Often, because our specialty is so broad, the art of EM is knowing where to find readily accessible resources. We must instinctively know resuscitation algorithms and emergency medication dosing, but many of the less emergent, less time sensitive, less frequently encountered diagnoses mandate quick referencing. Knowing and maintaining quality resources is essential.
TEXTS. While large textbooks are somewhat archaic, they still have their niche in learning EM. They provide the broad base of knowledge and the depth needed for the intimate study of a variety of subjects. They are not as handy for quick reference, but they do provide inclusive tables and spreadsheets that can be used as a reference if saved in a readily accessible format. But texts are best utilized when you are mentally fresh and have an extended period of time available, a large cup of coffee, and a firm couch.
- Rosen’s is the gold standard Emergency Medicine text, and should be the EM residents’ foundational guidebook. It is very detailed and thorough, does not lend itself to quick reading, but provides a breadth of information about every pathology encountered in the Emergency Department.
- Tintinalli’s is the runner up to Rosen’s. It is often more concise and an easier read than Rosen’s. Its tables, graphs, and pictures are phenomenal, and the bold words and phrases are helpful for scanning a topic if time is limited.
- Robert’s and Hedge’s is the EM procedure text. I recommend reviewing the pertinent chapters before procedure labs, before or after procedures on shifts, and for learning all the nuances of those procedures.
- EMRA minibooks. These are phenomenal little books (discounts and free books are available with an EMRA membership) with high yield information that can be used on shift or while quickly reviewing a case after shifts. I carried them in a small go-bag since we worked in a variety of ERs and I never knew which electronic resources would be available. I used the EMRA Antibiotic guide nearly every shift. EM Fundamentals is a concise review of the main EM pathologies, great to use during shifts as a EM1 or EM2, but especially helpful for a quick review after shifts. The EMRA EKG Guide is a basic, outlined format of all the main EKGs you need to know. While primarily aimed at junior residents, it also is great to review the specific definitions of each EKG abnormality. The Pressordex is a good resource for medication dosing if no electronic resource is available.
- ECGs for the EM Physician 1 and 2 by Amal Mattu are phenomenal for review and learning the nuances of EKG reading. Buy the hard copies. The ekgs and official reads are separated by 30-40 pages, so I would read a few EKGs and then flip back to the official read for reference. These books are great for getting in the necessary reps to become adept at EKG interpretation.
- The Resuscitation Crisis Manual by Scott Weingart is a new resource with phenomenal, high yield, bulleted, stepwise instructions on how to handle critically ill patients in the ER. The hard copy is wire bound and the pages are waterproof.
- Emergency Medicine: A Focused Review of the Core Curriculum is just one review book, but Joel Schofer, one of our Navy Staff Attendings, played a significant role as the editor. There are a plethora of other similar review books. These can be used for high yield reviews of EM content in preparation for boards, or as an adjunct to formal studying.
WEBSITES. The internet has revolutionized research and study habits. Most of us “younger” students are very comfortable with using websites as primary study resources. Just be judicious, the quality of these online resources varies widely and they are not necessarily vetted or peer reviewed. Many websites require subscriptions for their services, these can often be purchased at discounted prices as a resident. There are many FOAM (Free Open Access Medical) Educations sites that are phenomenal resources. Some can be used for rapid, on shift reference, and others present more lengthy, formal presentations of EM content. The FOAM world is rapidly expanding, but this can lend to one getting lost in a network of resources. Find a few trustworthy websites, use them frequently, then use Google for everything else. Below are a few resources that I found useful during residency:
- emresportsmouth.org is our residency website, it is password protected, and it is the hub for information sharing designed specifically for the NMCP EM Residency. All of your academic resources, schedules, “go-by’s,” rotation gouge, lab resources, off-service contact information, combat medicine resources, AWLS resources, and various other residency specific resources are available here.
- wikem.org is an excellent website for reference during shifts. Think of this site as the Wikipedia of EM, this may be where you start with your information gathering, but is not really considered a vetted source.
- uptodate.com is a thorough, non-EM specific resource that can be utilized on shift for a variety of clinical questions, drug referencing, etc. It is accessible through most DOD medical facilities, and you can obtain a personal account via our NMCP librarians. Once you obtain your personal account, as long as you are logged in, you can obtain CME credits for articles that you read and reference.
- emcrit.org is another phenomenal resource for the critical care that we deliver in the ER. In addition to the EMCRIT-RACC podcasts and articles, the website has expanded to include a variety of other contributors from various disciplines, but all specializing in resuscitation and critical care.
- emrap.org is rapidly becoming “THE EM” online resource. It started with a monthly podcast but is constantly expanding and becoming a one-stop shop for all things EM. But you do need a membership to access the content. This can be obtained cheaply during residency via an AAEM/RSA membership.
- emdocs.net is an EM-specific, FOAM website that contains many awesome articles, some of them authored by our very own residents and staff.
- rebelem.com is great for journal club preparation. If you can find the article to be reviewed on this website, you will be golden. This website reviews much of the current EM literature and comments on the quality of the studies and the evidence. There are other comparable websites that can be utilized similarly.
- ECGWeekly.com is another excellent option for learning EKGs. Dr. Amal Mattu – EKG guru – uploads one EKG every week and explains the nuances of the read, and the annual subscription is only $26. This is a great way to force yourself to improve your EKG reading skills regularly.
- MCCareer.org is Joel Schofer’s website and should be considered the go-to resource for your Navy career development and advancement. His FITREP writing resources are invaluable.
- kinnetikmedicine.org is my own website – shameless plug – with a focus on operational and resuscitation medicine. If you are interested in military dive medicine, operational courses, or wilderness medicine, then there are a variety of resources available, and the breadth is constantly expanding.
