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Emergency Medicine Residents' Appreciation Day

7 Tips I Learned During Residency

Posted on Wed, Mar 02, 2016
7 Tips I Learned During Residency

By Steven Mahon, D.O.
It was July 2011, and I was just sitting down for my emergency medicine residency orientation. Wearing slacks and a tie, I had my new white coat clean and pressed with three uniform pens in the chest pocket. Those pens were sitting just above my name, the new letters “D.O.” appearing as an alien addition. A rather weathered old attending rose to the podium and congratulated us on completing one of the most difficult journeys of our lives. He commended us on the embarkation of our young physician careers and said that our days as residents would be “over in the blink of an eye.”
Well, here I am almost a year after graduation. I'm wearing a scrub top pulled from the "I think it’s clean" pile of my closet, a red marker is the only writing utensil in reach, and I haven't seen my white coat in at least two years. I look back to those early days and reflect on residency, which was not easy, and most certainly it wasn’t quick.
There were some very long nights, frustrating cases and endless reading. It’s a grueling time meant to teach young doctors everything they need to graduate as competent, confident emergency department attendings. During that time I had the benefit of working with many great attendings who imparted words of wisdom. Some were good, some were not, but there have been many “one-liners” which have stuck with me throughout the year, and I now find myself repeating them to my own students. These are a few of my favorites:

  1. “The eyes cannot see what the mind does not know.” Essentially this boils down to the core of residency, to keep reading and expand your core knowledge. As EM physicians, we are tasked with the overwhelming responsibility to diagnose the undiagnosable. While no one is expected to regurgitate the treatment plan for perivenous encephalomyelitis (don't be afraid to look it up), you do need to be familiar with what is out there. You cannot diagnose or even look for a disease that you don’t know even exists. So plain and simple, read as much as you can and pick up as many cases as you can handle. This will allow your mind to reveal what your eyes are seeing.

  2. “As a resident, pick up cases which make you uncomfortable.” Everyone has their happy place; their zone of comfort where nothing can go wrong. We all love treating a classic chest pain and the five year old with ear pain. However as the ER physician, especially in a solo-covered shop, you’re going to have to pick up cases regardless of how comfortable you are. It’s important to expand your comfort zone as much as possible while you have an extra pair of hands to back you up. So rather than pick up yet another chest pain, instead pick up something where you have no clue how to work it up, something that makes you sweat a little. Discomfort now is better than discomfort later.

  3. “I don't care how you treat them, just don’t harm anyone.” This is one of my favorites, spoken by a rather jaded attending in a high-volume ER. A kidney stone will probably turn out the same whether you use opiates or NSAIDS, so don't sweat the details on the little stuff. Just know your dispositions, who is staying and who is going home, and do your best not to cause any harm. I think Hippocrates had something to say about this.

  4. “The room is yours, kid.” A terrifying thing to say to a young resident, but it’s sometimes necessary to push home a point. Eventually, we will be the only ones sitting at a desk, managing a room full of sick people. We are the captain of this ship; our crew is here to support us and we keep it moving. As a resident, it’s important to practice moving a busy room and keeping all the plates spinning, especially as you near your final year.

  5. “If the stomach works, use it.” A short one, but a good one. It means that in a room full of vomiting people (cold and flu season anyone?), if you can control and rehydrate orally, spare the IV. Both your staff and your patients with thank you in the end, not to mention that the room will move much quicker.

  6. “Trust your nurses.” The bottom line is that in the ED, we’re all in the trenches together. When “it” hits the fan, we’re exclusively reliant on our nurses to get the job done, and trust is key. I’m friends with almost all of our department’s nurses. I know their families and socialize whenever I can. The department always runs smoother on a road without potholes.

  7. “What you do matters.” A good one for final thoughts, which maybe doesn't need to be said, but maybe it does. One of the biggest enemies of ER physicians is burnout, essentially treating the endless droves of patients with coughs, colds and bruises in the waiting room. But remember that three year old with a simple ear infection you just discharged, which probably shouldn't have even been here? Her mother was terrified when she got the call from daycare, and she was crying when she left work early to get her daughter to the ER. Those five minutes that you just spent rolling your eyes while you tried looking in her daughter's ears were probably the most important minutes of that parent’s day, maybe even the most important minutes she has had being a mother up until that point. What we do matters, whether it’s pulling a last-minute “Hail Mary” and saving someone's life, or sitting down and giving 30 seconds of reassurance to a worried parent. We are in the business where nothing should be routine. 

