Emergency Medicine Residency Survival Guide

How to survive Emergency Medicine Residency.


Collaterals. Our residency is very much a resident run program, which can be intimidating at first, but this dynamic offers incredible leadership opportunities that mature and develop the NMCP residents far beyond their peers. During EM1 and EM2, you will generally be left alone to focus on learning, establish your practice patterns, and settle into EM. But, during EM3 and EM4, you are expected to assume leadership roles within the residency in addition to any positions that you may have electively assumed in the first two years. The primary fourth year collaterals are Chief Resident, SIM, Lab, Intern Coordinator, Medical Student Coordinator, Research, Journal Club, and PIPS (our M&M). The third year collateral positions are often assistants to the fourth years. The specific responsibilities of each collateral varies yearly, but each collateral invariably demands significant effort and consumes a measurable portion of your time. I encourage you to embrace your collateral, this is where you can have an immediate and lasting impact in your own residency program. I also encourage you to create a “go-by” or a concise turnover file for those who come behind you. Also, provide a thorough turnover to your successors to ensure that your efforts are not lost, and that the residency continues to improve each year. Bloom where you are planted, leave your collateral in a better condition than what you inherited.

More trauma scenarios at the end of residency final exercise.

Lectures. During residency, you will be responsible for delivering lectures to your peers. The requirements are constantly changing, but as an intern you will give 1-2 lectures, and as a fourth year you will give 4-6 lectures. These range from short, mini-topics to longer, thirty minute lectures. You are expected to study and research your topic to the point of being a subject matter expert, but this is often not the case. Unfortunately, many residents wait until the last minute to begin preparing. This is unprofessional and a disservice to your fellow residents and to yourself. The chiefs will disseminate the academic calendar at the beginning of the year which details the block schedule, the topic of each block, and the block when each resident is required to lecture. Review this calendar and the block topic for your lectures, then plan accordingly. Often, you will encounter an interesting patient or case over the coming months that meets your topic needs making your lecture preparation much easier.

Study and research your topic to the point of being a subject matter expert.

Also, begin focused preparation AT LEAST one month ahead of your lecture. During your lecture, present the core knowledge, the supporting evidence, and any newly available research. I attempted to present topics simply, and to leave the audience with just a few main memorable points. Improving your lecture preparation and delivery during residency is vital to your future success as a staff physician. Most physicians, especially those with a future in academia, will lecture numerous times throughout their careers, so prepare well. Residency is the perfect place to practice in a relatively safe environment with your peers and staff physicians in attendance. You will receive real time comments and recommendations, and also lecture reviews afterward. Use this advice to improve your performance.

Lecture time!


As if learning medicine during residency isn’t difficult enough, you also must complete a ton of administrative work. Most often, this seems to distract from the true purpose of residency, but it must be done, and you must learn to balance your time accordingly.

Life Organization. The best decision you can make for your professional life is to establish an organizational process early. There are many different products and approaches, but you must find what works for you. Some use books, hard copy calendars, organizers, etc., but I use electronic resources accessible from my Iphone since that was always on my person. Google products work perfect for my organizational needs – they are interconnected, user friendly, and free. I use Google calendar for recurring events, new events, and my shift schedules. Most shift scheduling software (including Amion) can sync automatically with your google calendar, this is a huge time-saver. I also use Gmail – it’s free, works great, is user friendly and easily searchable. You can’t automatically forward your DOD email, but you can individually forward important emails to your Gmail account, just label them accordingly in the email body or subject line so you can find it easily later. Google Drive is awesome for storing professional certificates, important articles, etc. Unfortunately, the .mil firewall does not allow you to access Google Drive from a DOD computer, so you may need to use your Gmail to supplement Drive. Google Docs and Google Sheets are also useful tools, but they are blocked on DOD computers. Google Keep and Google Tasks are great “to-do” list applications. Google Tasks allows you to set completion dates and it syncs with your google calendar, so I put all my license/merit badge expiration dates and big projects here. Tasks appear on my calendar, send notifications when due, and can be reviewed in list form on the app. Google Keep is great for simple task lists, grocery lists, etc. You can manage multiple lists, store pics or files, and check them off when complete. If you use Google Chrome, Gmail will automatically open a sidebar with Google Tasks, Keep, and Calendar readily available for referencing and editing. I also use Apple Notes for annual goal sheets and note taking. There are many different organizational tools available, but these are what I found helpful. Whatever you do, you must choose a system that allows you to stay organized, otherwise you will be mired in admin woes and forget many of the important events and tasks discussed below.