- openathens.net is also a great resource. Get an account via our librarians, this will give you access to PUBMED articles offsite, and many textbooks via online format. This is a great resource if you are on an outside rotation or not able to access the content available through the hospital intranet.
APPS. Smartphone apps have also revolutionized the learning sphere. You can now have complete textbooks in the palm of your hand that are easily searchable and readily available at the swipe of a finger. Below are a few EM specific apps that I found helpful in residency:
- PalmEM, ERres. PalmEM is easily my favorite EM app. It is organized by categories, but can be searched as well. It also has a “Pedi-tape” page – essentially the Broselow tape, which is essential for pediatric resuscitations. ERres is another great app that I used as a backup to PalmEM. If I couldn’t find it on PalmEM, I would then use ERres, but ERres is not as user friendly as PalmEM.
- Pedi-STAT. This is another pediatrics apps option. Also organized like a Broselow tape, you can use this interchangeably with the PalmEM “Pedi-tape” page and choose whichever format you like best.
- Uptodate. A great app from the awesome website. For those times when you don’t have uptodate access easily via the computer.
- MDCalc, Qx Calculate, MedCalc. MDCalc should be the only calculator app you ever really need for EM, but I occasionally needed to use the other calculator apps on inpatient and ICU rotations. If you can’t find a specific formula on one, just search the other, one of them should have what you need.
- Rosh Review. Awesome! Amazing app! The entirety of Rosh Review in the palm of your hand. This is great for doing questions on the bus, the train, the car, etc.. Fill those extra minutes with Rosh Review instead of social media.
- SonoSupport and Pocket EUS are excellent emergency ultrasound resources especially for new learners. They show standard views, give technique recommendations, and important measurements and data points.
- EMRAP. This app is constantly improving. There are so many more additions when compared to just a few years ago. It has all the EMRAP podcasts, along with the C3 content, EM Abstracts, LLSA article reviews, and Crunch Time EM. My only complaint was that it frequently logged out, requiring me to log in again to get back on the app (I know, knit-picky, but annoying when you are just trying to start an episode quickly while you are getting on the road).
- Epic Haiku. This app was an excellent resource for the Sentara inpatient rotations (Trauma/ICU). You can access Epic from your phone, look up your patients, their notes, their labs, etc. This was clutch for rounds, some residents read their notes straight off their phone instead of printing out everything (which was awesome, especially if the printer was acting funky that morning). It was also great for lengthy rounds when you needed updated labs. The greatest feature of this app though is the picture adding function. You can take pictures of physical exam findings, or lacerations, or other injuries via the app then upload them directly into the EMR without the pics staying on your phone or violating HIPAA. You can attach those pics to the physical exam section of your note. Again, an incredible tool.
- MilMed Apps. I didn’t use this app as much, but some of my co-residents did. It is specific to our hospital and contains the phone numbers to various specialties and departments. I’m not sure how reliable the information is or how frequently it is updated.
PODCASTS. Podcasts are also an amazing addition to life and learning. These can be used in a variety of manners, I used them mostly for passive learning while driving. Often, podcasts have associated notes posted on the hosting websites that can be referenced later for additional learning or exploring their sources. There are so many podcasts now it is hard to keep track – toxicology, pediatrics, basic EM, critical care, operational medicine, etc. Below are the core EM podcasts that you should add to your listening library during and after residency.
- EMRAP. Emergency Medicine Reviews and Perspectives was a monthly podcast created in 2001 by Dr. Mel Herbert. It has now expanded into a massive EMpire with many EM gurus contributing, and the offerings are constantly expanding. If you choose just one podcast source for residency, this would be a great choice, it literally has everything, and contains volumes of podcasts from previous years. During residency, you can access EMRAP cheaply via a yearly AAEM/RSA membership, after residency the price increases significantly. The core offering of EMRAP is the monthly 3-4 hour podcast divided into topical sections that are easily digestible in a short car ride. And they also publish associated pdf notes for each podcast that are phenomenal for reference.
- EMCRIT. The free, non-subscription, EMCRIT podcast was created by Dr. Scott Weingart, an ED intensivist from New York. He is EM trained and completed a critical care fellowship at Baltimore’s Shock Trauma Center. EMCRIT is the premier EM critical care podcast, and is an excellent resource for residents and attendings wanting to refine their critical care skills. Attempt listening to most of these podcasts at some point during residency, I’ve listened to many of them multiple times. His website has also expanded significantly to include other contributors and topics – PulmCrit, EMNerd, The Tox & Hound – but the EMCRIT podcast, now labeled EMCRIT-RACC, remains the core offering. They are also in the process of building an Internet Book of Critical Care, which will eventually contain all things critical care online. He also recently published the Resuscitation Crisis Manual, which is available in pdf and hard copy, and is an awesome, high-yield resource that every EM physician should own.
- ERCAST. This podcast is also one of my favorites, created by Dr. Rob Orman, EM physician. While he addresses purely medical themes, he often discusses the theory, the art, and the finer points of practicing EM. He recently made the podcast subscription based through Hippo Education, but he has left years of his initial podcasts freely available to the public on his original site linked above. These are golden, and you should make an attempt to at least browse and listen to much of them.
- MCCareer.org. This podcast was created by Dr. Joel Schofer, USN EM physician, and addresses issues related to career advancement in the Navy medical corps. This podcast is great for naval officers in addition to perusing and using his related website.
YOUTUBE. YouTube rocks! I am a visual learner, and there are so many helpful resources on YouTube for medicine, and more videos are being added constantly. Subscribe to the EMRAP HD, Essentials of EM, and EMCRIT YouTube channels, and explore the available learning aids. I may or may not have watched a few YouTube videos on my computer before performing procedures in the ER. Also, lectures from the EM greats are occasionally posted on YouTube free of charge.