Discover Top Posts Tagged with #residency issues

News Max - Donald Trump Tweet- Rick Grenell on Nevada

News Max – Donald Trump Tweet- Rick Grenell on Nevada

https://twitter.com/realDonaldTrump/status/1325967327611981829?s=20

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#Donald J Trump #Nevada #residency issues #Rick Grenell

Poe camp confident against citizenship, residency issues

The camp of Senator Grace Poe is confident, the case questioning her citizenship and residency has no legal leg to stand on.

Poe camp confident against citizenship, residency issues

#Poe camp confident against citizenship #residency issues

Don’t Be a Gym Teacher: The Value of Teaching Medical Students in the ED

Did you listen to Joseph Cruz's guest posts on his top 10 momentum breakers? If not, shame on you. Go listen to Part 1 and Part 2. Go ahead, we'll wait...

Did you hear how he discussed medical students in the context of breaking momentum? Joseph of course discusses some strategies in there to get medical students to work with you and be engaged. Well, a few listeners stood up for our med students. One of them was one of my current chief residents, and soon to be ultrasound fellows, Mark Gonzales, DO, MPH. So Mark decided to write the following piece. I agree wholeheartedly with Mark, and love working with medical students. And, I think it is crucial to learn how to be a good teacher as a resident, even if you're not planning on being an academic physician (look out for some upcoming related content on iTeachEM...). Read on to learn how you can do better by your students.

- Bob Stuntz, MD

“Those that can’t do, teach, and those that can’t teach…teach gym.”

– Jack Black, School of Rock

Comical, and hopefully inaccurate, this line from the movie School of Rock points directly at one of the saddest stereotypes about education in general: that people become teachers because they’re unable to do the work in their chosen field. Whether there’s any truth to this or not, this statement has no role when it comes to teaching emergency medicine. In our world, a quality teacher simply cannot be an inept clinician. And this responsibility goes for us as residents as much as it does for our attendings. Medical students require quality teaching from us much like we require adequate guidance from our attendings.

I heard someone once say, “I can only be expected to be as good as my attending.” There’s at least a partial truth to this. In turn, the same goes for the guy in the short white coat that showed up to work your shift with you. He is somewhat of a reflection of you by the end of the day, depending on how valuable you were to him. If you complain that he just follows you around or neglect him because he’s not going into EM or abandon him because his 7-minute presentation about a sprained ankle frustrated you, you’re not doing him any favors.

To me, it is a privilege just to be around medical students, let alone be a part of their education. And in EM, we almost exclusively have 4th year medical students – ones who have been through at least a year of clinical rotations, which makes teaching them that much easier. By the time they’ve gotten to you, they’ve picked a specialty that they’re hopefully excited about, they’re anxiously navigating the match process, they’re traveling to interviews, they can make more sense of the patients they see than they could a year ago, and they generally have a pretty good understanding of their role in the clinical setting. Do you remember your 4th year of med school?

Whether they’re going into EM or not, they have a lot to gain from you, and probably more than you realize. Our specialty applies to every other specialty and all doctors need knowledge of what to do in an emergency if they’re the only one around. Sure, a budding pathologist may not be all that interested in her EM rotation at first but you’ll never find someone more excited to make sense out of a CBC differential. So meet her halfway and do whatever you can to involve her interests with as many patients as possible, so called “learner-centered education1.” When she’s reviewing slides in the lab one day and you helped her understand how debilitating a sickle cell crisis can be or what it’s like to tell someone you found an apple core lesion on their CT scan, she’ll gain an appreciation for the big picture. It’s easier to draw interest out of them than you may think.

We’re also the only specialty with a board certified attending sitting next to us during every shift. Teaching opportunities are abounding in a busy ED and the answers from an expert are always at the ready whether you know what to tell them or not.

Have you ever worked a shift with a medical student when there aren’t enough “real” emergencies? Play the “what if” game. “What if” this weakness patient was 7 months old and liked to suck on bottles of honey? What would you consider if this first time mother who brought her crying, snotty-nosed kid in at 3am brought in a child who was inconsolable but otherwise well? You can do this same sort of thing with sick versus not sick. For example, you can do a FAST exam on a minor/stable trauma patient and show them what to look for if the patient was hypotensive. Or take that same patient and explain a clinical decision tool like NEXUS or Canadian C-spine. Or even just use this to introduce them to the NNT.

Some other ideas and considerations:

You can always go into the room with them and let them run the show, stepping in only if they really need you.

There’s always a pile of EKGs lying around somewhere. Same goes with the PACS list for reviewing CXRs and head CTs.

Want to cover the nuts and bolts of a given topic? ALiEM has you covered with Michelle Lin’s Paucis Verbis Cards, which you can easily load on your smartphone for free.

