The specialty of emergency medicine has made forward progress in holistic and objective assessments of auditioning medical students, with the introduction of the SLOE evaluations (which other specialties are now copying).
In addition to the objective evaluations of performance, candidates will be assessed on how well they respond to coaching and how well they fit into the team.
At the same time, rotators will likely be working with a new team every shift, which means new standards, new personalities, and new first impressions.
I suggest a 4-pillared mantra that carried me through my audition season and kept me grounded.
Humble
You may have gotten honors on every rotation in medical school. You may have already memorized Tintinalli’s. You may be the best medical student the program has even seen. However, if you come across as arrogant, they will not want you on the team. Emergency medicine in particular values whole people who are self-aware and have soft-skills, so your job is to present as a well-adjusted person.
Approach every clinical situation as an opportunity to learn, even the low acuity stuff. Don’t be too good to take on a tummy ache. There’s often a lot of learning value in these cases, especially as a newbie.
When a resident or attending offers constructive feedback, don’t justify or make an excuse—thank them and try to incorporate it. I recommend talking with your resident or attending before the start of each shift to go over their expectations and your learning goals, that way you have some tangibles to talk about during feedback.
You are going to want to impress your residents and attendings, but don’t go overboard with it. Presenting as relaxed and humble will outshine gunner vibes. They need you to graduate as a competent emergency physician, but what they need from you right now is to have an appropriate level of knowledge for a fourth-year medical student, to be able to learn, and to be someone that they would want to hang out with after shift.
Helpful
You can’t write prescriptions. You can’t discharge patients. There’s a lot that you can’t do, but don’t think that means you can’t be an asset to the team. Thinking back to Humility, realize there are about a hundred small tasks you could do to make your resident’s life easier. You could counsel the patient. You could call the taxi service to arrange the patient’s ride home. You could sift through the paper bag full of pills the patient brought in. You may not need a 4-year medical degree to do these tasks, but don’t ever think they are beneath you—it’s about helping the patient.
You want to come across as someone who is a team player and isn’t too good to get their hands dirty. You want the residents to think of you as someone who they would want on shift with them at 3 am.
You want to help your medical team, but potentially more important is being an asset to the nursing and support teams. Whatever impression you make on the nursing staff, your evaluators will hear about it. So go ahead and strip the bed after the patient discharges. Get vitals and document them. And if you can start an IV for them, it’s a game changer.
Hungry
People are attracted to passion. Don’t make them wonder if you want to be there. You should be “hunting the board” to pick up interesting patients. If there is a procedure going on for a patient you aren’t following, ask to watch anyway. You don’t necessarily have to stay late, but certainly don’t try to leave early.
Be careful not to go overboard though; you want to come across as someone who is genuinely jazzed about emergency medicine, not as a gunner. To that end, put some thought into why EM resonates with you, so that when an attending asks you “Why EM,” you have something more meaningful to offer than “I like the shift work.”
If you have your eyes wide open as to the pros and cons of the profession, and still want to dive in head first, you will come across as passionate and mature.
Hepatocytic
The liver looks like a sponge, and it was important that the pillar started with an “H.” So be a sponge—be a hepatocyte.
You need to have a baseline level of knowledge coming in, but beyond that your evaluators are more interested in your ability to learn in the emergency room than your current level of knowledge. So, when the increased intraocular pressure patient comes in and you don’t know how to manage it, don’t sweat it. What is important is that you take it as a learning opportunity. When you get home that night, do a little more research on it and let the resident know what you learned—maybe even offer to do a brief presentation on it. If you made it this far in medical school, we know that you can learn in a classroom, and probably on the wards, but show us that you can still learn in a fast-paced emergency department!
Summary
Auditions are a stressful time. Part of that comes from the relative subjectivity of being evaluated on your clinical skills and personality match by a group of people that you are just meeting. Although most of what I have presented above can be boiled down to “don’t be weird, just show that you can learn”, I think that it is helpful to have a mantra or a framework as you go into this somewhat nebulous process. I’ve written it as it worked for me, but please make your own adjustments based on your needs and the feedback you receive. And above all, try to enjoy the process!