Intern Resources

Welcome to NMCSD and Emergency Medicine!

The Intern resources pages were compiled by the Intern class of 2014 and edited year by year to help answer common questions regarding rotations and make finding the schedules a little easier for the following classes. They are still works in progress and will continue to be updated over the coming months, but can hopefully provide a little guidance when it comes to the first year of post-graduate training and remove some of the hassle when moving from one service to another.

Please contact the ACRs with any further questions regarding the leave policy.

NMCSD ED

Get familiar with your new home for the next four years. Months in our ED are busy and challenging; some residents feel these are our most challenging rotations. The expectations by staff, other residents, nursing, and consultants can be high, and the pace brisk.  You will work hard during these months, but will also be where the bulk of you EM learning occurs.  

The ED is divided into 2 or 3 pods of 8 beds (depending on the time of day). In addition, the Fast Track is run by nurse practitioners and occasionally an attending physician and sees a high volume of the less acute patients each day in 12-14 beds.  

As an intern, you are expected to handle 2-4 patients to start, and as the year progresses, you may be asked to carry more. The goal for a PGY-2 is to be fully responsible for a whole pod (8 beds). Therefore, to make this transition easier, it is always a good idea to push yourself. Remember you can always finish notes after the shift. We work 8-hour shifts, which start at different times.  Check your schedule regularly so you don’t miss or be late as there are occasionally changes. It is good form to be 10-15 minutes early. Also expect to be there after your shift at least 30 minutes to finish turnover of patients and charting.  

You will present your patients to the resident and/or attending covering your shift. Each attending or resident may want you to do something different for that shift so before the start of the shift ask them how they want the shift to go, or provide them with some goals of your own. Some will want you to present to the resident or some may want you to present directly to the attending. Neither is better, just a preference. Every attending is different; some will micromanage you and some you’ll barely fell like they are there at all. Everybody had favorites and ones where their souls die a little when they see them walking onto a shift.  THEY ALL HAVE SOMETHING TO TEACH YOU.

Nurses and Corpsmen work 12 hours shifts, with shift changes different then your own.  This is important to know because the execution of orders can cease for 30 minutes to an hour if you don’t stay on top of things.  Typically two nurses are assigned to each pod of the ED each covering 4 beds.  Know which nurses are working where so you can communicate properly.  

***DOUBLE CHECK ALL LABS AND RADIOLOGY STUDIES BEFORE YOU DISCHARGE A PATIENT***

No one likes a bad/missed outcome and/or M&M.

Become familiar with the airway/sepsis carts and where supplies are for when you need them.  The sepsis cart contains central line materials, ultrasound covers, gowns, drapes, and other useful supplies. There are two adult and one pediatric airway boxes, which can be brought to bedside for sick patients. There is also a glidescope for difficult intubations, and all of the airway boxes have a Bougie for use as an adjunct. There is other equipment in various locations in the ED such as panoptic opthalmoscope, tonopen, fluorescein, Rhino Rockets, and Afrin.  There is a slit lamp in Fast Track. Proparacaine is kept in the refrigerator or behind the computers in Fast Track.  

Utilize the ED social workers and pharmacists, who are in the department regularly. They are incredible resources with a wealth of knowledge in their fields; it never hurts to ask them before you ask a resident or attending. 

Conference is from 0800 to 1300 on Wednesdays.  Only reason to miss it is on a unit month (CCU, ICU, MERCY).

Fast Track

You will have 2-4 Fast Track shifts per NMCSD ED month to increase your comfort with lower acuity ED visits. These shifts are 8 hours as well, but start at slightly different times. The NPs are a great group of professionals. While working as an intern, the NPs or an attending will supervise you and you will staff patients with them as you would in the main ED. The NPs are a wealth of information, they have likely seen each chief complaint MANY times, and have tons of pearls to share. These visits are still incredibly important; many of the eye complaints go to fast track as will lots of children with fevers. There are also a lot of orthopedic complaints. These may be triaged as lower acuity (and some are mis-triaged), but still have the potential to be sick or have long-term complications. Unlike the main ED, you really are encouraged to do your documentation during your shift; it is unusual to stay more than 30 minutes after a shift. 

Have a good time, meet new people and cure them or rule out badness. You have chosen well.

Rotating Intern Resources

Coming soon.

Please contact LT Victoria Kay with any further questions.