Emergency Medicine by keralaguest


									Condell Medical Center
    7am-4pm, 2pm-11pm, 11pm-7am, or 12pm-9pm (pediatric emed)
    Attendance at 2 lectures during your days off is required
          o Lectures are at other sites (University of Chicago, Cook County, Lutheran, Resurrection,
    Most tracks, work 3 days followed by one day off and repeat
    Track D: stretch of 8 days in a row
    Every person has 2 days off in a row at one point during the 4 weeks
    No call

Work Environment:
    Work directly with an attending; No residents.
    PA student from RFUMS, no other medical students

The attending are awesome overall. If they get busy then they don’t have as much time to teach, but
they will always answer all of your questions. Every attending expects slightly different things from you,
though, so try to figure that out toward the beginning of your shift. The nurses are also awesome, and
are very willing to help you check off all of the items on your procedure log.

Condell EMED has a team environment which includes the physicians, PAs, nurses, and emergency med
techs. At Condell you definitely feel like part of the team as a student. Everyone is very willing to teach
as long as you show interest. EDs are obviously a fast paced and busy environment, but you will learn a
lot from everyone there. You will do focused H&Ps on your own, but the nurses and techs will teach you
how to do blood draws, IVs, fracture care, and wound care. Students work closely with the attending so
you don’t necessarily have learn on your own.

You have to do some “scut” work to complete your procedure log, but I didn’t have to do any
procedures or other scut work if it wasn’t on my list or if I had already completed it.

Strengths of the rotation:
     Level 1 Trauma Center
     Peds ER (4 shifts)
     Wide variety of cases
     Physicians and nurses are friendly and willing to teach

Patient Interaction:
     Level of patient contact is attending-dependent

For the most part I was able to see patients on my own during every shift. A lot of times the attending
will tell you which room to go into, you go take the focused H&P (and might bring a scribe with you, who
enters the info into the pt’s electronic chart for the attending), and then present the pt’s case to your
attending, who will then go back into the room with you.
There are tons of opportunities to take H&Ps and to also do procedures. I was able to do a lot of
suturing, stapling, wound care, etc in addition to the rest of the procedure list. There were lots of
female pelvic exams to do too, if you were so inclined.

There is a large Hispanic patient base so knowing your Spanish is a definitely a plus! You will see patients
of any age at Condell-- ranging from a few weeks old to very old and sick.

Tips, etc:
You basically eat when you can at the doctor stations so pack some food with you for each shift.

There is also a Gift Shop/Coffee Shop where you can buy snacks or study before or after your shifts.

One of the nice things about emed is that they have H&P worksheets that you print off and fill out.

I don’t think there is any way to properly prepare for the shelf. The questions (at least the majority) are
very random and the information is not in the text book or in the lectures.

Cook County
    16 8-hour shifts
    Day=8am-5pm, Evening=4pm-1am, Night=12am-9am

Work Environment:
    Interns, Residents and Attendings in a group of 5-8, depending on your team for the shift

Everyone is very friendly, the support staff is just used to a lot of people rotating and some are not as
concerned with making an effort. But if you smile and are polite, they warm up very quickly. The
physicians, PAs and other students were all very welcoming and understanding of our position as

It’s fast paced, but you have to run all your patients and decisions by the attending or whatever
resident/intern you’re working with for that shift. Because it’s often your first time working with them,
they want to watch your decisions before they trust you to do stuff on your own, but that usually
happens within an hour or two.

You are asked to take patients to X-ray/CT a lot, and get stuff ready for procedures, but all the doctors
there are doing the same thing, and it’s not such a big deal.

Everyone runs their patients by the attending, as a student they will probably come see the patient after
you see them, and then talk to you about what they’re going to do. You help in their care, writing on the
charts, admitting them and whatever else needs to be done. They all have a different style, some prefer
to teach more than others. The good part is that if you don’t like them, you are only working with them
for 8 hours at a time. In all my shifts I don’t thinking I had an attending or resident that I didn’t like or
wouldn’t want to work with again.
     Friendly physicians
     A lot of patients and procedures
     Freedom to work on your own
     You bring your own scrubs.
     The doctors are so helpful for teaching, and you learn a lot at every shift

Patient Interaction:
     See a lot of patients
     Green team—lots of procedures (splinting, I&D, stitches)
     Red team—critical care (may see CPR or NG tubes)
     Blue team—lots of H&Ps, psych, abdominal and chest issues that aren’t critical
     Your level of confidence will dictate how much you do on your own.

We’re the only school in the area that allows 3rd years to rotate in ER, so all the other students are 4th
years. Rush, RFU podiatry, UIC, etc. A lot of them were from out of town, wanting to do a Cook County
ER rotation. It was helpful to have more experienced students there to ask questions to and take their
lead if you weren’t sure how to handle a situation.

