Medical Students and Nurses Can Make a Great Team

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Author: Scott Bland, MSIII Campbell University School of Osteopathic Medicine
AAEM/RSA Medical Student Council Southern Region Representative '16-'17

This post was peer reviewed.
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In the medical realm, it is hard to go five minutes without hearing terms like “interprofessional,” “collaborative,” or “team based.” Many schools offer seminars intended to teach medical students how to interact with other professions. However, when we hit the floor for rotations, we sometimes struggle in our interactions with the largest of the health professions.[1] But nurses can be great allies in patient care and can really help a medical student transition into their clinical education. So here are a few tips on how to be a good team member with your nursing staff.

1. Treat others the way you want to be treated: If you are intentional about the quality of your work interactions, they will improve. Try to address people by their name. Be forgiving if they make a mistake. Say “please” and “thank you”.[2] If you ask a nurse to do something for your patient and they are busy, offer to help. One tip for how to phrase things is, “Mrs. Smith soiled her linens and needs them changed. If you are busy, I can go get the new linens and help you once I bring them to the room.” If the task is important, demonstrate that you are willing to get involved.

Management of Atrial Fibrilation with Rapid Ventricular Response — Choosing Rate Control Wisely

Image Credit: Pixabay

Author: Nathan Haas, MD
University of Michigan Department of Emergency
Originally Published: Modern Resident October/November 2014

Atrial fibrillation (AF) with rapid ventricular response (RVR) is relatively commonplace in the ED, and practice patterns vary in how rate control is achieved. Presented below are different approaches to accomplishing rate control, broken down by medication class and clinical situation.


Big Picture: Calcium Channel Blocker Versus Beta Blocker
The mainstays for rate control agents include calcium channel blockers (CCBs), such as verapamil or diltiazem, or beta blockers (BBs), such as esmolol or metoprolol. Recent literature has trended towards favoring CCB from an overall standpoint, although the difference between the two classes is far from clear-cut.[1]

Delivering Bad News

Image Credit: Pixabay

Author: Niklas Eriksson, MSIV
Loyola University Chicago Stritch School of Medicine
AAEM/RSA Social Media Committee

This post was peer reviewed.
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A variety of patients present in the emergency department (ED), and every ED physician, resident, and even student will encounter patients in critical condition or life-threatening injuries. As a result, it is an essential skill for an ED clinician to be able to give bad news. One of the more helpful mnemonics I have learned and been able to apply when having to break bad news to patients or their families is SPIKES. This mnemonic is often used by oncologists, but can apply equally well in the more acute ED setting.[1,2]

S: Setting. Make sure you are in an appropriate setting to deliver the news. A private room with minimal noise interference is preferable. A recent study showed that there is a discrepancy between patient and physician perspective on the level of privacy achieved during these conversations, indicating that more emphasis could be placed on finding an appropriate setting. [2,3] Also recognize the importance of introducing yourself and your role.[3,4]

P: Perception. Ask the patient and/or their family what their understanding of the transpired events has been thus far. It may be that the patient has been suffering from a chronic disease and they have been preparing for their eventual death for a long time, or this may be a sudden and unexpected occurrence. Many times it may be better to be direct. Overall, keep in mind that every family has different experiences with their loved ones and their diseases that makes each encounter different.

Residency Work Hour Restrictions: Is the Pendulum Swinging Back?

Author: Mike Wilk, MD
PGY-1, Brown EM
Originally Published: Common Sense January/February 2017

“I walked into the hospital on my first day of residency and didn’t walk out until 36 hours later. Those were the darkest days of my life, but I am the doctor that I am today because I went through that,” I still distinctly remember these words from one of my more senior physician mentors when our discussion turned to work hour restrictions. As I wondered how it was possible to physically stay awake for so long, there was no doubt in his mind that work hour restrictions were dampening the training experience of newly minted residents.

First instituted in 2003 and revised again in 2011, interns now “enjoy” an 80-hour work week restriction with a maximum shift length of 16 hours (PGY-2s and above are still allowed to work up to 28 consecutive hours). However, the pendulum may be swinging back on strict work hour restrictions as new research on the topic becomes available.

The event that led to work hour restrictions was the death of Libby Zion in 1984. An overworked medical intern on a 36-hour shift prescribed meperidine to the 18-year-old patient, who was on an antidepressant, the MAO inhibitor phenelzine. This drug combination is thought to have caused the serotonin syndrome, leading to Zion's death.

Group Therapy

Author: Mary Haas, MD
AAEM/RSA President '16-'17
Originally Published: Common Sense January/February 2017

It was Monday night, and Halloween. It was the perfect storm of an ever-expanding waiting room and a revolving-door resuscitation bay occupied by sick patient after sick patient. Following an emotionally exhausting shift, I sat with some fellow residents at The Pizza House, a local late-night joint where we grab food after a shift, tell stories, and debrief in Ann Arbor. We often jokingly refer to these sessions as “group therapy.” The mood that night was more somber than usual, despite the roar of intoxicated college students at nearby tables dressed up like Pokémon trainers and Game of Thrones characters.

My co-resident shared the story of two young males who suffered cardiac arrest by drowning, after jumping into a cold lake to rescue their friends who, unknown to them, had already made it to shore after a boating accident. Another resident shared the story of a teenage boy who died after being struck by a car while crossing the street on his way to school. Another shared the story of caring for a mom who presented with pre-eclampsia, a few days after her infant was unsuccessfully resuscitated by another of our colleagues and died from SIDS. I had just cared for a man who suffered a massive intracranial bleed while going to open the door for a few trick-or-treaters. I looked his teenage son in the eye and tried not to well up with tears as I translated the findings of the CT within five minutes of meeting him. Suddenly, it made sense that we had been so eager to sit, relax, and have a beer together. We had certainly earned it, based on the events of the last week. All of us needed to talk to someone who would understand.