Tips from a MS4: Excelling in Your EM Sub-Internship

Allison Gasnick, MS4
Case Western Reserve University School of Medicine
Medical Student Council Editor 2024-2025

After completing my sub-internships and reflecting on what worked, what didn’t, and gathering extensive feedback, I’ve put together this list of key tips to help you excel during your Emergency Medicine sub-internship:

1. Be Proactive but Know When to Step Back
   Take initiative by offering to assist with tasks. However, recognize when to step back and observe, especially in critical situations.
2. Present Patients Efficiently
   Read more about EMRA’s suggestions here.
3. Master the Basics
   Be confident with basic procedures like suturing and I&D. Prepare for common chief complaints like chest pain and shortness of breath.
4. Actively Participate in Team Discussions
   Contribute to differential diagnoses and treatment plans, but avoid dominating conversations. Ask thoughtful questions to show eagerness without overconfidence.
5. Get Familiar with the EMR
   Learn the basics of the EMR system quickly. Aim for clear, concise documentation that includes pertinent positives, negatives, and differential diagnoses. Write notes for all your patients.
6. Manage Your Time Well
   See patients efficiently and multitask effectively. Use downtime to see additional patients or follow up on tasks.
7. Be Open to Feedback and Reflect on It
   Regularly seek specific feedback from residents and attendings. Use criticism as a chance for growth and show that you're incorporating their advice.
8. Be a Team Player
   Collaborate with students, residents, and staff. Always offer help to anyone who could benefit from it.
9. Stay Calm and Adapt to Pressure
   In high-pressure situations, stay calm and focus on doing your job efficiently. Adapt quickly if things don’t go as planned.
10. Follow Up on Your Patients
    Track patient outcomes even after your shift ends. This helps you understand how your diagnoses and plans play out in real life.
11. Review and Study Outside of Shifts
    Read about cases you encountered and keep a notebook or app for clinical pearls. This helps reinforce learning.
12. Prepare for Shift Work
    Manage your energy by eating well, staying hydrated, and getting adequate sleep before shifts. Pack snacks!
13. Be Punctual and Reliable
    Arrive early and be prepared for each shift. Your reliability and punctuality will be noticed and appreciated.
14. Demonstrate Your Enthusiasm
    Show your passion for EM through your engagement and interest in the field.

Things People Don’t Tell You

1. Carry Fewer Patients Well
   It’s better to present a few patients thoroughly than to stretch yourself thin.
2. Ditch the Notebook
   Use a small sheet for jotting quick notes rather than a full notebook.
3. Ask Expectations at the Start of the Shift
   Every attending has different expectations; clarify them early.
4. Act on New Results Promptly
   Review new results quickly and propose changes to the plan, not just report them.
5. Small Gestures Matter
   Grab a blanket for a patient or keep trauma shears handy.
6. Be Eager to Learn
   Ask to observe procedures and engage with attendings about their roles beyond clinical work.
7. Stay Hydrated and Eat Well
   Drink water regularly and eat a good meal before your shift. People rarely eat on shift in my experience.
8. Study Efficiently
   Find manageable study methods, like listening to EMRAP C3 during walks or errands.
9. Use Imaging and Ultrasound Skills
   Practice interpreting images and using the ultrasound machine.
10. EMRA Books
    Use EMRA books to refine your differential diagnoses and treatment plans. They are excellent resources.

By following these tips and insights, you’ll excel in your EM sub-internship, make a good impression, and grow as a clinician.