Thursday, June 30, 2016

Top 10 Ways to Ace the Interview

Image Credit: Flickr
Author: Melanie Pollack, OMSIV
Vice President, AAEM/RSA Medical Student Council '15-'16

Congratulations, emergency medicine students! You've selected your away rotations, succeeded at them, and now you're interviewing! Here are 10 ways to shine during interview season. Good luck!

1. Scheduling

Prime interview time will be November through January, so try to plan your rotations so you will have available slots. An important matter to keep in mind is geography. Try to make your life easier by lumping regions around the same time so you can save some money. Another important tip is to not schedule your top program first. Get a few under your belt so you are comfortable when you arrive at a desired program. If you have to cancel an interview, make sure there is a reasonable amount of time so the program can fill the spot. The biggest no-no would be to no show. Emergency medicine is a small world and people talk. Do not cancel the night before or no show. Just don’t do it.

2. To be Early is to be On Time. To be On Time is to be Late. To be Late is Unacceptable.
First things first, be on time. Plain and simple. Plan ahead, map out the path to take and notice possible delays. If you are late, make sure to call the programs contact and explain what happened.

3. Dress Appropriately
Especially as emergency medicine professionals, dressing in a suit and tie can be hard. You are interviewing for a job and must dress accordingly. Men, a suit and tie is easy and appropriate. For women, a nice pant or skirt suit is acceptable. For both, keep it simple with black or blue suits and a nice white or neutral colored shirt. Do not wear extravagant jewelry. Try to avoid strong perfume or cologne.

Sunday, June 26, 2016

International Patient Transports

Recent flight By Dr. Chali Mulenga to Surabaya, Indonesia.
“The kindness of the locals was a true highlight.
I am already keeping in touch with some of the people I met.
Such wonderful people.”
Author: Amy Ho, MD
University of Chicago
Originally Published: Modern Resident April/May 2016

International transports and repatriation is a part of flight medicine and emergency medicine that the University of Chicago Emergency Medicine residency has taken special focus on. Its residents have dedicated time for these experiences, working as flight doctors for international repatriation of patients who fall ill and require stabilization in a foreign country but then desire to seek the remainder of their care in their home country. Here we interview the Chief Residents of the program responsible for running these opportunities, Drs. Chali Mulenga (CM) and Kelvin Adjei-Twum (KA), on their insight into these programs.

What are some of the international medical organizations you work with?
KA: One of the organizations we work with is Fox Flight, based in Toronto, Canada. It is an air ambulance company focused on critically ill international patient transfers. Teams include ACLS trained physicians (such as ourselves), nurses, respiratory therapists (RT) and paramedics. Critically ill patients are transferred on Learjets that are configured into mini-ICUs. More stable patients have medical escorts through commercial flights. These escorts carry with them medications and equipment to assist with active patient needs and management.

Thursday, June 23, 2016

7 Tips for Succeeding on Your Emergency Medicine Away Rotations

Source: Flickr
Author: Dan Holt, MS4
Midwest Regional Representative 2014-2015
AAEM/RSA Medical Student Council 

Away rotations provide great learning experiences and opportunities for growth as a medical student. Performing well on these rotations is extremely important for those of us looking to match into an emergency medicine residency. Below are seven tips for success from top medical students around the country who have already completed their rotations. There is no secret formula to guarantee honors in any rotation, however this is great place to start.

1. Introduce Yourself
As medical students, we are dependent on the skills, knowledge and expertise of all of the staff members in the emergency department. This includes nurses, techs, and the custodial staff. People will be more willing to help you out if they know you from the start, so the earlier in your shift that you get your name out there the better. Let others know you are a medical student and that you are willing to help with anything (and I mean anything).

2. Determine Expectations

Every attending and senior resident has different expectations for each medical student. They will expect different presenting styles, involvement in procedures, and responsibilities in note writing, etc. It’s best to figure out what your team wants from you as early in the shift as possible.

3. Communicate

Whether it’s specifically written or implied, a huge part of the evaluation process is communication. Attendings and residents are busy people. They may not always have the time or remember to keep you informed about changes in patient care plans. Make sure that you are checking in regularly and relay any new information to the rest of the team (nurses, techs, etc.) and most importantly to your patients. Communication is also a two-way street. If anything changes with your patients, make sure that you let your residents and attendings know in a timely manner. This lets them know that you are on top of things and that you are striving to be an integral part of the patient care team.

