Author: NL

EP13. Improve Your Efficiency

24H Le Mans 2013

Wish you were faster in the ED?  Believe it or not, the key to being more efficient is NOT about speed or the ability to multitask.  Instead, becoming an efficient emergency physician takes practice, experience, and the use of some key strategies to increase your productivity.  Be prepared to work hard, work smart, and learn how to task-switch effectively.

In addition, I highly recommend you read this important and informative letter, written by the CDEM Executive Committee, addressing the recent ranking of EM residency programs by U.S. News and World Report and Doximity.

And as an added bonus, check out this just-released video on presenting patients in the ED, put together by some amazingly talented peeps at EMRA and CDEM.  It is hot stuff.

References

  1. Kee R, Knott JC, Dreyfus S, Lederman R, Milton S, Joe K. One hundred tasks an hour: an observational study of emergency department consultant activities. Emerg Med Australas. 2012;24(3):294-302.
  2. Stephens RJ, Fairbanks RJ. Humans and multitask performance: let’s give credit where credit is due. Acad Emerg Med. 2012;19(2):232-4.
  3. Chisholm CD, Dornfeld AM, Nelson DR, Cordell WH. Work interrupted: a comparison of workplace interruptions in emergency departments and primary care offices. Ann Emerg Med. 2001;38(2):146-51.
  4. Chisholm CD, Weaver CS, Whenmouth L, Giles B. A task analysis of emergency physician activities in academic and community settings. Ann Emerg Med. 2011;58(2):117-22.
  5. Chisholm CD, Collison EK, Nelson DR, Cordell WH. Emergency department workplace interruptions: are emergency physicians “interrupt-driven” and “multitasking”?. Acad Emerg Med. 2000;7(11):1239-43.
  6. Laxmisan A, Hakimzada F, Sayan OR, Green RA, Zhang J, Patel VL. The multitasking clinician: decision-making and cognitive demand during and after team handoffs in emergency care. Int J Med Inform. 2007;76(11-12):801-11.
  7. Westbrook JI, Woods A, Rob MI, Dunsmuir WT, Day RO. Association of interruptions with an increased risk and severity of medication administration errors. Arch Intern Med. 2010;170(8):683-90.Photo above Creative Commons License Antoine Valentini via Compfight

EP12. EM Pharmacists

EMRx

Emergency Medicine Pharmacists are our allies in the ED.  They help us prescribe the right therapies, reduce medication errors, and provide the best possible care for our patients.  So get to know your ED pharmacist and tell them thanks for all that they do.  (And thanks to our own for sharing her thoughts with us on this podcast!)

Interested in more Pharm FOAM?  Check out these links…

Pharm FOAM on #FOAMedstudent

Emergency Medicine PharmD

And of course, tons of great pharmacy resources at ALiEM

References

  1. American Society of Health-System Pharmacists. ASHP statement on pharmacy services to the emergency department. Am J Health-Syst Pharm. 2008; 65:2380–3.
  2. Eppert HD, Reznek AJ. ASHP guidelines on emergency medicine pharmacist services. Am J Health Syst Pharm. 2011;68(23):e81-95.
  3. Ernst AA, Weiss SJ, Sullivan A, et al. On-site pharmacists in the ED improve medical errors. Am J Emerg Med. 2012;30(5):717-25.
  4. Cesarz JL, Steffenhagen AL, Svenson J, Hamedani AG. Emergency department discharge prescription interventions by emergency medicine pharmacists. Ann Emerg Med. 2013;61(2):209-14.e1.
  5. Rothschild JM, Churchill W, Erickson A, et al. Medication errors recovered by emergency department pharmacists. Ann Emerg Med. 2010;55(6):513-21.
  6. Patanwala AE, Sanders AB, Thomas MC, et al. A prospective, multicenter study of pharmacist activities resulting in medication error interception in the emergency department. Ann Emerg Med. 2012;59(5):369-73.

EP11. How To Be Competitive

Metropolitan SCM Championship IMG_1954

For all you M3s out there, now is the time to start getting ready for the EM residency application season!