So I hope some of my favorite one-liners stick with you as they have stuck with me. In reflection, residency is a time to absorb as much as you can. Read, practice, make yourself uncomfortable, be friendly and compassionate, and certainly do no harm.
Steven Mahon, DO

Steven Mahon, D.O., received his medical degree from the Chicago College of Osteopathic Medicine and completed his emergency medicine residency at St. James Midwestern University, Olympia Fields, Ill. He is an attending emergency physician at St. Anthony's Hospital in Crown Point, Ind.


How to Make the Most of Your Emergency Medicine Residency

Posted on Mon, Feb 29, 2016
How to Make the Most of Your Emergency Medicine Residency

In honor of Emergency Medicine Residents' Appreciation Day on March 2, an attending emergency physician offers a few tips for making the most of your residency.

By Shilpa Amin, MD, FACEP

Dr. Seuss said it best: “Congratulations! Today is your day. You’re off to great places! You’re off and away! You have brains in your head. You have feet in your shoes, you can steer yourself in any direction you choose.”
You have worked extremely hard to get into your residency program, now make the most of these important years! Each year is a stepping stone to help you find the perfect job; you are the person who’ll decide where to go.

There is no manual to surviving residency, but there are a few pieces of advice I’d like to offer.

Intern Year: Learn the basics. There is no real substitute for understanding the fundamentals of teamwork, hard work and efficient work. When you are an intern, you are working the most shifts, doing many procedures and learning to absorb direction from many people: senior residents, attendings and consultants. Take this year to really understand how the ED functions, because the operations of the ED are unique. Use this year as a base for success for the rest of your residency. Ask lots of questions. Read when you have time. And most importantly, HAVE FUN.

Junior Year: Be a mentor and true teacher to the interns. Remember the saying: “See one, do one, teach one.” You will quickly learn procedures and how to care for critically ill patients. Strive to be a strong leader in your junior year. This year you will have more time to read and more time to network.

  • Start talking to the seniors who just graduated and see where and how they found their jobs.
  • Align yourself with colleagues who work in a setting that you see yourself in (academic, community, administrative).
  • Attend national conferences such as ACEP, AAEM or SAEM. Visit the booths and speak to other physicians about what they like most (and least) about their jobs.

Use this year to build a foundation for your job search. Toward the end of your junior year, begin researching different employment models, consider if you want to apply for a fellowship and where geographically you want to practice. Begin drafting an initial version of your CV and have your program director and other faculty review it to help you revise.

Senior Year: This is when the job search is in full effect. Use the summer months to network, learn what an independent contractor is – speak with your accountant or adviser to see if this is the right fit for you to help better understand the job market. Reach out to alumni from your program for more information. Your program director and chairman also are great resources if you’re looking for a job in a location that you’re not familiar with. Begin thinking about who you are going to ask to fill out your references for your applications. Finalize your CV and write a cover letter. Begin sending out emails to the EDs you are interested in applying to.

September and October of senior year is when most residents start interviewing. Give yourself enough time during each interview to spend time in the ED and shadow one of the doctors for a few hours. This will give you a real sense of how the ED functions as a system and works as a team. Interview at enough places to give yourself a broader understanding of the different work environments available to you and where you would fit best. I recommend researching and preparing questions in advance of each interview. Ask for a current copy of the schedule. Be sure to fully understand compensation and scheduling, how vacations work, and what type of malpractice coverage you will have.

In November and December, review all of the information obtained from your interviews.
  • Ask yourself where you will be most happy and have the most successful career.
  • Ask your mentors to sit with you and decipher the information and assess each site.
  • Review your contract and have a contract attorney review it for you as well, specifically examining restrictive covenants and any confusing language.
  • As a courtesy, let anyone who extended an offer that you don’t accept know where you decided to start your career.

“Today is your day! Your mountain is waiting. So, get on your way!”

Shilpa Amin

Shilpa Amin, MD, FACEP, is a full-time attending emergency physician at Saint Barnabas Medical Center in Livingston, N.J. Dr. Amin also is the director of the physician recruiting team for EmCare Partners Group. She received a bachelor’s degree from Rosemont College in Rosemont, Pa., and her medical degree from SUNY Downstate, Brooklyn, N.Y. She completed the Jacobi/Montefiore Emergency Medicine Residency Program at Albert Einstein College of Medicine, where she served as chief resident. She enjoys spending her free time cooking, traveling and trying new cuisines with her husband and three young children.