You can’t formally see a non-English speaking patient alone for a H&P if you speak fluently. But you can
certainly find opportunities to use almost any language you know, just here and there speaking with
patients and being friendly or helpful.

Tips, etc:
     The exam is hard
     Bring a Powerbar
     Don’t bring anything that you can’t keep on your person that you don’t want stolen
     Shifts are busy; remember your patients and write them up later

Mount Sinai
            8-9 hour shifts
            3 possible shifts during each day
            Required to attend 2 conferences at another site (U of Chicago, Cook) that last 5-6
Work Environment:
    Trauma or medical “side” that all attendings, residents and nurses are divided into
    12 beds on each “side”

After you see a patient you present to a resident or attending, more often the residents. Then after you
see the patient together and if they have questions the attending is brought in.
You have to ask the nurses to let you or show you how to do blood draws and IV lines. You have to do
this extremely nicely because many are definitely not too happy to do that.

Wide variety of helpfulness among the staff and physicians. Some residents say nothing, and some
explain everything. It also depends on how busy it is if they have the time to help you. And usually the
attendings say even less.

felt like the attendings varied more between shifts and “sides” than the residents. The residents I
worked with were all very helpful and willing to explain diagnoses, managements and treatment options
so I ended up preferring to present to residents over attendings. Just make sure to present to the
attending once or twice so they know you’re there and know you’re stuff since each one evaluates you
at the end of each shift.

I would say there is no scut work whatsoever. The work you do really is down to how involved you want
to be. Ask and nurses and residents and they would usually be willing to let you observe, help or
independently perform the procedure.

Most of the procedures performed by the students are supervised by the resident and sometimes by the
attending. On rare occasions, the students can perform procedures independently. All cases are
presented to the attending at some point, usually by the resident (after you’ve presented to the
resident), or you.

     High availability and variability of cases
           o Mental health, trauma, infections. More than the standard chest pain/abdominal pain
              ER complaints
     Ample opportunity to see varied diagnosis in almost all of the chief complaints
     Trauma and normal ED are combinedwider variety of cases
     Peds and Adult ED are combinedwider variety of patients

Patient Interaction:

There is a great deal of patient contact here. For the most part you are the first person to attend to the
patient and will gather a focused H and P. Afterwards, be sure to look up previous visitations the patient
has had to correlate with the current visit. Then comes the presentation to the resident or the attending
where many will ask you how to go about the case as a way of evaluating your performance. After
presenting the resident/attending will fill in the gaps and administer the appropriate labs. Be sure to
follow up on these and keep the resident/attending informed and be active to ask to participate in any
procedures that your patients may need.

Given how busy this ER is, residents or attendings will not always think about you first while attending to
a patient. But if you are proactive, they will be happy to involve you into whatever you want to do. It is
your responsibility to be proactive. Many times I asked to go in with the resident or an attending to see
procedures. Even though, they were not required, they readily accepted and sometimes I got to help.

A perfect example is performing CPR, specifically chest compressions on a trauma patient. This is a
requirement. When there is a code yellow, everyone is scurrying to find all the equipment and everyone
assumes their roles in trying to save the patient. Time here is crucial and a student can get very confused
and feel out of place. When someone is doing the compressions, stand behind them and ask if they need
help. As it is tiring, usually people switch and there is someone waiting to take over.
There are PA students from RFUMS and Midwestern University, and a few med students from St.
Matthews Medical School. Everyone does the same work so you split up sides and then each see
patients on your sides. So if you are working with other students, you may or may not see as many
patients, but usually when it’s busy it doesn’t matter anyway cause there are so many patients.

Sinai definitely has a large Hispanic population. It is definitely an advantageous in knowing Spanish and
not having to page and wait for the interpreter all the time. English and Spanish were the only languages
I heard being used during my rotation

The range of ages is very wide at the Sinai ER but the majority of patients are of mid-elderly in age. This
likely also reflects higher disease prevalence and severity in these age groups as well, which causes them
to end up in the ER.

The one big advantage of ER at Sinai over other sites that I’ve heard is that the trauma and normal ER
(known as medical at Sinai) are together. The variety of medicine you can see as a result is greater as
you can pick which side of the ER you want to work in each shift. Moreover, unlike Cook, they don’t
separate the pediatric cases from the adult population

Tips, etc:
     The conferences at Cook were interesting for the most part
     Require self-study to solidify the pathophysiology and treatment as the residents and doctors
         don’t always have time to explain everything for every case.
     Be sure to look up a patient’s previous hospital visits that relate to the current complaint
     There are computers available in the ER and there is one in the break room. The ones in the ER
         are always under constant use by staff for patient information and should not be hogged. There
         was never a problem finding an open computer for use.

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