Electives for CCFP-EM

[MDwannabe02]

Would like to match to a rural family med program, then do a +1 EM year. Currently in 3rd year and at my school we don’t start electives till 4th year (rural family with some specialty exposure for all of 3rd year). Just wondering what electives I should look into for the best learning opportunities? I’ve heard anesthesia, emerg and ICU (as a resident) would be good for this. Anything else? Will family elective(s) be needed to be done to have a competitive application broadly (not picky about location)?

[bearded frog]

I'm skeptical that med school electives will have much bearing on your +1 EM application in 3 years. I'll stand corrected if someone with experience disagrees, but you should be focusing entirely on matching family medicine in places you want to work. You will have opportunities in residency for electives and working towards that +1, and residency electives are quite different from medical school, and recommendations will hold a lot more weight.

[MDwannabe02]

1 hour ago, bearded frog said:

I'm skeptical that med school electives will have much bearing on your +1 EM application in 3 years. I'll stand corrected if someone with experience disagrees, but you should be focusing entirely on matching family medicine in places you want to work. You will have opportunities in residency for electives and working towards that +1, and residency electives are quite different from medical school, and recommendations will hold a lot more weight.

Thanks!

[Arztin]

Many EM programs don't look at med school electives nor their evals. 

Focus on learning and matching to FM at sites you like for now.

[MDwannabe02]

On 9/22/2019 at 5:13 PM, Arztin said:

Many EM programs don't look at med school electives nor their evals. 

Focus on learning and matching to FM at sites you like for now.

Excellent, that’s the kind of answer I was hoping for. Would prefer to take a variety of electives to fill in knowledge gaps rather than being strategic about matching (either for family or potential +1 EM down the road). Thanks!

[medigeek]

In terms of skill development, it's great to do an anesthesia and ICU rotation. If you go onto do the +1, you want to do >100 intubations by the end of it and you can always get started on those numbers now as a med student. Same with getting a couple lines in the ICU, seeing a chest tube at least etc. A community or rural ED rotation can give you exposure to reductions as well + other quick procedures/lac repairs. 

 

[JohnGrisham]

59 minutes ago, medigeek said:

In terms of skill development, it's great to do an anesthesia and ICU rotation. If you go onto do the +1, you want to do >100 intubations by the end of it and you can always get started on those numbers now as a med student. Same with getting a couple lines in the ICU, seeing a chest tube at least etc. A community or rural ED rotation can give you exposure to reductions as well + other quick procedures/lac repairs. 

 

Agreed with this. Not sure why people see MS4 as being magically much different than R1 for example, especially in FM.  Many MS4, are indistinguishable from the mid-year R1s, and do plenty of procedures. You can always build up your experience if you seek it out, things don't magically change when you get the title of resident...I would think that taking initiative and responsibility would be a +, and if you already have done procedures and participated in codes, resus' etc, you'll be that much more prepared for when you hopefully get to experience them as a resident and further build from that and impress preceptors. 

Maybe my experience was atypical, but i logged 50+ lac repairs, 10+ reductions and was able to take care of the conscious sedation(supervised but unprompted), and did 6 chest tubes. On 2 week anesthesia, in a controlled pre-op setting of course, did at least 40 intubations (sub par hit rate of success on first try, and some more difficult ones with a glidescope). Talking to colleagues who did their undergrad med rotations in community hospitals, this doesn't seem atypical.  

If you know you already want to go in that direction, get the practice in at any opportunity available - the more time in the discipline you have, the more potential opportunties walk through the door. 

That said procedures aren't the end of the world, and shouldn't take priority over developing your clinical acumen and decision making skills - which is priority. But you want to be equipped with the bread and butter skills and be interchangeable with different tools.

 

[medigeek]

11 hours ago, JohnGrisham said:

Agreed with this. Not sure why people see MS4 as being magically much different than R1 for example, especially in FM.  Many MS4, are indistinguishable from the mid-year R1s, and do plenty of procedures. You can always build up your experience if you seek it out, things don't magically change when you get the title of resident...I would think that taking initiative and responsibility would be a +, and if you already have done procedures and participated in codes, resus' etc, you'll be that much more prepared for when you hopefully get to experience them as a resident and further build from that and impress preceptors. 

