By: Cody Couperus

Here I present a few methods to study for your clerkship, some rotation advice for EM bound students, tips for learning critical EM skills, and some continuing education ideas. I hope that this resource will be useful to you in your EM adventures, and please give us your feedback on this project!

The General Approach

  1. The Basics – “I just want to do well on my clerkship and on my shelf exam”
    1. Purchase a copy of EMRA’s  Basics of Emergency Medicine ($15)
    2. Subscribe to an EM podcast (EM Clerkship, EM Cases, Core EM, EM Basic, etc)
    3. Be an active participant in the ED – act excited to be there – be excited to be there!
  2. The Considerer – “I’m trying to rule in or rule out EM as a career”
    1. Do the basics (above).
    2. Consider purchasing the 600 question Rosh Review question bank ($99)
    3. Read the EM Clerkship Primer.
  3. The Future ED Doc – “I’m hard committed to EM, it fit’s me like a glove”
    1. Do the 1200 question Rosh Review question bank ($199)
    2. Read through Introduction to Clinical Emergency Medicine or EM Secrets (in my opinion they are better than the other books).
    3. Subscribe to as many EM podcasts as you can find and pick 4-5 favorites
    4. Get an EMRA membership ($55) – Don’t wait, I promise it’s worth it!
    5. Be serious about learning ECGs, ultrasound, and radiology (see below).
    6. Review the basics for common EM procedures (Lacerations, Abscess I&D, Lumbar Puncture, RSI, Central Lines)
    7. Have easy access to definitive resources (Rosen’s or Tintinalli’s) and a procedure book.

Rotation advice for EM bound students

If you research advice for your EM rotation then you’ll undoubtedly find comments emphasizing how you are constantly being evaluated and how your interview is the whole rotation. People who say this are, indeed, correct – but I think the emphasis is all wrong. What is important is to do your best, keep learning, and enjoy your shifts. A motto I’ve tried to use is, “smile, be nice, and be smart.” Honestly, if you are enthusiastic about being there, excited to learn, and nice to the people around you, then you are going to be successful. That said, any level of competence you can muster is going to help you go the extra mile and look like a rock star. 

So the question then is, “how does one gain and maximize competence?” Well, the answer would depend on if you’re considering knowledge, critical thinking, history taking, physical exam, procedures, diagnosis, management, or something else. 

I do believe that having a large fund of knowledge is instrumental to achieving the highest levels of success. This means consuming educational content related to emergency medicine on a daily basis. Hopefully, since you love EM, this activity will actually be fun and engaging most of the time. EM is a great place to be an independent learner. There are so many ways to consume new knowledge from podcasts, blogs, or textbooks. Continued learning has to become a habit and you should start now. I urge you, do not wait for somebody to teach you something – be an advocate for your own fund of knowledge. Go out there and get it. 

Some things can’t be learned through a podcast or textbook and this is where experience and practice come in. For things like history, physical, ultrasound, and procedures you have to do it before you can truly know it. When you see a patient with a pathology and when you see an abnormal finding yourself, then this is when you know it the best and can identify it again in the future. This is not to say that being prepared is not helpful. Certainly, reading up on procedures and knowing the questions to ask will be useful, but I do not think it can take you 100% of the way to competency. All of this said, be engaged in your rotation and try to see as many patients as you can – even the drunk guy in the hallway. Do anything except sitting and waiting. You never know if that drunk guy is actually having an MI until you ask him some questions. 

So, yes, on your rotation you will be constantly evaluated, but instead of worrying about that try to smile, be nice, and be smart. Consume educational content every day in some capacity, read your textbooks, do your question banks, read up on procedures, figure out how be an EKG master, and overall be an advocate for your continued growth as a clinician. Doing this will make you look like a rock star, will make people want to work with you, and will get you that top notch SLOE.

