise the safety of our colleagues, staff, and patients. Check out our archived EM Bound newsletters from April-May for COVID-19 information, as well as links to important websites and videos.

If you leave home, remember the 3 W’s:

Wear a cloth covering your nose and mouth.
Wait 6 feet apart. Avoid close contact.
Wash your hands or use hand sanitizer.

CLERKSHIP LIFE & RESIDENCY APPLICATION SEASON

The Residency Personal Statement:
Creating That One Perfect Page

Benjamin H. Schnapp, MD MEd
Associate Residency Program Director
University of Wisconsin Emergency Medicine Residency, Madison, WI

Although the personal statement is one of the parts of the residency application that will likely take you the most time, studies suggest it is among the least valuable parts of the application for program directors. So why think about it at all? A great personal statement can still separate you from a group of similar applicants. A poor one can also get your application moved to the bottom of the pile. Here are some helpful tips on how to get the most out of your personal statement:

Explain any potential red flags: This is THE most critical way that you can use your personal statement. Failed a class in medical school? Had to take time off? Professionalism issues? Didn’t match in your chosen specialty the first time? Programs have seen it all before. Your personal statement is a chance to provide more details to contextualize these to your potential future program. If you feel like it’s a significant deficit in your application, it’s worth mentioning. For some applicants, this is straightforward (e.g. time off for a family emergency); for others, this may be a more significant challenge (e.g. an arrest during medical school). Use your statement to describe how you’ve grown and changed from any potential setbacks – a resilient, adaptable medical student is likely to roll with the punches during the challenges of residency as well and may be viewed even more favorably than an applicant who has faced fewer obstacles.
Tell a story to your reader: Many personal statements fail by dryly reciting accomplishments or describing to faculty how great emergency medicine is (they already know!). Readers are naturally drawn into a hook-beginning-middle-end structure, so it makes sense to try to create something that weaves a narrative and ties in personal attributes as well as the characteristics of your desired residency. Your story need not describe a momentous occasion; expanding a tiny moment into a meaningful personal story can be one of the most powerful ways to grab your reader.
Be genuine: While it may seem tempting to spin a dramatic tale or an epic tearjerker, the most important characteristic of a personal statement is that it represents you faithfully. This is the only part of your application that isn’t flat lines on a CV; it’s your chance to come alive for residencies, for them to understand what makes you tick and why you’ve chosen your specialty of interest. If it’s a topic that means something to you, it will be much more likely to jump off the page and you’re also likely to get asked about it during interviews. It makes practical sense to pick something close to your heart.
Don’t boast: Every program director has likely had a chuckle over a personal statement where the applicant swings in to save the day from a neglectful resident, or performs a critical procedure that saves the patients’ life in the nick of time. While these are certainly stories, and may even be genuine, medicine is quintessentially a team sport and good patient outcomes are rarely the result of one individual’s actions. When personal statements reflect a maverick sensibility or an unrealistic sense of importance, it may raise questions about your ability to work as a team, your recognition of your role in the care of your patients, and your ability to provide support and ask for help.
Pay attention to detail: Fair or not, lots of typos, misspellings, or misused words will raise unpleasant questions from prospective programs about your attention to detail in the clinical environment too. Utilize all of the resources at your disposal to make sure that obvious mistakes are caught – use multiple proofreaders, spelling and grammar checks, and give it one last look before uploading. Similarly, the personal statement is intended to be one page; writing two and a half suggests an inability to follow straightforward instructions. Most residency personal statements are unlikely to significantly help or hurt you, but these types of mistakes can get your application moved off the ‘invite’ list quickly.
You may not be Bill Shakespeare… and that’s okay: There is no requirement that your personal statement is the next great piece of nonfiction. Program directors understand that many people got into medicine for similar reasons – a personal or family illness, experience with shadowing or scribing, or out of a desire to help people. If this rings true for you, there is no harm to this route; there is always a way to put a personal spin on a familiar theme. Trying to go out on a limb with a wildly innovative statement may hurt you more than help you.

Looking forward to reading lots of great statements (and seeing you virtually) this year!

Acknowledgments: Dr. Kimberly Manning: Here’s a great Twitter thread on Residency Interviews .

If you’d like to see examples of real personal statements that current physicians have used, try the Personal Statement Library!

EXPAND YOUR SOCIAL MEDIA HORIZONS

The academic year is underway with new roles and responsibilities underway. The growing curve can be challenging. Stay on top of the latest using social media! This is a great way to connect and broaden your knowledge while building a virtual community of colleagues and mentors.

Three suggested Twitter accounts to follow today:

Here are some Twitter hashtags that will continue to help you with your journey:

You can engage with us at @ALiEMteam. We’d love to hear how you are doing!

PERSPECTIVES

MEDICAL STUDENT PERSPECTIVES

Diversity, Equity, and Inclusion in Medicine

Diversity, equity, and inclusion (DEI) are crucial in providing better care for our patients, and a culture of safety, acceptance, and opportunity for all around us. We reached out on #MedStudentTwitter to get students’ perspectives on DEI. Check out the responses, and also consider contributing your own voice.

A special thanks to those medical students who shared their perspectives:

Ololade Akinfemiwa, MS4, St. Georges SOM
Daniel Ayorinde, MS 4, Howard University College of Medicine
Elizabeth De Jesus, MS4, Tufts University SOM
Apre Dixon-Gleaves, MS4, Howard University
Cody Hill, MS4, St. Georges SOM
Yeonsoo Sara Lee, MS1, Mayo Clinic SOM

ALiEM HIGHLIGHT REEL

The 3 most popular clinical blog posts in July 2020 were the following:

EM BOUND TEAM

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Editor-in-Chief: Sree Natesan, MD (Duke University) – @sreeja_natesan
Top News Section Editor: Al’ai Alvarez, MD (Stanford University) – @alvarezzzy
SpotLight Section Editor: Moises Gallegos, MD MPH (Stanford University) – @moyinscrubs
Clerkship Section Editor: David Gordon MD (Duke University)
Medical Student Liaison: Bryn Dhir (Johns Hopkins University) – @BDhir
Chief Advisor: Michelle Lin, MD (University of California, San Francisco) – @M_Lin