Take them on a “flow tour” through the ED – from triage through checkout. They’ll gain an appreciation for patient flow and develop a basic concept of the bigger picture.

Show them different parts of your shop – give a detailed tour through the trauma bay or the airway cart or the suture cart. You might even discover something there yourself.

Go into an empty exam room and just start giving them a case where they have to figure out how to use a piece of equipment (transcutaneous pacing is a good one).

Suggest a blog or podcast. This list is a good start, but of course don’t forget to mention EMRes.

EM is a case-based specialty. They should know and read this book.

Set them up for presenting to the attending the way you know the attending will want. You’ll both look good and you’ll get along better for it.

Set them up for their intern year. Have them do discharge instructions, have them figure out what specific x-ray views they want, see how they do with picking up two patients at a time if you feel like they’re ready for it.

Are they a little long-winded with presentations? Break the case down for them into illness scripts so they have an idea of what’s important (i.e., 37yoF, recent 10 hour road trip, smoker, takes OCPs, here with chest pain and tachycardia).

Is feedback awkward for you? Just do the sandwich thing – a positive, a point for improvement, then another positive (i.e., “Your documentation is thorough and your presentations are concise and right on point. You could probably improve by following up on patients a little more timely and letting me know results before I see them, which will make you that much more impressive. This shouldn’t be difficult given your level of enthusiasm and how patient-centered you seem to be.)

Fortunately medical students can be valuable to you as well. This is an opportunity for you to recognize your own gaps and broaden your own knowledge base. You’ll start asking yourself questions and leading yourself to more answers. This only makes you a better clinician. Try not to just view them as an impediment to your efficiency or your free pass out of rectal exams for the day. Utilize the capabilities they have to make you more efficient. You can always see a couple patients while they’re seeing one and get a good start on your note while they present to you. Or you can pop into the room where they’re seeing a patient and have them do a bedside presentation after you finish up in another room. Again, these are 4th year students – give them a little more room to do things and a little push of their comfort level so they’re more ready for life as an intern in a few months.

Finally, some people like giving them rules. I have only two rules for medical students: 1) never hesitate to find me if something seems wrong (abnormal vitals, looks sick, acute changes, concerning mechanism of injury, etc.) and 2) let me know if you want to see another patient. That way they’re more comfortable saying they’re uncomfortable and I can make sure they’re not walking into a bad situation. Set them up for success and recognize their value. View it as a symbiotic relationship between the two of you. Don’t be the proverbial gym teacher.

Guth, Todd A. Resident as Educator: A guidebook written by residents for residents. EMRA. 2013.

Joshi, Nikita. What makes a good clinical educator? Academic Life in Emergency Medicine (ALiEM). 1 May 2014. http://www.aliem.com/makes-good-clinical-educator/

#residency issues #medical students

Episode 27: Momentum Breakers, Part 2

In Epsiode 27, EM Resident contributor Dr. Joseph Cruz of edocc.com rounds out his top 5 ED shift momentum breakers for the EM resident. We have talked about the importance of mental simulation and preparation for your shifts before. It is just as important to think about what is going to slow you down or stop you in your tracks on your next shift.

If you are interested in helping contribute to the EM Res Podcast, let me know. I am always happy to have resident contributors as well. Make sure to check out Joseph's blog, The ED on Cruise Control. Follow him on Twitter @CruzaderJC. Our next few episodes will be coming from another guest resident contributor, Jacob Avila (@UltrasoundMD), who will be talking about the use of US in undifferentiated dyspnea.

Also, make sure to check out the EM Res Podcast Google community, and head on over to Emergency Board Review if you are interested in helping out with a completely free resource for EM board review!

#residency issues

Episode 24.5: "EBM is crap..."

While making Episode 24, we had a little aside talking about the pitfalls of evidence based medicine. It did not really fit in with the full episode, so here it is in all its half episode glory. Dr. Kaminstein makes his feelings known, and we talk about those feelings. Some great points are raised and debated regarding the art and practice of our specialty, and how EBM fits in. What do you think? Let us know in the comments below.

#evidence based medicine #residency issues #emergency medicine

Episode 24: What do I read, and how do I do it?

In Episode 24, EM Res vets Drs. Kaminstein and Kochert return with Dr. Becker's debut to talk about how residents should approach reading medical research articles. Do you need to read everything? What should you read? How do you do it? All this and more in the first of a series on reading original research for residents.

The first thing you need to know is that if you are an intern, and maybe even a second year, it is ok if you are not keeping up to date on the latest and greatest in original EM research. The most important thing you can do during this time is to cover the basics. Develop your basic knowledge and skills in EM.

Once you do delve into research, pick one or two journals to start out with. Annals of EM and Journal of EM come to mind (full disclosure: I am on the Annals Social Media team, and on the AAEM YPS board). Once you have a journal or two, skim the titles and see what interests you. If you see an interesting title, read the abstract and see if the full article is worth your time.

