Away Rotations, Medical Students

Conquering Your Away Rotations in 10 Easy Steps

Summer is here, and that means that it is time for away rotations. There are many resources out there with great advice on how to well on your away rotations - check out emra.org and EM Resident. To start your preparation, here are 10 tips to help you succeed.

1. Before your first day, make sure that you have the following EMRA resources:

  1. EMRA Antibiotic Guide
  2. EMRA Basics of Emergency Medicine (both the adult and pediatric versions)
  3. EMRA EKG Guide

2. On the first day of orientation, make sure you get the other rotators’ phone numbers and make a group text thread. This will be helpful for both rotation questions, as well as to organize group outings on your days off. 

3. Acquaint yourself with the clerkship coordinator and other staff. They can point you in the right direction. If you make a good impression on them they typically will put in a good word with program leadership. Be aware, the opposite is true as well, and students have been dropped down on or completely off rank lists for being rude to program coordinators and other staff members.

4. If you will be taking one of the standardized SAEM exams, use the Clerkship Directors in Emergency Medicine (CDEM) M4 curriculum to study. If your rotation uses a different exam, such as the NBME shelf exam, make sure that you understand which study materials students have found helpful in the past. Current residents who rotated at the program as a fourth-year medical student can be helpful in suggesting study materials. Focus your study efforts during the first 2 weeks of your rotation, not only so that you can use your newfound knowledge during your shifts in the ED, but also so you do not end up trying to cram your studying into the final days leading up to the exam.  

5. On shift, the following will help you get the highly desired “on par with resident performance” feedback:

  • First and foremost - know your patient. Know their history, current medications, pertinent past medical and surgical history, pending labs/imaging, and their exam.
  • Own your patient - update them as labs and imaging return, call consults if they are warranted, and reassess your patient after any interventions. Note: This is the crucial step that many medical students miss early on in their training!
  • At the beginning of each shift,with a resident/attending who is new to you:
    1. Introduce yourself.
    2. Ask if there are any patients you should not see (pelvic exams, patients who need a translator, etc.).
    3. Clarify whether you can freely pick up patients or if you should ask first. Remember, they can get very busy managing multiple patients/residents, and being respectful of their time is important.
  • If a bedside ultrasound is part of your workup (once you have confirmed your workup with your resident/attending), get the ultrasound set up and ready to go in the patient room prior to obtaining images with the resident/attending present. This shows initiative and saves your resident/attending time, which is always appreciated.
  • If a procedure is part of your patient plan, and after your resident/attending has confirmed you can perform the procedure, have everything ready to go in the patient room before you grab your resident/attending. Remember, you should never start the procedure without their direct supervision. If you are unsure what supplies you’ll need, ask a resident, nurse, or tech to help you gather supplies. Do not ask a tech or nurse to do it FOR you, as it is important you learn where supplies are located so you can become self-sufficient during your rotation.

6. At the end of every shift, ask for feedback. This helps you to understand what specific skills/tasks you should work on during your rotation, as well as gives you some insight into what written feedback the residents and attendings you work with will include in your formal feedback, which is used to write your SLOE.

7. Socialize or go out with the residents for food and/or drinks after shift. It’s a great way to get to know the residents better and will help you get a better feel of the culture of the residency.

8. During your month, meet with the clerkship director, as well as the program director, if possible.You should meet with the clerkship director halfway through the rotation for feedback. Use this meeting to gauge how your SLOE might read. Meeting with the program director gives you the opportunity to ask residency-specific questions.

9. If offered an interview during your rotation before October, take it! Coming back to interview later in the season will not give you a leg up, but it will definitely hurt your bank account.  

10. If you get along well with particular residents, keep in touch. They can offer invaluable assistance when navigating the application process and interview season.

BONUS: Have fun! In the moment, away rotations seem high-stakes, which they are in regard to the content and strength of your SLOE(s). However, during your away rotations, you might experience your first champagne tap, the first time you actually understood what you were looking at during a bedside cardiac ultrasound, and/or the first time you intubate a patient. Work hard, and get out there - the ED awaits!

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