Sunday, June 19, 2016

Notes from the Night Shift: Single Parents as Patients

Source: Flickr
Author: Heather Boynton, MD
UC San Diego Health System
Originally Published: Modern Resident February/March 2016

With pediatric cases, we often say that we have two patients: the child and the parent. How does our approach change when the parent is the patient, and the kids are in the room too?

On a recent string of overnight shifts, I noticed I was seeing a lot of single parents who told me they decided to come to the ED at night so that their children would sleep through most of the visit. My first patient was a young, single, working mother with two small children. In tears she told me how she had been having rectal bleeding for over a week. During the day she worked at a new job, and was afraid to take time off to go to a clinic; at night she had no one to watch her kids, and money was tight, making a babysitter feel like a sacrifice. Her toddler had been outfitted with headphones and was deeply engrossed in a cartoon; the older child, a girl maybe five or six years old, looked at her shoes. My sexual history taking, usually easy with frank, plain language, halted and stumbled. I put off a bimanual exam. When I returned with a pelvic cart and someone to watch the kids, they were asleep in the bed I wanted to use for my patient, and she was in a chair.

Another patient, also a single mother, was roomed with her two young children around 11:00pm while her two older children waited in the waiting room. She, too, had been having symptoms for about a week, complaining of a bad headache with nausea. I sent labs and started fluids. I decided to order Compazine without Benadryl, concerned that the combination would be too sedating. When I checked on my patient twenty minutes later, she was standing on her bed, screaming and pulling her clothes off. Now all four children were in the room, and the youngest two were crying. Fortunately, more fluids and a small dose of benztropine resolved things.

A few pearls:
  • Make sure your patient is in the right room. A room with a door helps keep young children calm in an otherwise chaotic environment. A small family camped out for the night can wreak havoc on department flow, so think early about your plan for discharge or admission.

  • Identify up-front what parts of your assessment would be best completed without children. Ask your ancillary staff for help when you need a sexual history, pelvic or rectal exams. Twenty minutes may be hard to come by, but five minutes is usually doable.

  • Use the equipment available to you. Paper, pens, warm blankets and small containers of milk from the patient food refrigerators go a long way to smooth over a late-night visit. If your ED has reclining chairs, try to get one into your patient’s room. Encourage the patient to tuck a child into a soft chair or cot instead of the patient bed.

Sunday, June 12, 2016

The Proper Start to Your Financial Journey

Photo: Flickr
Author: James M. Dahle, MD
Author of The White Coat Investor: A Doctor’s Guide to Personal Finance and Investing
Originally Published: Modern Resident August/September 2015

I’m occasionally asked to give very young physicians, i.e., students and residents, some financial advice. Typically these doctors have a low income, a dramatically negative net worth, little financial education and plenty of naiveté. In fact, I was recently questioned by a student how anyone could possibly spend more than $10,000 per month (to which I replied that I spent more than that on taxes alone.) The truth is that many of these physicians will find themselves spending more than $10,000 a month long before their net worth even reaches zero.

Sunday, June 5, 2016

Relevance of New CDC Opiate Guidelines for Emergency Physicians

Author: Samuel Bergin, MSIV, Uniformed Services University of the Health Sciences
Chad Roberts, MSII and Scott Pew, MPH Candidate
University of Utah
Originally Published: Modern Resident April/May 2016

While the CDC was compiling data from 1999 to 2014, more than 165,000 people in the US died from overdoses linked to prescription opioids.[1] The opioids most commonly prescribed include methadone, oxycodone and hydrocodone. From 2004 to 2010, ED visits due to abuse of prescription drugs increased 115% while visits due to illicit drugs increased 18%.[2] Currently up to 1,000 people per day are treated in emergency departments for misusing prescription opioids. While emergency physicians are responsible for less than 5% of immediate and extended-release opiate prescriptions, they prescribe opiates for 17% of ED discharges.[4] Reasons for ED opioid prescriptions most commonly include back pain, abdominal pain and fractures/sprains.[4] We are in a position to help play a pivotal role in prescriptions, addictions and treating overdoses.[3]

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