Skills to Master

  1. Learning ECGs: Here is one strategy to learn this very important skill.
    1. Review this blog post by Adam Rosh, MD
    2. Get the book: ECG’s for the Emergency Physician by Amal Mattu ($30)
    3. Do at least 10 ECGs per day, write down your interpretation, check the correct interpretation, write down what you learned
    4. Repeat over and over. 
  1. Learning Radiology: the key here is that you don’t need to learn all of radiology. Try to focus on chest xrays, abdominal xrays, chest CT, abdomen CT, and head CT. 
    1. If you have 60$ to spare, the best way to learn EM radiology is to watch a Radiopaedia on demand course – they are really well done. Take notes!
    2. I highly recommend “Learning Radiology: Recognizing the Basics” by William Herring. Read chapters 2-20, 25, 26, and 27. This is about 250 pages total, but there are lots of pictures I promise. This was a game changer for me. 
    3. In practice, try to commit to your own read before viewing the radiology report. Practice, practice, practice.
  1. Learning Ultrasound:
    1. Learn one ultrasound exam at a time. Watch one video on how to do it, try it on a patient, and then watch more videos based on where you struggled.
    2. While your very nice patient is waiting 2 hours for their CT scan, ask if they would be willing to let you ultrasound them for learning purposes. Seriously, THIS IS THE SECRET TO LEARNING ULTRASOUND AS A MED STUDENT.
    3. Below is a suggested sequence to learn ultrasound exams, each exam should take about an hour to learn prior to practicing it
      1. 4 view cardiac exam including parasternal long axis, parasternal short axis, four chamber view, and subxiphoid view
      2. EFAST exam  (trauma)
      3. Lung ultrasound basics
      4. RUQ exam (gallbladder)
      5. Renal ultrasound (kidney stones)
      6. RLQ exam (appendix) [good luck comrade] 
      7. vii.RUSH exam (the “my pt is dying of shock and I don’t know why” exam)
    4. I highly recommend “Critical Care Ultrasound” by Philip Lumb. This has very good chapters on DVT ultrasound, echo, lung ultrasound, and peripheral IV access.  
    5. On that note, get somebody to teach you US guided IVs. This is hands down the best way to get good at ultrasound guided procedures. Doing a US guided peripheral IV and a radial arterial line are very similar, for example.  
  2. Common Procedures
    1. Youtube each of these sometime the week before your rotation that way you have some semblance of familiarity and can do the procedure with guidance and supervision.
      1. Interrupted sutures with instrument ties, digital nerve block, nasogastric tube, orogastric tube, peripheral IV, foley catheter, abscess drainage, paracentesis, thoracentesis, and lumbar puncture.
    2. Special case: intubation – I’d recommend trying to do a couple weeks of anesthesia before your EM rotation if only to get basic competence with intubation. During a trauma when your attending asks if you’ve intubated before and you say “I’ve done a couple dozen,” then you’ll be glad you did that rotation, trust me. 

EM Resource List

  1. Books
    1. Review books in order of quality (in my opinion): EM Secrets, Introduction to Clinical Emergency Medicine, Blueprints, Case Files, First Aid (the later few are a little shorter)
    2. Procedure book: Roberts and Hedge’s Clinical Procedures in Emergency Medicine. 
    3. Definitive resource: Rosen’s or Tintinalli’s
    4. Question bank: the main qbank will be Rosh Review, they have a medical student package (600 q’s) and a resident package (1200 q’s). You may also consider the SAEM qbank.
  1. Podcasts 
    1. EM Clerkship podcast – ☺ (obligatory)
    2. RoshCast – questions reviewed from the Rosh Review EM Qbank!
    3. EM:RAP paid, or free with an EMRA membership – excellent monthly focused education (C3 content) and more heterogeneous podcast (EM:RAP) and also some bonus content in between!
    4. Emergency Medicine Cases – check out the archives for wonderfully done reviews on topics like GI bleed, stroke, pediatric trauma, and more!
    5. EMCrit – focuses on critical care topics, be sure to check the archives for some of the best discussions I’ve ever heard on vasopressor usage and BP management in the ED!
    6. The Curbisders – an internal medicine podcast, but quite relevant for EM docs too
    7. The Skeptics Guide to Emergency Medicine – systematic literature review of EM related articles. This is really well done and you’ll learn a lot about big impact studies, how to review literature, and how to put that into practice.
    8. Mastering Intensive Care – about the art of medicine, talking to patients, and being an all around great provider. I’d strongly suggest listening to the 2017 year end review! 
    9. ERCast
    10. The RAGE Podcast
    11. Academic Life in Emergency Medicine
    12. CRACKCast
    13. IM Reasoning – an IM podcast, but many really relevant episodes.
    14. Louisville Lectures (video) – also IM, also relevant.
    15. Ultrasound podcast
    16. FOAMcast
    17. Annals of Emergency Medicine
    18. Pediatric Emergency Playbook
    19. EMsanbox
    20. The Resus Room
    21. RCEM Learning
  2. Phone Apps – some are obvious, like UpToDate, but check these out!
    1. Check out the episode on this topic
    2. Full Code Pro – if you’re asked to keep time in a code, rock it with this app – (you’ll probably see some of the nurses using this one!)
    3. MDCalc – has your HEART score, CURB-65 score, Well’s criteria, etc at easy access
    4. Pedi STAT – all your pediatric dosages, normal vital signs, ETT size, and much more.
    5. 1 Minute US – quick review on commonly done ultrasounds
  1. Online resources
    1. EMRA  – the best thing here for a med student, honestly, is the free EM:RAP membership and a discount on the Rosh Review qbank. That said, there are lots of other great benefits: https://www.emra.org/benefits/
    2. EM Clerkship Primer: 100 page book on how do rock your rotation! Lots of great advice in here about taking histories, interacting with preceptors/staff, presentations, differentials, and much more!