How To Be a Successful Student in The ED: 101

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Hello Students! Welcome to one and all.

No matter what type of student you are, I wanted to share with you tips to make you successful during your rotation through the Emergency Department. I'm hoping this post doesn't come off as rude, but I am going to put things very bluntly, that way there are no gray areas.

I have been working as an EM PA for 2 years this upcoming March (2024). I also spent 16 weeks in the ED on two separate rotations as a student. I also used to scribe in the ED for 2 years prior to PA school, and traveled along the East Coast doing so. I am telling you all of this just to let you know I have spent quite a bit of time in the Emergency Department, functioning in many different roles. I have a very keen understanding to the ins and outs of how the ED runs, and how important each role is.

For many students, the Emergnecy Department is a scary rotation. It is busy. It is high risk, yet high reward. There are a million things going on at once. The amount of knowledge your are expected to know feels infinite. There are going to be staff and patients with very strong personalities that you will encounter. It is without a doubt, one of the most stressful rotations you are likely to experience. However, I can guarantee you that if you go into this rotation putting your best effort forward, it will be one of the most fun and rewarding rotations you will have.

Being a good, or successful, student in the ED ultimately boils down to one basic principle: Be Willing to Try

I know what some of you may be thinking, who would show up to a rotation (which students are PAYING a LOT of money to be at) and not try? But TRUST ME when I tell you I have worked with some very subpar students. Students who did not try. And these students weren't subpar because they answered "pimping" questions wrong or were given unreasonable expectations. These students were subpar because they showed up and were technically physically at the rotation, but other than literally physically being in the department did essentially NOTHING else unless asked.

On that note, we are going to segway into a lovely bulleted list of basic principles to follow on your EM rotation. Doing so will ensure 1) a good review, 2) a fun rotation, 3) lots of learning, 4) your moneys worth of experience (remember you are paying to be here.. many of your are in DEBT and took LOANS out to be here...), 5) you are a contributing team member.

Principle #1: Show Up & Be On Time

Showing up to your clinical rotation late is frankly rude. So much comes from a first impression, and first impressions go both ways. It's our first impression of you, and it's your first impression of us. Let's start these impressions on the best note possible. Of course, unforseen circumstances can and will happen. If you are pulled over on your way to your rotation, call or email someone letting them know you will be late. If you are going to be late for a reason that is out of your control (not due to oversleeping or poor planning). It takes a LOT of time and effort to precept a student. We are gladly dedicating that time to you, for your education, to teach and help YOU. So please show up on time (aka 10-15 minutes earlier than your scheduled shift) so you are settled in, had time to use the bathroom, time to put your lunch in the break room, and are ready to see your first patient with us the start of the shift.

Additionally, if you are scheduled to work a shift please show up. Of course if you are sick, or, have a personal or family emeregency are 100% exceptions. But I cannot tell you how many students have not showed up to their shift (especially toward the end) so they can study. Skipping your rotation to study is not acceptable. A big thing about PA school is prioritization of your time and staying organized. If every other student can show up to rotation and manage to find time to study, so can you. Understand that this is a reflection of your commitment to learn and your work ethic. If you are hoping to get a job offer from one of your rotations, do not miss your shift. I know students have altogether FAILED rotations because of this.

Principle #2: Introduce Yourself to Your Patients and Your Peers

I know how intimidating it is to meet new people in a new environment. I have been there. It is a very socially awkward situation. You don't know the flow, the culture, the relationships, or frankly, anything about anyone. That is okay. Introduce yourself anyway. One of my biggest pet peeves is when a student shows up and just stands there. They do not say hi, they are literally mute. I do not know who you are or why you are here. I do not know if you are an ED student, a student from a different department, a patient's family member, an employee from a different department, or some random person in the department.

Going back to first impressions, take that time to leave a good one by introducing yourself. A simple phrase such as "Hello, my name is ________. I am a (type of) student from (school). I am scheduled to work with (name) today."

Of course, you can modify that statement as you see fit, but a basic phrase such as what is mentioned above will take you a long way. Additionally, introducing yourself to your patients is important too. If you are at the point in your rotation where you are seeing patients initially by yourself, then going back in later with your preceptor, you are probably already doing this. But, if you are early on in your student journey and are seeing patients alongside your preceptor, if they do not introduce you to the patient, make sure you take the time to do so. A patient can feel uncomfortable not knowing who you are in the room. This can not only put them at ease, but by simply having the courage to introduce yourself you are showing us you care about patient rapport, and are willing to take initiative.

