Welcome to Emergency Medicine: A Resource Masterpost for Newcomers

Welcome to the emergency department. A place of chaos, excitement, and lots of learning opportunities.

I hope this blog post will serve as a mini introduction, so you can go into your new rotation armed with the resources you need to succeed. It's broken down by training levels, from medical student to graduating resident, as well as "EM" and "non-EM" folks.

Let’s start with something that will benefit anyone, no matter the level: 

Whether you’re an MS3 rotating through the ED as a mandatory rotation, an off-service resident stuck in the ED for a mandatory 1 month rotation or a 3rd year emergency medicine resident, FOAMed is going to be your saving grace. 

FOAMed: what is it, how to use it? 

It stands for Free Open-Access Medical Education, and it’s a term that encompasses all the educational content that you can find on the internet at no cost: podcasts, blogs, some YouTube channels, even some apps. 

Most of these resources are very well-researched, evidence-based recommendations. After a while, you become familiar with different websites and start to have favorites, but the first five are usually very reliable. 

Before each patient interaction, do a quick FOAMed search for their chief complaint so you don’t forget key concepts. How? 

Type this into Google: “hemoptysis FOAMed” 

If it’s not coming up with the desired blogs, add “emergency medicine” to the search bar, so it looks like this: 

Here’s a link to the first one, to give you an idea of how amazing these resources are. They give clinical pearls, helpful differentials, diagnostic recommendations and so much more. 

So let’s go by level: 

MEDICAL STUDENT LEVEL 

Welcome to the ED. I hope you love it with us. Here is some information to help you get prepared:

If you’re going into emergency medicine:

First things first, sign up for EMRA. They will send you a Welcome Box and it comes with a PHENOMENAL clinical handbook called EM Fundamentals. Here’s a direct link to the book on Amazon, but you get this and a bunch of other helpful books and supplies if you sign up for a membership.

Use FOAMed resources as mentioned above, it will help you a lot.  

• How to Crush Your SLOE: A Podcast Series 
  • Before you start your rotation, give this podcast series a listen, whether you’re an MS3 or MS4. If you’re an international medical graduate, this is still incredibly helpful. 
  • This series is worth its weight in gold. Seriously. Listen to it. It’s short, sweet, to the point, and all of his suggestions are fantastic. I’ll cover a few things that I’ve found to be important, but he does it better.
  • https://www.emclerkship.com/tips-1-5/

Here are some of my favorite medical student-level podcasts: 

• EM Clerkship (the whole rest of the podcast) 
• EM Docs 
• Core EM
• Anatomy for Emergency Medicine (old podcast, but still excellent) 

Now for some general tips. Here are some things I recommend to all EM-bound students, after working as student coordinator for my program for 6 months: 

• Don’t be late. Seriously. It looks bad and we all notice. At least 10 minutes early to shift is perfect. 
• Be prepared with supplies: shears, stethoscope, pen, etc. 
• Act interested, be eager, look like you actually want to be with us. It really changes how people relate to you.
• Anticipate what your team might need: bring the ultrasound bedside, gather supplies for the laceration repair, etc. 
• You shouldn’t be bored. If you don’t have anything to do, find something to do. Here are some ideas: 
  • Ask nurses if you can help with IVs 
  • Reassess your patients: do they feel better after the meds? Did they give urine yet? 
  • Ask if you can see a new patient (and choose a specific one, by saying, "Is it okay if I go see Mr. Smith in Room 2?")
  • Read about your patients’ conditions online, check FOAMed resources before you present to your resident, and be ready to come up with a good differential
  • We all use our phones at work, but don't be constantly glued to it. And if you are on your phone, it definitely shouldn’t be Instagram/texting

If you’re not going into EM:

This rotation still has the potential to teach you a lot. A lot of patients come through the ED, so understanding the workflow is helpful to have a good relationship with your future colleagues. No matter what you’re going into, there’s a lot to learn.

The limitations of the emergency department are often a source of frustration for our consultants, but I think that once you work with us, you start to understand a little better what the constraints of an ED workup. 

Be honest about what you’re going into, but be eager and show a desire to learn. Residents and attendings alike will relate differently to you if you show a little interest.

RESIDENCY-LEVEL

The FOAMed search method I mentioned above works great in residency too, so don't forget to use it.

If you're an off-service rotator:

For those of you doing a mandatory EM rotation (I’m looking at you, anesthesia and internal medicine) – welcome. Seriously. I hope you enjoy the ED. There’s so much to see and do, and we're a friendly, generally happy group. 

Here are some of my tips: 

• Respect our schedule. We do shift work, and we are rarely late (hopefully). Even if you don’t have to take sign-outs (our off-service rotators don’t), it’s still important to show up a few minutes before your shift starts. You’re part of the team now. 
• Introduce yourself to us, let us know how long you’ll be with us, and what you’d like to do/learn/see. 
• Your time in the ED is a great chance to get better at procedures: lines, ultrasounds, and more. A lot of the “rare” procedures may go to the interns or the residents (sorry about that), but we’re happy to teach you whenever we can. But it’s important to let us know what you’re interested in doing. 
• Use this time to LEARN as much as you can. If you’re in IM, a lot of your future patients will come from your ED colleagues. Seeing / experiencing the trials and tribulations in the emergency department will make you a more compassionate colleague. 