Remember, once you start reading, the discussion is the writer's chance to slant their results as they see fit. There is a reason this section is last - it should be the least important part of your analysis.

Think about articles in PICO format.

P: What type of patient are they looking at/what is the patient population?

I: What is the intervention?

C: What is the control?

O: What are the outcomes?

This should give you the foundation to start. This is the first in a series of podcasts where we will cover more advanced topics so that you too can be able to critically read and appraise the medical literature by the time you are done with your EM residency.

Here are some great resources cited during our discussion:

The Skeptics Guide to EM

Emergency Medicine Abstracts

EMCrit

EM Literature of Note

EM Nerd

EM Journal Watch

EM:RAP paper chase

SMART:EM

A few announcements:

I have been away for the last month working on Emergency Board Review! Go check it out. Check out our latest review lecture on nervous system disorders. Find the lectures on our podcast on iTunes, or any podcast software. Check out the revamped website, rate the board review resources, and get involved. Are you an upper level resident and want to help out with the Emergency Board Review project? Get in touch with me at [email protected], or use the website contact form if you are interested in any of the open topics

Want to write for the EM Res Blog? Have an idea for an article, or even a series (US of the week, Image of the week…)? Want to help with podcast episodes? I want to expand the EM Res Blog and Podcast, but I need your help to do it. Residents, educators, anyone anywhere - send your ideas to me at [email protected] or @BobStuntz, and let's see if we can make this thing even better!

Please go join our Google Community. The goal is to have this be a place that EM residents and educators (you can help answer resident questions) can get together to discuss resident issues and questions, both clinical and non-clinical.

Allowed to use my podcasts for asynchronous learning? Check out the test below!

Check out the podcast below, or go listen here.

If you have gotten approval from your program director to use the EM Res Podcast for individualized interactive instruction (asynchronous learning), the check out the test below or go take it here.

#emergency medicine residency #emergency medicine #residency issues #research

Episode 23: What's the "Best" Residency?

In Episode 23, with the upcoming US EM residency interview season about to descend upon us all, I talk about a recent survey that claims to list the best EM residencies, why you should ignore it, what applicants should look for in a residency, and our duty as educators to find the right fit.

f you are a medical student going into the EM Match this year, check out the following great videos to see what you should be doing, and how you can be the best applicant you can be:

The EM Rotation, ERAS, and am I competitive

Interviewing Strategies

Here is the original link I saw to the list of top EM residencies as compiled by Doximity and USNWR's survey

ere is a link to the consensus document regarding the problems with this report.

Announcements:

Listen here or check out the podcast below:

#residency issues #ERAS #SLOE #EM Match #interview

Episode 22: Do an H/P, But Don't Forget Ultrasound

Episode 22 is a response to an article on KevinMD from April 2014, "Forget Ultrasound, Do a Proper History and Physical Instead." In this article, written by a radiologist, Dr. Saurabh Jha (@roguerad - follow him. I do, very interesting thoughts and perspective), the argument is made that POC US is being done indiscriminately, instead of a good H/P. Amongst other things, the article concludes that POC US is bad for patients, costing taxpayer money and leading to over testing and over diagnosis. POC US has been similarly accused recently in regards to leading to over testing (see this thought provoking post from EM Nerd). Dr. Jha's article was originally written in response to this article from NEJM, which sang praises for POC US, but did have some mischaracterizations.

Admittedly, we may have overall overreacted a bit to this article as can be seen in the comments (the title alone is inflammatory, but frankly KevinMD often is recently). Dr. Jha made the following clarification in the comment section:

"I'm advocating against indiscriminate use of ultrasound, as routine, as a substitute or extension of H & P (see NEJM article), not against selective use of imaging within clinical context."

We agree in some respects:

We should all absolutely be doing a good H/P, and using US as a diagnostic test in the clinical context of our patients.

We should all be properly trained.

US is not a simple, learn this overnight kind of thing. It takes dedicated training, and constant learning and practice - which we do well in the POC US community.

The US is not a stethoscope, nor is it an extension of your physical exam, and should not be used indiscriminately.

But, the physical exam is not so great:

How good is a Rovsing's sign?

How about a Homan's sign? See here or here.

Murphy's sign?

One thing we do know is that POC US does have a positive impact on patient care through faster door to diagnosis times, faster throughput, and improved patient satisfaction, based on previous POC US studies.

Announcements:

Tumblr Users: I'm aware of the video issue and will do my best to get it to cross over. Consider following the blog here at emrespodcast.org, or subscribe to the RSS feed. Getting a bunch of new Tumblr followers recently, so want to make sure this is working out for you.

Now, onto the Podcast:

Listen here or listen below:

#Ultrasound #Radiology #History and Physical #emergency medicine #residency issues #decision making