July 17, 2012

Residents: Please Read

This is adapted from an email I sent to the incoming EM residents as I graduated a few weeks ago. Of course, no monetary conflicts of interests of any kind, and these recommendations are just personal tips:

As outgoing academic chief, one thing I cannot stress enough is that you really need to read during residency.

You cannot just show up for shifts.

You need to do more than listen to EMCrit, and all of the other great sites like Life in the Fast Lane, ERCAST, PHARM, SMARTEM, etc. (I know I left a lot of great sources out -- there are too many to name). Not that you shouldn't read or listen to this stuff, but recognize that the topics covered are generally things that are sexy: interesting, controversial, or very practical or technical tips & tricks. But those are all different than a core curriculum.

And while you should listen to EMCrit etc., that sort of clinical information is not sufficient for board prep nor for core topics, especially the tough/less popular ones that are over-represented on the boards and under-represented in our patients (and nobody likes) like ophtho, derm, and even bread & butter simple illnesses like gastroenteritis.

Other than reading a textbook (which I wish I had done much more of), top things I think you can do to be both a better doctor & better board prepped: the idea should be to focus on building a foundation of core content, without getting completely distracted by the some of the more fun bells & whistles out there. There are lots of places to find great EM core content curricula; here are some examples: 

EM:RAP -- probably the best "core topic" podcast. It comes free with a resident EMRA membership. Worth figuring out how to download. They cover major topics, and last year introduced their "C3" project where they review core topics for board prep.

Read Annals of Emergency Medicine. Every month. You don't need to read it cover to cover, but at least browse through the abstracts & editor reviews. I will admit that at first it seems to cover obscure topics, but after reading for a few months I realized that something relevant from a recent Annals came up every single shift. Articles are picked by the leaders in our specialty, and they're quite good at it. I keep mine in the bathroom and slowly get through it.

Emergency Medical Abstracts -- also free with resident EMRA. great podcast that started in the late 1970s (they used to mail out cassette tapes) by Rick Bukata & Jerry Hoffman (who is probably the most worthwhile EM figure out there). They go through 30 abstracts from recent journals of all stripes, all relevant, and discuss each one for 2-10 minutes, which includes a lot of banter on the topic. A lot of people are put off by the (brief) methodology discussion of each paper but I promise it's worthwhile.

Some others: Life in the Fast Lane and EM Basic both have plenty of excellent free core content.

Also: get on national committees. EMRA, ACEP, etc. Easy to get on, little work with huge reward, and most are just a matter of signing up.

Last tips: 
  1. be nice to everyone (it pays off)
  2. do what's best for the patient (not only is it the right thing to do but you get to win more fights)
  3. and remember: as Jerry Hoffman says: we have the best job in the world, and as Mel Herbert says, what we do, matters 

And please read.

7 comments:

  1. As a current third year/chief, this is a great list. I stumbled across most of these throughout my residency so far and all have been immensely helpful. There is only one thing I could add... Annals of Emergency Medicine has a monthly 30 min podcast. Absolutely read the journal, but if you need a quick summary and a quick editorial on the articles, listen to the podcast.

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    1. thanks! I agree -- the Annals podcast is pretty good, and of course done by David Newman & Ashley Shreves of SMARTEM. 2 downsides: they don't cover all the articles; tough to keep podcasts in the bathroom

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  2. Great post, advice, and list of online sources. These definitely supplemented my textbook readings and helped me stayed up to date.

    Like you said you left some of them out. I would have to say embasic.org by Steve Carroll is one of them. Just like the name says it's basic, but it's also very clinical and practical.

    Javier

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    1. Thanks! Another good source. Your points tie in well with my main goal here: residents need to learn about core knowledge before arguing about ketofol's potential role in DSI. As my wife puts it, when you're building a house, you need to build a solid foundation before you pick out the drapes

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  3. Great post Seth.
    Though I'd like to point out there is plenty of non-sexy stuff on LITFL - and I'm not (just) talking about the photos of Cadogan...
    Just type 'oph' into the clinical cases database - we've got over 30 cases covering more than you'll ever want to know on eyes :-)
    http://lifeinthefastlane.com/education/clinical-cases/
    All the best,
    Chris

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    1. Chris- You are absolutely right -- LITFL has a lot of core content & "brick & mortar" meded. Sorry to clump you with the "sexy" sites like EMCrit. Again, my main point isn't that interns should read X site instead of Y site but that it's easy for a resident to get caught up in the stuff on bougie-chest tubes & DSI and think that you are "reading" while ignoring the core content.

      My goal here was just to remind junior docs that a foundation in core content is much more important (although less fun to build) than some of the sexier stuff out there, and I think this post comes off too much as "here are my specific recommendations" which is not what I intended.

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    2. Not a problem Seth - I think your post and message is spot on - no apologies needed!
      Chris

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