How to Crush your 3rd Year of Medical School When You’re Interested in Emergency Medicine

Evan Miller, OMS IV

Nicholas Bourque, OMS IV

So you’re interested in Emergency Medicine! Congratulations and we’re so glad you joined us. For the purpose of this article, we’re going to assume that students are close to starting their 3rd year of medical school and haven’t had the opportunity to be involved in Emergency Medicine-specific extracurriculars up to this point. That’s okay! By the end of this article, you’ll hopefully have some great ideas for where to go next. We hope you can use this to succeed in your 3rd year rotations, explore areas of interest in Emergency Medicine, or strengthen your application for Sub-I rotations and beyond. We will divide up the article into different steps you can take in no particular order of importance, but we suggest you start reading from the top. We are currently two DO students in our 4th year interested in applying for Emergency Medicine residency in the coming months. Our areas of interest include Wilderness Medicine, Military Medicine, and International Medicine. 

We’re not sponsored or receiving any benefits from the companies/products we’re mentioning below, just mentioning some resources that have worked well for us personally. 

1. First, we suggest you join EMRA! The Emergency Medicine Residents’ Association (EMRA) is a great source for information for almost everything related to Emergency Medicine. You may have found this article by already being an EMRA member, but if you’re not, we suggest signing up for membership. This will get you access to information and networking opportunities you won’t find anywhere else. After signing up, you’ll soon receive a box in the mail with some pocket-sized EM reference guides which are perfect to carry around in your white lab coat in your 3rd year. One of my favorites is the “EM Fundamentals” book, which I have in my white coat now as I’m about to head off to my ED shift today. Your EMRA membership will also get you access to the EM:RAP podcast along with all of their educational and how-to videos that are incredibly helpful when preparing to try a procedure for the first time.  This year, I’m serving on the Medical Student Council (MSC) as the Mentorship Coordinator, which means that I help pair medical students with Resident and Physician mentors who are interested in helping and answering questions along the way. This service is only available to active EMRA members! If you’re interested in this program, please check out the website for more information. Feel free to apply or send us an email and we’ll get back to you quickly. The MSC is just one of the many ways that EMRA can help you gain leadership experience if you’re interested. There are also many different options for joining committees and getting involved in that way. You can find more information on that here.
2. Make a study plan to do well on your exams this year. Across different specialties, quality applicants have performed well on shelf/COMAT exams as well as Step 2/Level 2 at the end of the year. Find a study plan that works well for you! Developing a study plan and staying consistent throughout the year will help you to do well on exams as well as demonstrating knowledge in the clinic while seeing patients. Here are some resources that worked well for us throughout the year and how we suggest using them:
3. Uworld - This should be no surprise, as it’s been the standard for shelf/COMAT and board studying for quite some time. We suggest exhausting the questions for every block as you go through the year and then resetting the questions when you get ready to start studying for Step 2/Level 2. For our DO colleagues, we have personally used COMQUEST and know many people who have had success with COMBANK. If you’re going for the 270, you could consider a combination of these such as Uworld throughout the year and then the COMQUEST COMAT package specific to each rotation. 
4. Online MedEd - This was our favorite resource to review and build foundational knowledge throughout the year. The site used to be free to use and has since charged a fee, but has built up resources to have available videos, readings, questions, and more. We learned a lot especially through studying the videos throughout the year and found that they had excellent tagging in Anki through the AnKing package if you choose to use this resource too. For our DO colleagues, there is also a great selection of OMM videos which we used to prepare for our OMM COMAT and Level 2. 
5. Amboss - We have had a membership to Amboss since our first year of medical school and it has never let us down. We found this to be an excellent resource for quickly looking up information on the fly in the clinic, as well as going into question blocks specific to organ systems or pathologies you might be weak in. It’s a wide-ranging reference guide, but you can use this to supplement your Uworld or COMBANK/COMQUEST questions too. 
6. Podcasts - Some of our favorites have been EM Clerkship, Step 2 Secrets, and Divine Intervention. If you enjoy listening to podcasts or have some long drives ahead of you, we recommend you check some or all of these out! We would listen to Step 2 Secrets throughout the year as it tied in very well with specific rotations we were on. EM Clerkship is great for identifying presentations in EM and has a wide-ranging list of topics from previous episodes. Divine Intervention is pretty well-known and has a lot of deep dives into whatever topic might interest you. 
7. Other - Consider purchasing a review book to take with you on rotations. We liked Master the Boards and First Aid for Step 2. These can work well to have something in your bag to have quick access to in any down time. Books like Surgical Recall and Dr. Pestana’s Surgery Notes are excellent to prepare for surgery, while also serving as great information for EM as they talk about different suture techniques, next steps for the patient presenting with trauma, and more. OMT Review by Savarese is a great place to start for a hard-copy OMM review text. 

