The Open Door

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Author: Lauren Lamparter – Medical Student Council President

Originally published: Common Sense
September/October 2020

One of the reasons I am drawn to and pursuing a career in emergency medicine is its open-door policy — all are welcome, regardless of their ability to pay, the color of their skin, their legal status, or their sexual orientation. The emergency department (ED) is open 24-hours a day, seven days a week, 365 days a year to serve those in need, no matter their ailment or chief complaint. It is a place where there should be no discrimination based on race, religion, insurance status, or gender. All are welcome and will be taken care of with the priority of receiving the best care we can possibly give. I aspire to be an emergency medicine physician so I too can be a champion of health for all; someone who can set aside my implicit biases and provide for a fellow human who is in need of help. 

A Medical Student/Paramedic's Perspective on COVID-19

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Author: Matthew Carvey

Originally published: Common Sense

July/August 2020

Medic-1 is responding to an assault in a rural location. Dispatch notifies EMS that the patient has a fever and was put on mandatory self-isolation for 14 days. On arrival, EMS dons a sterile cap, goggles, an N95 mask, face shield, gown, and gloves. The patient, belligerent and intoxicated on alcohol and psilocybin, yells at EMS ‘I have the COVID!’. She rushes EMS, removes the practitioners mask, and coughs in his face. Police arrest the woman under the Mental Health Act, and EMS transports, only for her to spit and verbally abuse them the entire length of transport. EMS unloads the patient and awaits triage. After handing over care, EMS doffs all used PPE, and don’s new equipment to thoroughly clean the ambulance. One of the practitioner’s displays signs of COVID-19 three days later. This article is a medical student/paramedic’s perspective on COVID-19.

Medical Student Experiences with Ethical and Legal Cases

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Author: David Fine, Medical Student Council President

Originally published: Common Sense
May/June 2020

The purpose of medical education is to train future providers to be prepared for the multitude of patients, presentations, and complications that they might face in their future careers. Ethical and legal dilemmas are incredibly complicated and vary based on where you practice, so they are often less discussed than our essential medical fundamentals. Being somewhat familiar with common problems, however, is relevant not only to your future career but your rotations as well. I aim to share a few of the complex situations that I faced, which may apply to your rotations in the emergency department or on the floors.

Dilemma 1: A patient who was frustrated with long wait times starts the patient interview by stating that they are recording the conversation. 

Nine Steps to The Best Medical Notebook You'll Ever Use

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This post was peer reviewed.
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Author: Philip A Castrovinci MD
Undersea Medical Officer
US Navy

While a medical student, I remember a fourth-year emergency medicine resident with a notebook of his own creation. We did not see a single patient over a dozen shifts that he didn't pull out the notebook to extract some high-yield crucial information about the variety of conditions we came across. It was like a clown car of medical knowledge. He let me look at it. It was glorious. What I found was, and subsequently copied, was the best medical notebook I have ever seen. I forget what I learned during those dozen shifts, but the organization of the medical notebook will stay with me for the rest of my career.

Own Your Worth

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Author: Adriana Coleska, MD
AAEM/RSA Board of Directors

Originally published: Common Sense

March/April 2020

As emergency medicine (EM) physicians, we use humor as a way to cope with a difficult diagnosis, patient loss, or an uncomfortable consultant interaction. While those who have worked with me in the emergency department know that I thrive on a relaxed and joking environment to make the shifts go by, I want to shed light on a worrisome trend that I have noticed. I want to talk about the overuse of self-deprecating humor by physicians in our specialty. I have only been in the field of emergency medicine for 2.5 years, and I cannot count how many times I’ve heard my co-residents, friends in EM, even attendings end a story or consultation with the phrase “but what do I know, I am just an emergency room doctor.” Some physicians have even gone so far as coining the term “JAFERD” (just another f****** emergency room doctor).

Though jokes, even self-deprecating ones, can quickly diffuse a tense situation, my sense is that sometimes the “just an ER doc” phrase comes from a place of insecurity. I’ve witnessed residents and attendings give thorough explanations regarding their thought process and reason for a consult, only to end with the wobbly “but I’m not sure, I am only an ER doc.” Using this statement in a professional setting diminishes the validity of your question and possibly the consultant’s opinion of your clinical knowledge and reliability. Why use language that can negatively impact your intelligence? Have you ever heard a surgeon say “I am JUST a surgeon?” We all went to medical school and matched in a competitive field, trust in your knowledge and hard work, be confident in your exam and thought process. We are not perfect. We are allowed to get things wrong; it’s hard to keep up with new literature and new protocols on all of medicine. But when speaking to a consultant who is questioning your management, don’t shy away and hide behind the phrase JAFERD. Explain to them where you are coming from and eagerly ask to be educated on the new literature that consultant is guiding their treatment off of. And while some may use JAFERD as an inside joke, when heard by outsiders the “just” portion of the phrase can be misconstrued as lacking confidence or as excusatory.

Letter to Our Emergency Medicine Residents and Medical Students

Image Credit: CDC

Dear Emergency Medicine Residents and Students,

We have reached a critical time in modern medicine with the pandemic of Coronavirus (COVID-19). Today, I wanted to take a minute to remind you just how important you are in this fight against COVID-19.

Over the coming days and weeks, your efforts will be critical in helping to manage large numbers of critically ill patients and to help stifle the spread of this deadly virus. As emergency medicine residents and medical students you are the front-line, at all times. You are the engine of the emergency department - arguably the most essential department for containing and treating this virus. Every single patient you see, every treatment you administer, every intubation you perform, is one further step in gaining control against COVID-19.

