Author: Ashley Rider, MD, EM Resident, Highland Emergency Medicine, on behalf of the CORD Student Advising Task Force

The CORD Student Advising Task Force has created the Emergency Medicine Medical Student Planner as a roadmap to guide students through medical school.  As an advisor we encourage you to pass this on to your student advisees, the local EMIG, your medical school Dean’s, or anyone else you think it would help.  We also encourage you to modify it to fit your school’s unique requirements and schedule considerations.  

You can download the Planner here:  med-student-planner-1

In this post we will expand on the timeline described in this concise guide to preparing for a career in Emergency Medicine.

Students interested in EM come to us at at different stages in their medical school careers. Timelines are unique for each student. While this framework will look different for each individual, there are four basic stages to recognize when advising EM-bound medical students.

Consider, Explore, Commit, Educate

Questions to ask students that are considering Emergency Medicine:

• Do you like all specialties during your clerkship rotations ?
• Are you thrilled to care for patients of all ages, regardless of social circumstance or ability to pay?
• Would you rather know “a little about a lot” rather than “a lot about a little” ?
• Are you energized by the challenge of caring for critical patients ?
• Do you prefer to work on a team of people ?
• Do you enjoy fast-paced environments and making decisions based on limited information ?
• Do you like procedures as well as talking to patients ?
• Are you okay with brief interactions with patients, and a lack of longitudinal care?
• Can you tolerate shiftwork and working holidays/weekends for the rest of your life?

If students are unsure at this stage, encourage them to gain more exposure to the ED. This may take the form of volunteering in the emergency department, EMS experience, or shadowing an emergency physician. Interested students should also participate in a two week emergency medicine elective if possible. This can be an excellent  introduction to the emergency department prior to participating in a sub-I. Finally, stress that students focus on performance in the pre-clinical years in order to establish a strong foundation in physiology and systems.  

Students exploring emergency medicine

There are many avenues to exploring emergency medicine during the pre-clinical and early clinical years.

• Encourage the student to join the school’s  Emergency Medicine Interest Group (EMIG). Depending on the activity level of the institution’s EMIG, it may afford experience with emergency-related events, shadowing experiences, or EM training. If your EMIG is limited in scope, consider bolstering its activities. Check out this great resource from EMRA on EMIG resources. 
• On a state and national scale, students may consider attending ACEP or SAEM conferences. Scholarships are available through EMRA for students with financial need, particularly those with academic contributions to the conference.
• Encourage students to join EMRA  for access to invaluable resources, guidance, magazines, and awards. The annual cost is $55 for a medical student and $105 for a resident/fellow. EMRA has created a variety of tools to help students interested in EM. Once an EMRA member, some of the resources available to students include the EMRA: Basics of Emergency Medicine pocket differential diagnosis guide, The EMRA Antibiotic Guide, and the EMRA Match Tool (https://webapps.emra.org/match#/).   EMRA has also recently started hosting EMRA Hangouts, monthly interactive videocast discussions with EM Program Directors and advisors.   

Students committed to the speciality:

Encourage students destined for a career in emergency medicine to get involved!

• Identify a mentor for the student. This individual should be someone that ideally is familiar with the application process and shares similar interests or characteristics with the student.
• Take on leadership roles. These may include taking on an EMIG position, joining an EMRA committee, working on a community project, gaining experience with international emergency medicine, leading a clinic, developing a quality improvement project, teaching BLS, serving as medical providers at sporting events, or volunteering in the ED. The student’s commitment should be consistent and longitudinal, not only to demonstrate dedication, but to leave a lasting impact.
• Research is an ever-growing presence in emergency medicine.  If a student is interested in completing a project while in medical school, help them identify a research mentor. The student may work on a project that is already underway or create their own. If the project falls in the latter category, suggest that students consider starting the IRB approval process within the 1st or 2nd year of medical school, so that data collection and analysis may be performed during their 3rd year. Remind students that case reports and review articles can be accomplished within a much smaller window of time and at any point during medical school.

Educate students applying to emergency medicine

The MS4 year is all about applying to residency and establishing a foundation EM.

• In January-March of MS3 year, students should start planning away rotations. All of the research performed at this stage will be helpful later on, when selecting programs during the ERAS application process. They should take into account the size of the program, number of years of training (3 vs. 4), geography, and hospital setting (academic, community, county). Exposure to different programs through away rotations can help inform students’ rank lists at a later point in time.
• During the winter of MS3 year they should ensure vaccinations/titers are up to date and documented with Occupational Health, to facilitate completion of away rotation documentation. Students should work on a solid Curriculum Vitae, as most away applications will require one.
• In March-April students should select a few away rotations as described above, and then apply for a specific month through the Visiting Student Application Service (VSAS).
• In March-June students should schedule a home EM rotation. During this rotation they should aim to gain experience developing and presenting a differential diagnosis and plan for various ED complaints. The following are excellent resources for an appropriate presentation format:
  • Article: The 3 Minute Emergency Medicine Medical Student Presentation: A Variation On A Theme
  • Video: Patient Presentations in Emergency Medicine
• Away rotations: Ideally between June and September of MS4 year. Reasons why this experience is important for students:
  • They are are an excellent opportunity for personal and professional growth.
  • Students gain experience with new people, a new layout, or different approaches to patient care.
  • Students should receive a  Standard Letter Of Evaluation (SLOE) from a month-long rotation, which will be used with ERAS during the application process. Ideally students have one SLOE from their home rotation and 1-2 from away rotations.
  • Encourage students to learn as much as possible on their rotations, take really good care of patients, and interact positively with all members of the healthcare team. They should show up on time, be enthusiastic, take ownership of patients, and work hard. It is an excellent dry run for residency.
• During Spring MS3 through Summer MS4 students should be preparing to take Step 2CK and Step 2CS. Be sure to advise students to schedule these tests far in advance so that scores may return prior to interview season.
• Preparing to apply during Summer MS4 year:  Begin working on the personal statement and summarizing extracurriculars for the ERAS application that opens in July.  Applications are submitted in the first week of September with programs receiving them on September 15.  
• Ongoing learning during MS4 year:  They should read core articles and texts in emergency medicine,  listen to introductory podcasts, continue working on research projects and community initiatives, and attend SAEM or ACEP national meetings.