Who wants to ace their next clinical rotation?  There aren’t many healthcare students we know that would answer “no”.  But perhaps you want to separate yourself from the rest of the pack because you are highly interested in one specific specialty.  Perhaps you want to eventually work in the host department, obtain a Standardized Letter of Evaluation (SLOE) from a generalist/specialist, or eventually rank high in the residency Match for the specialty in discussion.  Chances are good at some point in your didactic or clinical year, regardless of healthcare profession, you were faced with similar questions.

Well now you can stop “googling” or flipping through text chapters to find answers from reputable sources.  Truth be told, we at Clinical Rotation know what healthcare students are thinking and questioning because we have been in their shoes before.  And, based on our audience’s feedback, we have realized it would be of great interest and value for clinical students to get deep into the minds of the people that know clinical rotations and clerkships the best – the evaluating preceptors and clinical rotation (clerkship) directors themselves.  As such, we decided to take on a new content series entitled Ace Your Clinical Rotation, with each core and elective specialty as our target.  Our first stop, naturally, is every hospital’s “front door” – the Emergency Department (ED).

In this series Ace Your Clinical Rotation:  Emergency Medicine, we are eliciting the expertise of Dr. Brandon J. Godbout, M.D., who is accordingly “foremost an every-day emergency medicine doc”, as well as an experienced preceptor in a busy urban emergency department located in New York City.  With such a background, I believe it is safe to report that we found a content expert.

We asked Dr. Godbout the simple question:  “How can healthcare students ace their emergency medicine (EM) clinical rotation?”

“The emergency medicine clinical rotation is across the board, one of the more challenging rotations in clinical healthcare education.  The reason being is that the ED is an unpredictably busy environment with patients presenting with highly variable acute and/or chronic symptoms that touch on every specialty in medicine.  This is also the beauty of emergency medicine.  One minute you may be resuscitating a pediatric patient with status epilepticus (pediatric neurology) and the next minute managing a family with a toxic exposure to carbon monoxide (toxicology).  This poses a particular challenge to learners in the ED, especially those early on in their clinical year, where (i) they have not yet had exposure to many of the types of patients they will end up managing in the ED, and (ii) the unregulated speed and acuity of a busy emergency department can at times hinder ideal teaching moments between the student and preceptor.  Knowing some of these challenges is the first step towards acing your EM clinical rotation.

Let’s first address the challenge of what I describe as the “potpourri” of medicine, where any patient with any complaint can arrive at any time to the emergency department.  The best learners I have worked with in the ED have planned well in advance of their EM clinical rotation, regardless of its position in their clinical year, have anticipated this challenge, and prepared by investing in and reading an EM-specific text book.  There are more advanced texts like Tintanalli’s or Rosen’s for those strongly considering a career in emergency medicine, however there are many more basic texts for those unsure.  Broad medical knowledge is necessary in the ED, so prepare in advance!

Another key recommendation is knowing where to find “rapid references”, and actually reference them prior to planning your medical decision making on emergency department patients.  It is completely okay to recognize that “I will never know everything in emergency medicine”, but it is never okay to say real-time that “I cannot find the answer to my clinical question”.  With that said, in our digital-age, there are many online references (like UpToDate and VisualDx), pocket guides (like EMRA’s various pocket books and Tarascon Pocket Pharmacopoeia), and cellphone apps (like MDCalc and Epocrates) designed with the EM clinician in mind to rapidly find answers to true emergencies.  You will most certainly gain preceptor points if you calculate the ABCD2 Score on a patient with TIA symptoms (e.g., everyone’s favorite “resolved dizziness”) in order to fully understand the need for advanced imaging and/or hospital admission prior to presenting the case to your preceptor.  Additionally, if you have time to “PubMed” evidence-based medicine (EBM) and include it in your medical decision making, you will officially earn the medical term “rockstar”.  So know your “rapid references” and actually use them.

Now let’s address the challenge of being a learner in a busy emergency department.  As mentioned, the perfect storm factors of the ED can impede learning opportunities with the preceptor.  It is essential to know how to use your time and believe me your preceptor will notice.  EM clinicians are constantly being pulled in every direction and knowing when to help, follow, observe, discuss, and/or participate is essential to the working partnership between a learner and preceptor.

First and foremost, always and I mean ALWAYS be proactive.  If a resuscitation presents, participate and ask how you can assist.  Frequent is the case that a preceptor is so focused on the resuscitation, that they forget to include their learner.  Make your presence known and never feel like you are in the way.  Resuscitations are the core of emergency medicine and often provide the most rich opportunities to learn and participate – from second IV placement, to chest compressions, to gathering pressure bags and equipment, or simply stepping back and observing the care – just do it.  Remember you can be an essential part of the ED team, should you choose to be.  Get involved and make your interests and presence known.

To the contrary, know what to do with down-time.  If your preceptor has to chart, call a consultant, use the bathroom, know what to do.  Perhaps you can suggest seeing a new patient and start a workup while they catch up.  Alternatively, you can read up on your current patient’s medical conditions, help the nurses, techs, patients, family members, provide updates, contribute to the the overall patient experience or health of the department.  There is always something to do and learn from in the ED and the best learners never sit still, never ‘disappear’, and never appear bored.  Actively seek knowledge.  These are some of the keys to success during your EM clinical rotation.”

To recap our conversation, in order to ace your EM clinical rotation:

  1.  Be aware of the learning challenges that exist in the emergency department and develop ways to overcome them
  2.  Develop your broad medical knowledge and understanding of emergency medicine in advance of your rotation
  3.  Know your “rapid references”, use them, and try to incorporate EBM into your medical decision making
  4.  Be proactive, get involved, and make your interests and presence known (especially in the resus room)
  5.  Make good use of down-time, never appear bored, and actively seek knowledge