Emergency Rotation

[Guest CaesarCornelius]

Hey All

 

I thought I would throw this out to see what other people who have been through clerkship think.

 

Dal is changing clerkship to include a 1 month block of emergency medicine. The old system still had emergency medicine, but it was spread over the year (20 shifts). To compensate they are removing the 4 week elective block in the psych/family unit, where you used to have to choose between psych/family for those 4 weeks (ie: we still have 4wks of family and 4wks of psych, but know we have 4 weeks of emerg instead of another 4 wks of psych/FM).

 

What are your thoughts on this? I should also mention that they got rid of the week of ophthalmology and ENT during the surgical block. We can still do those specialties, but they will now be during our 'elective time'.

 

CC

[Guest jmh2005]

I think that probably a good thing...no matter what specialty you do, you should know how to triage emergencies and deal with (at least gain an approach to)potential life-and-death situations. At Mac, we only have a 2 week ER block, 10 shifts built into our Family Med block...should probably be more...but then again, I like EM so I may be biased!

 

You can always do optho/ENT as electives ..that's what we do at Mac..we get two weeks of elective in surgery (I chose plastics)...but it would be good to know how to use the darn opthalmoscope (I don't even think I can spell it...!)...hopefully before I graduate in May!

[Guest mgupta]

at UWO we can do ENT/optho only if we choose it as our selective (2 week selective. i didnt choose it and dont really regret it.). also, we do 2 wks adult emerg and 2 wks pediatric emergy. other than that ,we dont have emerg (correct me if im wrong).

 

i think its great you are getting to do 4 wks of emerg and not having to worry about doing a shift right after a long day of work (ie the old dal system).

 

as for missing out on optho/ent, i'm sure u'll see lots of eye injuries and nasal fractures in ER to make up that part of your education .

[Guest Ian Wong]

I think it's a shame that you have to lose Ophtho and ENT to fit in EM, but can see the benefits either way. EM is a 4 week required rotation in the third year clerkships at UBC, and is usually a really good rotation; lots to see and do.

 

Still, ENT and Ophtho complaints make up a HUGE component of your average Family Medicine work-week (red ears and pharyngitis/tonsillitis in kids, sinusitis, hearing loss, dizziness, thyroid issues, neck masses, dysphagia, GERD, red eyes, foreign bodies, poor or blurry vision, headache, and a whole bunch of other things that necessitate a good head and neck exam).

 

I think a week or two in each field where you are doing nothing but looking into fundi or at tympanic membranes, or learning to feel for thyroid nodules or neck masses is much better at developing your skills than doing them sporadically throughout the year (whenever a given patient pops up in whichever clerkship you are in). I'm not gunshy about whipping out the ophthalmoscope to look at someone's fundus, which probably isn't true for everybody (in a similar vein, I continue to suck at pelvic exams, probably because I didn't do many of them as a med student). Anything you can do to improve your physical exam skills as a med student will help you later as a resident.

 

Still, I think doing 4 weeks of EM is great in that it helps you develop quick thinking, focussed H&P's and treatment plans, and it's a wonderful specialty in which to integrate your clinical knowledge, since you'll be seeing patients with complaints spanning every other specialty.

 

I don't really see a "bad" outcome either way your schedule ends up.

 

Ian

[Guest UWOMED2005]

The situation has already been described for UWO.

 

Emerg SHOULD be a mandatory rotation, preferably longer than 2 weeks (even 6 weeks.) In many ways I find emerg IS medicine. You'll see most of your common presenting problems there, and not have the Dx spoonfed to you as the patient hasn't been worked up.

 

In contrast, tert care rotations like oncology (mandatory at UWO) give you little skills in terms of working up problems and Diagnosing. By the time a patient gets to oncology the Dx has been made and everything has been worked up. All I learnt on oncology was a bit about management of oncological emergencies such as SVCO or cord compression (a worthy end) and a bit about chemotherapeutic regimens (a less worthy end as these will change by the time I get into practice and it's just something I'd refer for anyways.)

[Guest Ian Wong]

Floating back to the top...

 

Ian