The ED can be a scary place for some PA students, but we’re here to help you feel confident and excited as you approach your emergency medicine rotation. It’ll be challenging for sure, but in a good way—there’s so much to learn!
In this article, I’ll give you some tips to help you excel in the ED, walk you through what a typical day is like, and reveal ways to prepare for your end-of-rotation exam. Let’s get started!
My Emergency Medicine Rotation Experience
During my ED rotation I did tons of sutures, paracentesis, placed an internal jugular vein catheter, did intubations, fracture reductions, I&D, and slit lamp exams. I placed IV’s, did finger dislocation reduction, shoulder reductions, FAST exams, trauma assessments, and so much more!
I actually ended up enjoying it more than any other rotation in PA school. So much so, that I accepted my first job while I was on it!
The thing that made me fall in love with emergency medicine is that it’s such a broad field. Truly anything can walk in those doors, so you have to keep your differential wide open and be ready for it.
In my opinion, working in the emergency department is also the best way to expand your skill set. You’ll practice lots of procedures while you’re there.
So my advice is don’t approach your ED rotation like it’s something to be afraid of. View it as an incredible opportunity to be on the front lines of medicine and gain a wealth of experience!
3 Things You Can Do to Rock Your EM Rotation
“Great,” you may be thinking, “This doesn’t have to be a negative experience—but what do I need to do to get the most out of it?”
I’d say it’s important to keep in mind the old adage: be prepared!
During my EM rotation, I was able to be hands-on in so many situations because I was prepared and willing to say “yes” when asked to do something. This is how you’ll learn a lot and feel like part of the team as a student.
To make sure you hit the ground running on day one, I recommend the following:
1. Bring what you need.
It’s a good thing scrubs have a LOT of pockets these days because in the ER, we really fill them. The top tools to have with you are a stethoscope, a small notebook/pen, trauma sheers, and a pen light.
I like the pen lights that have the pupil sizes in millimeters on them! In a trauma when you’re doing the secondary assessment, you have to shout out the pupil sizes and I’m horrible at guessing.
I’d also make sure to shove some gloves in your pocket when you get on shift. That way, you’re always ready!
You’ll also want to have things like the EMRA Antibiotic Guide and any ER notes from school or Tintinalli’s for reference.
Also, use MDCalc (phone app) for things like the HEART score, Wells, PERC, the Canadian CT Head Rule, PECARN, etc.
If possible, having UpToDate on your phone may be helpful as well. During my rotation we had UpToDate on the computers which was nice, especially for students whose schools didn’t provide a subscription.
Check out this post for more apps to have handy during PA school and beyond! 8 Best Apps for PA Students & PA-Cs
2. Remember the basics.
Do your best to come with the basics down! Think about things you KNOW you’re going to see. These include UTIs, pneumonia, COVID/flu, strep throat, chest pain/MI, strokes, ear infections, broken bones, pelvic pain, dislocated joints, vaginal bleeding in pregnancy, lac repairs, foreign body in the ear, etc.
These are the bread and butter of emergency medicine and knowing the basics of how to diagnose and treat them will help you feel confident while giving you a foundation of knowledge to build on.
Pro tip: Use mnemonics like “OLDCARTS” so you don’t forget to ask pertinent questions. This will help you present to your preceptor in an organized fashion.
3. Eat/drink/use the restroom when you can!
This rotation is unique as it’s not an 8 a.m. to 5 p.m. type of gig. My shifts as a student ranged from 6 a.m. to 4 p.m., 2 p.m. to 12 a.m., 4 p.m. to 2 a.m., and 9 p.m.to 7a.m. There’s no dedicated lunch break most of the time, so take advantage of “slow” times and grab a snack or drink of water.
Bring healthy snacks and maybe some caffeine, especially if you’re like me and you struggle to stay up late. Make sure to eat a nutritious meal before coming in for your shift. This helps just in case you don’t get a good chance to eat!
A Day in the Life: PA Student on Emergency Medicine Rotation
To give you a greater sense of what a typical day will be like, I’d like to review what you can expect schedule wise while you’re on rotation.
Please keep in mind every day is different because shifts vary, but the most common shifts I did were the 2 p.m. to 12 a.m. and the 4 p.m. to 2 a.m. swing shifts.
Here was my typical day when I was working those shifts:
Morning
I would TRY to sleep in knowing I’d be staying up late. Usually I’d wake up and try to get a bit of exercise and a healthy meal before going in. I also packed my dinner as the cafeteria was only intermittently open and the food was a bit unpredictable(if you know what I mean).
Afternoon
I’d leave to give myself enough time to park, get to the ED, and pick up my student phone. Then, I’d prepare myself to be present for “sign out,” which is when the providers who are currently on “sign out” their patients to the oncoming team.
As you can imagine, there are constant moving pieces in the emergency department, so not all the imaging, labs, procedures, or consultations may have been done for a patient when a provider’s shift is ending. Therefore, the providers who are on hand that stuff off to the next team to keep the care going and avoid staying way over their shift.
Evening
The shifts honestly go by so fast in a busy ED. During the night, I used to make sure all the attending physicians and the APP team knew I was there so they could use me as a resource to get procedures done or let me know if anything new or interesting was coming in.
My rotation was at a trauma hospital and every time a trauma was coming in there was a specific noise that would play through the ED. Then a voice would announce, “Moderate trauma, Code 1, or Code 2” to indicate what type of emergency was coming in.
I learned to go immediately to the trauma bay so I could be present and a part of whatever life-saving measures needed to happen. This is how I was able to perform so many procedures and experience so many different types of patients. I also got to go up to the helipad and help receive patients being flown into our ED!
After Shift
I would stay at least 10 hours (sometimes 12) to help my preceptor as much as possible, then go home and sleep as best I could.
I usually had about 12 shifts a month, so there were plenty of days off between shifts when I could study for my EOR exam and catch up on sleep when needed! That’s another good thing about working in the ED: it comes with a good balance of days on and off.
How to Study for Your Emergency Medicine EOR
You need to prep for you EM EOR in a way that works for you, but please keep the following in mind:
- Question banks are your friend! Blueprint PA (formerly Rosh Review) is great because you can sort questions by body systems or difficulty level. If you’re looking for something less in depth, things like Smarty PANCE and Pance Prep Pearls may be helpful.
- Podcasts are nice if you have a longer commute. For EM, I liked EM:RAP and CoreEM.
- There are also some great YouTube reviews of the Emergency Medicine PANCE Blueprint that I’d sometimes listen to as another form of studying.
In Closing
The ER is a great place to learn! Even if it is not your future specialty, come in open-minded and I promise you’ll leave a stronger provider than when you came in.
Your ER rotation is going to be an intense experience, but it can be incredibly rewarding if you follow the tips we’ve given you. Come in ready to go and who knows, you may realize this exciting and challenging environment feels like home.
