Emergency Medicine Residency Survival Guide

How to survive Emergency Medicine Residency.


Knowing how to study during residency is difficult for a variety of reasons. We are very busy regularly working between sixty and eighty hours a week, we all learn dissimilarly, the various exams and boards mandate divergent study patterns, and study styles change throughout residency. Always remember though, you are a resident, and residency is supposed to be difficult, a constant bombardment and immersion in medicine. Learning EM should be your primary focus, and this requires diligence, discipline, and perseverance. Remember, residency is only a brief moment in time compared to the rest of your career, so work hard! Hard work pays off.

You are a resident, and residency is supposed to be difficult…but, hard work pays off.

Chronology. The early years of EM residency are grueling, there is so much to know. So you must focus on high yield information for a vast array of topics, but you must also read broadly and deeply to ensure a complete understanding. Finding this balance can be difficult, but EM interns must invest significant time into reading and studying. In our residency, following the reading schedule assigned by the program director and chiefs will cover the entirety of Tintinalli’s in two years. This can be daunting, but should be attempted. If you are limited on time, at least scan the assigned chapters, study the bold words and phrases, and peruse the tables. Supplement Tintinalli’s with high yield, concise material from review books and FOAM (Free Open Access Medical) Education – websites, and emergency medicine specific apps (see below). As residency progresses, the ratio of time spent with different sources will change. As you become familiar with more topics, less time can be spent in the texts, and you should invest more time into cutting edge literature, and dissecting the original literature upon which our foundational EM practices are based. Occasionally, you will need to dive deeply again into a topic for review, and this should be expanded to multiple sources, including texts, websites, and articles.

Senior NMCP EM residents teaching Damage Control Resuscitation to brand new EM interns during intern orientation.

Off-service. Off-service rotations can be difficult as well. Many of the inpatient rotations require long hours and there are few days off during the month. Thankfully, the shift intensity is rarely as brutal as an EM shift, so you can study during shifts occasionally. During off-service rotations, you should learn their approach to patients, pick their brains about topics in which they are subject matter experts, but always keep in mind that you are an EM resident. Much of what you learn on these rotations has no EM application, but learn what you can, and focus on translating that knowledge into the ER realm. Knowing your colleagues’ world will make you a better EM physician and improve your interactions with your consultants in the future. These rotations are primetime for networking. Be kind, work hard, play nice. This will serve you well throughout the rest of your residency and your career – especially in the military. Military medicine is a very small world. In your future career, you may work closely with many of these co-residents, consultants, and staff attendings in small hospitals and austere locations. So make friends, not enemies.

Be kind, work hard, play nice. This will serve you well throughout the rest of your residency and your career – especially in the military. Military medicine is a very small world.

Podcasts. Since EM requires a mastery of a vast breadth of knowledge, and since residency is so short, you should nearly always be studying. A great way to study passively is via podcasts. Our residency has many outside rotations, and you will often have lengthy commutes. Don’t waste this time. You should listen to EM podcasts during your drives, at least when your mind is fresh – on the drive into work. My mind was fried after most shifts, and instead of listening I found myself spacing during my drives home, so I stopped listening to educational podcasts after work. I consider passive learning from podcasts to be supplemental, and never a primary mode of studying since you are frequently distracted and never 100% focused. But podcasts add depth and breadth to your studying and to your awareness of what is going on in the EM world. It is also a great way to keep up on current practices.

Podcasts add depth and breadth to your studying and to your awareness of what is going on in the EM world.

Boards. Boards are weird, despite all of your studying and even if you are performing like a rockstar on shifts, you must still study specifically for boards, otherwise you will fail. The best way to study for the yearly ITE (Inservice Training Exam) is by practicing board style questions – and lots of them (more below). Oral boards are also their own entity, they are a game, and you must learn to play that game well (more below). Promotion boards – “promo boards” – are specific to our residency, and preparation should begin months ahead (more below).

Our NMCP ER resuscitation bay.

Procedures. The ACGME minimum requirements for procedure numbers are easily achievable. Only 30% can be completed in simulations, except for the extremely rare procedures – “pericardiocentesis, cardiac pacing, and cricothyrotomies.” Remember, these numbers are the absolute minimums. These numbers will never make you an expert, but they should at least make you competent. Procedures are also performed less frequently in the ER with the implementation of more conservative management approaches, so residents often struggle for procedures. Positive pressure ventilation saves many patients from intubation. This is great for the patients, but bad for training. So approach every procedure as a precious commodity. You should prepare outside of the ER and the procedure lab by reading Robert’s and Hedge’s, perusing website blogs, watching YouTube videos, and mastering the nuances of each procedure. This will maximize your learning curve. Also, our residency provides many procedural opportunities through simulations and cadaver lab. And with the internet and a vast array of resources, you should achieve competence and in some cases master these procedures by the end of residency. Watch the YouTube channels EMRAP HD and EMCRIT for awesome procedural education.

Variation. Everyone learns differently, the approaches described above will not work for all. But each resident must figure out how to implement a broad review of all EM content, while focusing on board specific and rotation specific study, and reviewing clinical questions encountered during each shift. Studying in residency is a balancing act, but you can do it. Focusing intensely and working hard during these few years of residency will pay dividends in your future career.

NMCP EM residents teaching Prolonged Field Care at Operation Gunpowder – a 3rd year medical student exercise at USUHS.

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