To do list:

  • Find and meet with an advisor, preferably someone trained in EM and familiar with the EM residency application process
  • Start looking into residency programs and take note of program-specific application requirements
  • Consider doing an away EM rotation in addition to your home rotation and contact schools to apply for a spot
  • Discuss with your advisor when it’s best for you to take Step 2 and aim for a higher score than on Step 1
  • Consider where you’ll need to get letters of recommendation or SLOEs (usually at least 2 from EM faculty + maybe one or two from outside of EM)
  • Keep working on getting those honors/A+’s on your M3 rotations!
  • Start writing your CV and personal statement

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Links and References

SAEM Residency and Clerkship Directories

CDEM Emergency Medicine Clerkship Primer 

EMRA Medical Student Survival Guide and other Advising Resources

1. Crane JT, Ferraro CM. Selection criteria for emergency medicine residency applicants. Acad Emerg Med. 2000;7:54-60.

2. Lotfipour S, Luu R, Hayden SR, Vaca F, Hoonpongsimanont W, Langdorf M. Becoming an emergency medicine resident: a practical guide for medical students. J Emerg Med. 2008;35(3):339-44.

3. Green M, Jones P, Thomas JX. Selection criteria for residency: results of a national program directors survey. Acad Med. 2009;84(3):362-7.

4. Breyer MJ, Sadosty A, Biros M. Factors Affecting Candidate Placement on an Emergency Medicine Residency Program’s Rank Order List. West J Emerg Med. 2012;13(6):458-62.

5. Hayden SR, Hayden M, Gamst A. What characteristics of applicants to emergency medicine residency programs predict future success as an emergency medicine resident?. Acad Emerg Med. 2005;12(3):206-10.

Photo Creative Commons License Charles Smith via Compfight

EP10. Medical Decision Making and Bias

child Head

How do you get from the classroom to the clinic or hospital ward?  How do you translate knowledge into clinical practice?  Using cognitive strategy techniques can help you understand the medical decision making process.  But beware of bias…

References

1. Sandhu HSS, Carpenter CR. Clinical decision making: opening the black box of cognitive reasoning. Ann Emerg Med. 2006;48:713-719.

2. Croskerry P. Achieving quality in clinical decision making: cognitive strategies and detection of bias. Acad Emerg Med 2002;9:1184–1204.

3. Kovacs G, Croskerry P. Clinical decision making: an emergency medicine perspective. Acad Emerg Med. 1999;6:947–52.

4. Croskerry, P. The Importance of Cognitive Errors in Diagnosis and Strategies to Minimize Them. Acad. Med. 2003;78:775–780.

Photo Credit: Charly W. Karl via Compfight

EP9. A Look Back at 2014 and Resolutions for the New Year

Happy New Year

2015 is only hours away and yet 2014 was such an exciting year in EM it’s hard to let it go…  Here are some of my favorite articles from 2014!

Fibrinolysis for Patients with Intermediate-Risk Pulmonary Embolism – PEITHO Investigators

A Randomized Trial of Protocol-Based Care for Early Septic Shock – ProCESS Investigators

Goal-Directed Resuscitation for Patients with Early Septic Shock – ARISE Investigators

Use of esmolol after failure of standard cardiopulmonary resuscitation to treat patients with refractory ventricullar fibrillation

A Simplified and Structured Teaching Tool for the Evaluation and Management of Pulseless Electrical Activity

Delayed Sequence Intubation: A Prospective Observational Study

Integration of Social Media in Emergency Medicine Residency Curriculum

Photo Credit: Steve Jurvetson via Compfight

EP8. 100 Days to Match Day

gotta match ?

Mark your calendars!  It’s now 100 days until Match Day on March 20, 2015.  If you haven’t already started working on your rank list, now’s the time.  NRMP opens on January 15th and the final deadline for rank list submissions is February 25th at 9pm EST.  I hope this episode helps shed some light on this part of the process, and if you want more, check out these awesome sites…

EM Advisor

EM Mentoring 101

Academic Life in Emergency Medicine – EM Match Advice

Photo Credit: LASZLO ILYES via Compfight