The best decision you can make for your professional life is to establish an organizational process early.

Research. Our residency program requires significant research involvement and the completion of scholarly activities to graduate. Fortunately, our research programs are incredibly robust. We are home to the Combat Trauma Research Group which is constantly producing new data and publications geared towards improving the safety and survivability of our warfighters down range. Residents at all levels frequently present posters, publish articles, and win national research awards regularly – including most recently Dr. Eric Sulava being named the 2018 ACEP Resident Researcher of the Year. So get involved early, find a staff mentor, and enjoy the opportunities to improve your world.

Physician License. You must maintain a current physician’s license during training and renew before expiration, or risk professional repercussions. I chose to license in Virginia, the state license is inexpensive and easy to maintain and renew online. Some may choose to license in their home state or in their eventual practice location, but ensure that you adequately research the requirements and the cost, it may save you future grief.

Exploring the inside of a C-130 rigged for patient transport.

Merit Badges. ACLS/ATLS/PALS/BLS are the main merit badges. NRP is great to have, although not required everywhere. Make sure that you keep these current, it is ultimately your responsibility. The residency “Program Management Specialist” (AKA Mom) will help you with these and remind you when they are due. She will also forward your certifications to the outside hospitals for upcoming rotations, but you must remain up-to-date or risk rejection from the rotation. Schedule renewal courses far ahead of time, some are infrequently offered at NMCP, and the course dates may conflict with your other residency responsibilities.

DEA number. You must also maintain a DEA license as a resident physician. It lasts three years, so if you apply as an EM2 and go straight through, you will not have to renew during residency. But, if your training experience is prolonged and circuitous like mine, then you must renew during residency. As a DOD physician, you are exempted from the application fee ($731 a few years ago). Don’t let your DEA license expire, or you will have problems prescribing controlled substances during outside rotations.

New EM interns learning TCCC on the fly.

New Innovations. During residency, you must log your work hours, lab hours, academics, and any procedures. Below are a few tips.

  • New Innovations is the logging website that our residency utilizes.
  • Log regularly, ideally after shifts, or at least weekly. Or if you get behind, log AT LEAST every few months.
  • Keep track of good cases/procedures. Some residents use books and patient stickers, but be careful, this is PII. Never lose or misplace that book.
  • Review the “loggable” procedures in New Innovations occasionally to remind yourself of the procedures you should be logging, and to jog your memory about cases you may have forgotten.
  • You will perform sufficient procedures during residency to meet the minimum requirements per ACGME, but you should aim to surpass this significantly. Keep logging. These numbers will count after residency as well.
  • Log labs, log Cadaver, log Simulations, etc. These will count (but only 30%), max them out, especially with the very rare procedures.
  • You can also log cases and procedures that you supervised for junior residents and medical students.
The incredible Appalachian Trail. A moment of peace.

Relias (formerly Swank, formerly NKO…). Military online training will prove to be the bane of your existence. Yes, most of these training modules are ridiculous, but they must be completed to keep the residency leadership from sending you annoying emails. While this may be the least of your personal worries, if you are constantly delinquent on Relias, your leadership will notice and there will be consequences. Pro tip – google that specific training module, you may find random websites with helpful information…

PHA/BCA/PRT/Dental/Urinalysis. You are a resident, but you are also a naval officer. And the Navy must maintain its medical readiness. Ensure that you complete your annual PHA, and remain at least a Category 2 on your dental record. As a naval officer, you should maintain some level of physical fitness during residency, which can be difficult, but it can be done with discipline and prioritization. The BCA/PRT cycle occurs twice a year in the spring and the fall. Great news! If you score excellent on your PRT now, you are only required to complete one PRT per year. And scoring excellent on the PRT is not too difficult, even while only maintaining an average fitness level. Randomly, you will be selected for a urinalysis, but “Mom” will remind you if you are in the hospital, or cover for you if you are away. Don’t forget the urinalysis if you are present, however inconvenient. Fulfill your patriotic duties and “pee for your country.”

NMCP EM Class of 2019 Graduation aboard the USS Wisonsin.

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