Emergency Medicine

Emergency Medicine is a totally rad four-week clerkship with eleven 8-hour clinical shifts and 4 didactic sessions. You will receive your schedule about 2 weeks before the start of the clerkship and typically work with a different doctor each shift. Shift times vary and you can swap with other people during the clerkship as long as you let the directors know. The only limitation is you cannot legally work two shifts in too close of proximity due to work hour guidelines (e.g. you should not be working an afternoon one day and then the morning the next). You may have some night shifts depending on how many people are on clerkship with you; typically it is no more than two nights total, usually consecutive. You are expected to present one interesting case presentation (very casual). They have an online learning tool called Rosh Review designed for EM residents which you are expected to sign up for and use (mildly useful for shelf, may be a bit too detailed). There is an NBME shelf at the end of the rotation. Overall, the rotation will give you as much as you want to put into it, but it is an excellent opportunity to work on your independent interviewing, examination, and plan-creating skills. This is the time in med school when you feel most like a real doctor!

• Clinical shifts (8-hours each, 11 shifts total)

• EKG curriculum (self-review, nothing to turn in)

  • Tutorial 

  • Bradydysrhythmias 

  • Tachydysrhythmias 

  • Assessment 

• Rosh Review (200 “required” questions)

• Self-reflection assignment (no length requirement, open-ended)

• Simulation session (on orientation day)

• Case Presentation (10-15 minute powerpoint)

• NBME Advanced Emergency Medicine Clinical Examination 

• Students must score greater or equal to the 10th percentile on the NBME  exam. 

• Students will be evaluated by all the faculty with whom they work through MedHub evaluations

• Complete 200 questions in ROSH review

• Complete self-reflection assignment

All grading is holistic; if you’re getting good scores generally, you shouldn’t stress about your NBME. The faculty evaluations are key.

“High Pass and Honors may be awarded to students who demonstrate exceptional overall achievement across the components of the clerkship, and will not be automatically denied or awarded based on NBME exam score alone.”

No limit to the number of Honors per rotation.

Here is what a typical student schedule might look like, but it is HIGHLY variable. This represents only one week. Each MS[letter] is a different student. They will list the shift start time, but then refer to the Shift Times guide to figure out when the full shift actually is.

You’ll have 11 shifts total and 4 didactic sessions. The least amount of shifts I had in a week was 2 and the most was 5.

Shift Times

6a = 6a-2p

7a = 7a-3p

8s = 8a-11a

8a = 8a-4p

9s = 9a-11a

9a = 9a-5p

10a = 10a-6p

12p = 12p-8p

1p = 1p-9p

2p = 2p-10p

3p = 3p-11p

4p = 4p-12a

11p = 11p-7a

• Mayo Clinic Emergency Department

• There are two “zones" in the ED — orange and green. In the morning, check with the nursing station to figure out which zone your attending is in and head to that workroom. You can use any of the open workstations, there's usually plenty open. Also check out one of the phones from the central nursing station at the beginning of your shift.

• At the beginning of your shift, you’ll hit “sign in” after you log into EPIC under the PMXH ED context. This is a little button at the top left of the ED status board. You’ll then login as a medical student and put your ED phone in so people can contact you. The ED automatically assigns patients to physicians, so you’ll have to keep an eye on the status board constantly. Once you're ready to assign yourself to a patient, you can right click on the patient and hit "assign me.” So for example, if you're working the 7am-3pm shift, keep an eye out for any patients automatically assigned to the 7a physician on the board. Those can potentially be your patients!

• Clinical Performance Evaluation

  • Each day, you should come probably 5-10 minutes early to shift to check a mini schedule at the desks to find out where your preceptor will be (green or yellow workroom).

  • Meet up with your preceptor and introduce yourself. Starting 15 minutes before your shift time, your preceptor will get assigned patients. Sign up your name next to the patients you would like to see and inform your attending. Do this quickly or sometimes residents may hop onto the patients.

  • Go see your patient, get an H & P, develop a ddx and plan, and present to your attending. They may see the patient with you or without you and then agree or disagree with your plan. You should attempt to put in orders yourself for practice, although this is not required and several attendings do it while you present.

  • Write your ED note. You should update this (easiest through ED Events) as the patient’s testing comes back.

    • Tip: click the bell icon to be notified of when results are available!

  • If they end up getting admitted, you should call the admitting team and sign out the patient to them.

  • You can see as many or as few patients as you feel like. A reasonable workload is one where you are seeing interesting patients but not having to stay late to finish notes. This may entail 3-4 patients depending on the difficulty of their case. Your team does not get assigned new patients 90 minutes before the end of your shift, so you may leave early if you front-load and wrap up your patients early.

  • At the end of the shift, you should ask your preceptor for feedback and give them a feedback paper sheet for them to fill out and put in Dr. Rappaport’s box. You can also offer a digital MedHub eval, but many of them like the paper copy you will receive during orientation.

• Weekly Didactics

  • There are weekly didactics of approximately 2 hours long on various topics

  • In the later two didactic sessions, you will be presenting interesting patients to the group.

• Case Presentation

  • This is extremely casual. Find an interesting patient you experienced and then present the initial presentation, history, physical exam, workup, and treatment. This should not be stressful!

• EKG assessment

  • They will teach you a methodical way of going through EKGs. Follow those rules detailed on BrightSpace and you will be fine. 

• ROSH Review

  • This is at the EM resident level and has many details which you don’t actually need to know for our purposes. It’s good as a general guide for things you could come across and you need to complete it for the clerkship, but grade does not matter. I do not know if they officially check how many questions you do, and it is low yield compared to UWorld.

• NBME exam

  • It’s an NBME on par with other NBMEs. I would not stress excessively. Focus on understanding how to triage. It may reference back to the Surgery clerkship questions too.

*most important resources are in red that you should do at minimum to pass

• UWORLD

  • You know where to find that!

• NBME Practice Exams

• Rosh Review (at least 200 questions)

This is fully up to you. I’d recommend doing a CMS Form if you are unsure how much material you have already learned up to this point. I also found the CMS Form to be very high-yield for the actual NBME. Based on that, the most thorough strategy is to complete one pass of Rosh Review without getting caught up on the small points. Regardless, if you do UWorld questions throughout the month of EM, you should be good to go.

• There is a standard ED template in EPIC which will come up when you write ED notes. Use that.

• Optional H&P template: https://learninghub.mayo.edu/content/enforced/23238-co_mcasom_core_7520_1_e/ARZ/Student%20Template.pdf?ou=23238 

• Understand what an emergency is, when to call your preceptor for backup.

• Be able to develop ddx for common complaints (abdominal pain, chest pain, back pain, AMS, fever, headache, shortness of breath, etc.)

• Understand when to get a CT with contrast vs. CT without contrast. Generally, a CT non-contrast is helpful for head imaging if you are suspecting a stroke, or abdominal imaging if you suspect a large kidney stone. Otherwise, in a patient without renal issues or contrast allergy, a CT with contrast is often preferred (many providers even get a CT with contrast if they do suspect a kidney stone).

• Complete the 200 required cases in Rosh Review

• Complete the EKG assignment (aka read through pdfs)

• Return your assigned ED phone (loaned throughout the rotation) on your last shift to Terri

• Submit the Self-Reflection assignment (due final Wednesday)

• Log work hours in MedHub

• Complete and log required cases and procedures