3. Develop your skills - Emergency Medicine is known for its involvement in a range of procedures and odds are you enjoy doing these or you wouldn’t be interested in EM! Here’s a great framework for thinking about this- Improving skills and gaining practice in those that you can use in the ER will take practice and intentionality throughout the year. Here’s a short list of some skills we suggest you work on:
   1. IV access - Peripheral IVs, Central IVs, and Ultrasound-guided access take time to develop. We suggest reading up on indications, watching some videos on how they are done, and then asking your residents or attendings while on rotation if you can get some practice with these. While working in the ED, we have had great luck with working closely with nurses and asking to assist in placement of peripheral IVs to start. After you feel comfortable with that, you can start integrating the Ultrasound machines to gain practice there, and then when some opportunities come up to place a Central line, you’ll likely be in a great place to do so.
   2. Splinting - If you’re able to schedule rotations in your 3rd year to where you can work with other specialties such as Ortho, this is going to give you a lot more practice in areas like this. We suggest the same approach as above where you read about indications and techniques, watch videos on it, and then actively look for and ask for opportunities to practice.
   3. Intubation - Specialties like anesthesia and EM are going to be some of your best opportunities for this. We gained practice with this in our 2nd and 3rd years through skills labs with other students and residents where we were able to practice on mannequins and then patients whenever appropriate.
   4. Suturing - Your surgical rotations are going to be excellent opportunities to learn about this. We began by reading about suturing in Surgical Recall and purchasing a suturing kit to practice at home. We suggest you watch YouTube videos to demonstrate the process while practicing on your own, and then seek out suture clinics to hone your skills and ask for specific suggestions. There are many types of sutures, but the most common that we have found in EM is the simple interrupted with instrument ties and we’d recommend working on this the most. 
   5. Foley catheter placement - Similar process to the skills outlined above. We were also able to gain a lot of practice while in the OR.
4. Explore EM through extracurriculars - There are so many ways to get involved and these can be a ton of fun! We’ll break this down by category below.
   1. Clubs - You should join your school’s Emergency Medicine Interest Group if you haven’t already! You can make great connections and have opportunities to practice skills while learning more about the specialty. This can also be an awesome opportunity to gain leadership experience if you’re interested in being on your school’s board.
   2. Conferences - There are many national EM organizations that host conferences around the country. Check to see if your school provides funding to go and you could be attending a few days’ worth of sessions while being able to experience a new city! If you’re not sure where to start, we suggest checking out this years’ ACEP (American College of Emergency Physicians) conference and/or SAEM (Society for Academic Emergency Medicine). 
   3. Research- While research may not be critical to an emergency medicine residency application, it is a great way to set yourself apart from other applicants. We chose to join a research team at one of our local hospitals’ emergency departments. We spent our time in the lab mostly during our summer before 2nd year and during a dedicated research block during 3rd year. This worked well because both of these allowed us to focus on research without getting overwhelmed or sacrificing important study time. With that being said, there is no bad time to get involved in research and students find many different ways to stay active in their research throughout their medical school years.
5. EM Subspecialties - Fellowship opportunities in EM are growing rapidly. For a listing of many of the current options, check out this site.
   1. Throughout our first few years of medical school, we attended a couple Wilderness Medicine conferences, graduated from military Officer Training School, and checked out international rotations for our 4th year. We had a ton of fun and learned a lot! It’s worth looking into funding available through your school to attend these and then any possible certifications you can gain. This is all able to be written into your residency applications down the road. 
6. Check out other requirements - We suggest checking out residency application requirements early on! You will usually want to set up 2 or 3 4th year rotations from which you can request a letter of rec in the form of a SLOE (Standardized Letter of Evaluation). EM Wiki has a great list of residency programs to check out as you prepare to apply to 4th year rotations on VSLO.
7. Have fun! Relax and enjoy yourself along the way this year. Take a moment to recognize all your accomplishments over the first couple years of medical school. Congratulations on all you’ve accomplished so far, and we wish you the best of luck with your 3rd year! We felt like 3rd year went extremely quickly, so take time to reflect and enjoy. Make sure you’re taking care of yourself along the way and trying to keep up with hobbies and personal relationships. Reach out to us at EMRA and the MSC if we can ever help you or answer any questions!