As for resources, a lot of the same ones I talked about for MS-4s are really really helpful. The EM mindset is a little different than you might be used to, and the workups are a lot more “limited” than on the floors. 

For my beloved incoming emergency medicine interns:

Welcome to the best specialty (hehe). Do not feel the need to study before residency starts. Relax, build good habits, and get into a wellness-mindset (fitness, eating well, sleeping enough). Build good routines so that they’ll be easier to maintain. 

For the first few months of residency (or weeks leading up to it, if you feel like you MUST study): check out the AliEM curriculum. Here’s the direct link. 

It’s phenomenal.  

Otherwise, your best friends are going to be: 

• PediStat for pediatrics doses
• EMRA Antibiotic Guide (app or booklet, either way, it’s worth the money) 
• WikEM and other FOAMed resources 
• ECGWeekly (paid, but our program got us a subscription, so worth an ask) 
• EM:RAP (paid, but if your program gets you ACEP membership, it’s included) 
• Rosh Review (hopefully your program gets this for you) 
• UpToDate for weird doses 
  • Note that most hospitals will give you free UpToDate access so you don’t have to pay for it – just log into your account from a computer at your institution to get free access. 
• Your fellow residents (they have a wealth of knowledge about how things are run at your place) ]

Podcasts that I think are great: 

• EM Docs: pure gold
• Emergency Medicine Cases: my favorites are the Quick Hits series 
• Internet Book of Critical Care: no longer updated, but their old episodes are all excellent
• Core EM: solid, basic things you should know
• Anatomy for Emergency Medicine: a very niche podcast that may come in handy; no longer updated but still relevant 

For my fellow burned-out senior emergency medicine residents:

If you’ve been doing this for a few years, you will likely know a lot of the basics. This is when it’s time to level up your knowledge, go beyond what you’re taught by your attendings, and develop your own practice. 

The above resources should all be familiar to you. 

The follow ones are what I consider sort of “next level.” 

Let me start with podcasts, most of which are FOAMed (free, open-access). 

• EM Rapid Bombs (paid): an auditory question bank, to prepare you for your board exam 
  • EM Board Bombs (free): slightly longer-winded, free version
• EMCrit (free and paid): this isn’t your basic emergency medicine content. I only recently found out that the paid version is only $20 for residents, which is an absolute steal. Highly recommend. However, he’s got tons of great content for absolutely free.
• Skeptics Guide to EM (free): they dissect research papers using the PICO approach
• ResusX (free): relatively new podcast but very powerful; their DKA episode changed the way I think about DKA
• The Resus Room (free): they also discuss papers, and they have a “Roadside to Resus” series, which talks a lot about prehospital medicine 
• Stimulus Podcast (free): a bit different than the above-mentioned ones - this is about how to maintain career longevity in medicine (fight burnout, be happier, etc.) 

And finally...

For those of us getting ready to graduate residency and move onto the next phase of our lives:

There's so much to think about, it's a little overwhelming.

If you're going into fellowship, a lot of this advice is still relevant.

If you're going straight into working, you'll want to start looking for a job around the end of 2nd year. Some of my co-residents signed as early as September of PGY-3, but of course, it varies.

Your job for the last 10-12 months is to start getting your finances in order. You may want to hire a tax person (I will, for sure), but long before that, there are some things to think about.

In terms of your finances, time to educate yourself.

• Podcast: Financial Residency (give it a listen, it’s great, I learned so much) 
• Podcast: White Coat Investor (also a blog)
• Travel hacking / points: I wrote a separate finance blog post, check it out here 
• Disability insurance: don’t graduate residency without getting it.
  • I signed up my first year of residency and pay about $90 with each paycheck, but you can wait until near the end of residency. 
  • Set up a free call to discuss your options with a broker (affiliate link)

Medical malpractice: I started thinking about this more and more as I went through residency. The jitters started early PGY-3 and continue into today. Here are my thoughts.

For starters, I DON’T recommend this for the juniors. Don’t obsess over your notes. Do not worry about liability and lawsuits. Your job is to learn how to take good care of your patients. 

I think late PGY-2 is a great time to start thinking about this stuff. 

It's not just about protecting yourself medico-legally: it's also about patient safety and providing good care, and these have given me a lot of food for thought.

• Here are my favorite resources so far:
  • MedMal Insiders (podcast): this is FREE and extremely bingeable. Not all the episodes are related to emergency medicine but they are short and still offer a ton of value. 
  • MedMal Reviewer (newsletter): free, with a paid option (which I haven’t been able to afford yet). These are long-winded cases that are also fascinating – you can learn so much.
  • EMCrit also has a few medicolegal episodes which I thought were great

I’m planning a full “Path to Attendinghood” ebook or course or series or blog post (clearly haven’t decided yet), so much much more on this, coming soon. 

Please let me know what questions you have. So much more to come!