How to Approach Third Year (M3) as an EM-bound Medical Student

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Author: Taylor Petrusevski, MS4
Loyola Stritch School of Medicine
AAEM/RSA Publications & Social Media Committee

You made it through the seemingly endless lectures and question blocks that consume the pre-clinical years of medical school. In third year, it’s time to bring your classroom knowledge to the bedside. It is an exciting and overwhelming transition, but it is such a transformative year and a pivotal point in your training. You are building the foundation of your clinical skills and the formulation of your practice patterns start now. Among many variables, including Standard Letters of Evaluation (SLOEs), performance on the emergency medicine (EM) clerkship, interviews, and Step scores, third year clerkship performance continues to be an important parameter that program directors use when evaluating candidates.[1] While some studies note that your third year clerkship grades do not carry as much statistical weight as these aforementioned application components, your third year clerkships serve as the foundation of clinical skills that will allow you to succeed on your EM rotations, which is heavily weighted.[2] There are several methods to successfully navigate this transition. Different learning models emphasize the best cognitive practices to bridge this transition, noting that active reflection is just as important as preparing and actually getting the clinical experience.[3] Ultimately, do what works for you. Here are some suggestions on how to approach M3 as an emergency medicine (EM) bound student:

CPR Induced Consciousness – An Important Phenomenon to be Aware Of

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Author: Jake Toy, DO
Harbor UCLA Medical Center
Originally published: Common Sense July/August 2019

In a recent resuscitation of an unconscious elderly woman in ventricular fibrillation, my team observed that upon initiation of cardiopulmonary resuscitation (CPR), she began to make purposeful movements with her arms and legs. During compressions, she batted at the mechanical CPR device and reached for her endotracheal tube. When attempting to place a femoral line, she withdrew to pain from the needle on that side. Through these periods of seemingly purposeful movements, her eyes remained closed and she was not responsive to voice commands. Upon pulse checks, these movements abruptly ceased. Many questions arose during this resuscitation for my team: Should we physically restrain the patient? Should we chemically sedate? What was the level of the patient’s awareness?

SVI: The Next Step 2 CS

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Author: Haig Aintablian, MD
AAEM/RSA President
Originally published: Common Sense July/August 2019

I did great on my SVI. The day of, I had just gotten a haircut and shaved my beard. My top half was covered by a nicely pressed navy blue suit jacket my mom bought me 4 years ago but that I hadn’t touched since my undergrad graduation. Under the blazer, a white shirt I’d worn twice that week already, and a baby blue tie I’m pretty sure I’ve had since high school. Best of all though, my bottom half was covered with a pair of stereotypical grey Hanes boxers – the type you buy in a 6+1 pack because you get one for free. I sat behind a desk in the middle of my half disastrous room (the side not covered by the camera), prayed an Our Father, and I said what had become my motivational slogan at this point, “**** it, we’re almost done.” I looked great on camera. My upper body displaying a professional, well-groomed student against a clean room backdrop with undergraduate degrees newly hung on the wall. There were no tight pants to hold me back (away rotations made me gain weight like a CHFer off Lasix). Regardless of how I looked on camera, I felt a deep helplessness. During the hardest half year of medical school trying to prove myself on away rotation after away rotation, devoid of family, friends, and proper sleep or nutrition, I was expected to be a robot in front of a video camera for reasons no medical student understood, no administrator could directly answer, and almost no PD would actually care about (let alone watch).

2018-19 AAEM/RSA Medical Student Scholarship Winners Share Why They Are Choosing EM

Author: Jordan Neichelle Powell
University of Rochester School of Medicine and Dentistry

RSA is proud to share the following essay from one of the 2018-2019 Medical Student Scholarship winners, Jordan Neichelle Powell. We felt this essay best exemplified why she is choosing EM as a specialty. Congratulations, Jordan!

One cold winter night during a pediatric emergency medicine (EM) shift I had the pleasure of taking care of a nine-year-old girl with what I thought would be a typical sick visit during the winter season. Upon informing the parent and the child that she would soon be discharged, she stopped me before leaving the room. She informed me that she had a secret to tell me. As I approached her bedside, she timorously shared that she has never seen someone that looked like her take care of her. I remained silent since the words that so easily flowed from her mouth were not what I was expecting. She then shared that she wanted to be a doctor just like me one day. Experiencing sudden shock, I also felt a sense of humbling warmth. Before I left her I hugged her and whispered back in her ear that she could be anything that she wanted to be. That moment, is one of many that constantly remind me of why I went into medicine and decided to pursue Emergency Medicine as my specialty. This specialty not only allows me to be a positive influence on those underrepresented in the community but has also been an opportunity to learn from and advocate for patients as well. It can be something as small as representation and letting a little girl know that she too can be whatever she wants to be; or, on a larger scale, making sure that a patient knows that they are safe, heard, and cared for.

2018-19 AAEM/RSA Medical Student Scholarship Winners Share Why They Are Choosing EM

Author: Abdullah Faiq
Howard College of Medicine

RSA is proud to share the following essay from one of the 2018-2019 Medical Student Scholarship winners, Abdullah Faiq. We felt this essay best exemplified why they are choosing EM as a specialty. Congratulations, Abdullah!

As I stitched my patient’s last sutures, drawing his eyebrows back into alignment, I turned my attention to his visibly relieved wife. “Don’t worry, he’ll be as handsome as he was yesterday.” She laughed, complimented my work, and insisted her husband take a selfie for the kids. A few hours earlier, he had been in a life-threatening car accident, arriving as a code yellow with 1.5L of blood loss. I lifted the suture mat off his face and saw him smile for the first time. It was 3AM, I felt present and focused, and there was no place I would rather have been.