Principle #3: Know When to Ask Meaningful Questions

We are here to be an asset to your learning. We want you to ask us questions. It is okay to bring in your EOR topics or Learning Objectives with you to keep a copy in your bag. Then, when there is downtime, you can bring this out and ask specific questions regarding the content you will be tested on. I also recommend bringing test questions or principles that you are getting wrong on flash cards or practice questions. We can break down the basics with you so hopefully we teach you that principle well enough you get the question right next time.

It is important to know when to ask questions during a shift. During critical patients or when the ED is high volume and the provider is weighed down with tasks is not the time to do so. In these instances, write down your questions you think of throughout your shift, so you can ask your preceptor during a free moment, down time, or at the end of the shift. Again, we want you to learn as much as possible, but sometimes questions can distract from a more important task at hand.

You can also ask us about our careers, interviewing advice, resume advice, and resources we find helpful to pass to you.

Principle #4: Seek Out Learning Opportunities

When you are on your rotation, taking initiative is a key trait to have. For starters, your preceptor should not be asking you to see patients. Instead, you should be asking your preceptor which patient to see next.

I find that a lot of the students I have worked with have been lazy. Yes, L A Z Y. And I am not trying to put down others. However, I do have a great story to share with you all as an example:

As a preceptor, I used to ask students if they were ready to go see the next patient with me. One time, I asked a PA student that question, and they answered back to me, "No, I'll sit this one out." You must be wondering...why? No this student was not sitting "this one out" to use the restroom, get something to eat, or finish writing a note for a prior patient that I asked them to help me with. Any of these reasons I would have found excusable. This student was "sitting this one out" to do Rosh Review practice questions. Something that can be done at home. This particular student was giving up a great clinical experience to stare at the computer and do practice questions. Why show up to the rotation if you are not going to give your full effort and participate?

This particular instance put such a bad taste in my mouth. I was shell shocked. From that point forward, I decided that I am not going to 'hold someone's hand' to go see a patient with me. If you're working with me as your preceptor and see me going to see a patient, you should come with. I will no longer ask a student to see a patient with me. It is up to them to do the right thing, and take that initiative.

As a student, if there is a case you find interesting, you should ask to go see it. If there is a procedure or a task you want to try, you should ask to do it. Almost every time, I'm sure the answer will be yes. As a student I helped with central lines, intubations, NG/OG tubes, chest compressions during CPR, establishing IV access, I&Ds, splint placements, laceration repairs, FB removals, and so, so, SO much more.

The best thing about EM is we have see a little bit of everything. When specialists are consulted, you can go into the room and see their history and exam. You can learn from so many different people and resources in one magical place.

When I was a student, I would introduce myself to everyone (nursing staff, RT, phlebotomy, trauma, etc) with the following phrase:

"Hello, my name is _______. I am a PA student from (school) on my EM rotation. If you see me in the department and are doing something that you would be willing to teach me, I would love to learn."

This simple phrase opened more doors than I can count. It made my rotation SO much more fun and memorable. My procedure list was filled in record time, and I am sure it is because of this phrase.

Even if EM isn't the specialty you want to work in as a graduate, there is still so much to learn that you can take with you to whatever specialty you are going to be practicing in. We are not asking you to go into EM when you graduate, but we are asking you to be present and to give an effort.

Principle #5: Be Helpful

While you are with us, you are a valuable member of our team. Put your best effort in helping the team. In the ED, to stay afloat, we MUST all work together.

We know you don't have much experience, and are just learning. We DO NOT expect you to be perfect or an EM prodigy. But a lot of things don't require any of these things. You can help nursing staff place Foley catheters, roll patients, and get a patient a warm blanket. You can offer to run to the supply room to get a needed object while your preceptor is gowned and gloved doing a sterile procedure. You can help your preceptor by trying to write a note or two (& it is good practice, too). You can be helpful by taking the time to obtain a good history and reliable exam. We know this will come with practice, but working with a student who provides reliable information to us is much more helpful than working with a student who provides untrustworthy information, because that sets us back a step. We now have to start all the way back at square 1, and will continue to question every piece of information you tell us while you're with us.

I know a lot of these principles seem straight forward and self explanatory, but it seems from my own personal experience they may not be. Again, I did not write this to put anyone down. I love precepting students at my job. I was not a student too long ago myself and remember what it is like. I am writing this after having recurrent experiences that were simply put, unimpressive. Honestly, an unhelpful, uninterested student slows us down, and makes our jobs as providers much, much harder. We want to teach you. We work in EM because we love the variety, the acuity, and always seeing or learning something new. We love practicing medicine. We want to share that love with you. Show us you want to learn, too.

XO,

Manny ❤️

P.S.

How was your EM rotation experience? What made it good or bad? Please share in the comments below!