Maybe my experience was atypical, but i logged 50+ lac repairs, 10+ reductions and was able to take care of the conscious sedation(supervised but unprompted), and did 6 chest tubes. On 2 week anesthesia, in a controlled pre-op setting of course, did at least 40 intubations (sub par hit rate of success on first try, and some more difficult ones with a glidescope). Talking to colleagues who did their undergrad med rotations in community hospitals, this doesn't seem atypical.  

If you know you already want to go in that direction, get the practice in at any opportunity available - the more time in the discipline you have, the more potential opportunties walk through the door. 

That said procedures aren't the end of the world, and shouldn't take priority over developing your clinical acumen and decision making skills - which is priority. But you want to be equipped with the bread and butter skills and be interchangeable with different tools.

 

Where did you get 6 chest tubes?? 

[JohnGrisham]

5 hours ago, medigeek said:

Where did you get 6 chest tubes?? 

Generic community hospital. First two was just assisting and other  4 was doing them fully with staff at my side in case something went wrong. Prior to these 6, I had seen two done as just a fly on the wall on a different rotation. So was aware from a practical theory p.o.v. 

Of course, other people who did emerg(even at the same hospital) never even saw one happening. Apart of it is being read up on it, or the very least have gone through the med-carts at your hospital to see what kind of procedure kits they have are.

Hence to my point of getting access to the experience is hit or miss, and really depends on how much time you spend hanging around in that environment; which correlates with being in that specialty with potential access to it.  A lot of luck with timing (or lack of luck for the patient being in that position ha). As well letting staff know "btw if theres any procedures that come through, i'd love to pulled out of the patient im seeing to assist if possible". The internist on the inpatient ward heard this and then called down to the ward to see if i wanted to do a paracentesis. A relatively easy procedure sure, but builds in muscle memory of getting used to the bedside U/S and how to put the apparatus together properly for the fluid retrieval. So getting a few of those under my belt was great! To other people this is nothing special at all, but for me it added a tiny bit of comfort that "okay if someone ever asks me to help or to do this on my own if im a junior staff, I can somewhat think my way through and not be completely blind from a practical stand point".

An r2 doing their first chest tube on their 2nd to last FM rotation, is no better off than an MS3 on their first rotation of emerg. Procedural skills are step-wise and if you don't have experience doing them, you don't have experience doing them.  Theoretical knowledge aside of course.  

To add to the variability: i have never inserted a foley catheter in a male, never done an in/out, and still am terrible at doing periperhal IVs due to lack of exposure.

 

[medigeek]

2 hours ago, JohnGrisham said:

Generic community hospital. First two was just assisting and other  4 was doing them fully with staff at my side in case something went wrong. Prior to these 6, I had seen two done as just a fly on the wall on a different rotation. So was aware from a practical theory p.o.v. 

Of course, other people who did emerg(even at the same hospital) never even saw one happening. Apart of it is being read up on it, or the very least have gone through the med-carts at your hospital to see what kind of procedure kits they have are.

Hence to my point of getting access to the experience is hit or miss, and really depends on how much time you spend hanging around in that environment; which correlates with being in that specialty with potential access to it.  A lot of luck with timing (or lack of luck for the patient being in that position ha). As well letting staff know "btw if theres any procedures that come through, i'd love to pulled out of the patient im seeing to assist if possible". The internist on the inpatient ward heard this and then called down to the ward to see if i wanted to do a paracentesis. A relatively easy procedure sure, but builds in muscle memory of getting used to the bedside U/S and how to put the apparatus together properly for the fluid retrieval. So getting a few of those under my belt was great! To other people this is nothing special at all, but for me it added a tiny bit of comfort that "okay if someone ever asks me to help or to do this on my own if im a junior staff, I can somewhat think my way through and not be completely blind from a practical stand point".

An r2 doing their first chest tube on their 2nd to last FM rotation, is no better off than an MS3 on their first rotation of emerg. Procedural skills are step-wise and if you don't have experience doing them, you don't have experience doing them.  Theoretical knowledge aside of course.  

To add to the variability: i have never inserted a foley catheter in a male, never done an in/out, and still am terrible at doing periperhal IVs due to lack of exposure.

 

Very well said. I will add that sim labs and procedure courses can certainly help get things down as well. The latter is great for learning things the right way and learning rare procedures (ex. crics, pericardiocentesis etc)