On Shift Tips

During your rotation at Doctor’s Hospital, you will be expected to draw from your experiences in other rotations as a third and fourth year medical student. The following are tips of how to do well on shift: 

Promptness

Arrive at your assigned pod 15 minutes prior to the shift start time. 15 minutes is on time, on time is late!

Communication

  • Introduce yourself to the attending, resident, nurses, NPs/PAs that are working during your time. 
  • Discuss with your resident and attending physician your goals for your shift, anything you would like to work on, and how you can help them
  • Ask for help. Asking for help shows that you know your limitations but are willing to learn. 
  • Develop a complaint-specific differential diagnosis. Before returning to your resident/attending to present, formulate your differential and plan. If you can come up with the differentials that are life threatening, most likely, least likely, and the zebras, you will impress everyone with your knowledge. It’s ok to tell your preceptors that you need to take a minute to look something up, such as the management for a suspected acute appendicitis. 
  • Every resident and attending works with medical students differently. In general, ask them what they expect from a student. Otherwise, try to perform a 3-5 minute concise presentation. Presentation tips are provided below. 
  • Take 5-10 minutes for your complaint-directed H&P’s with a patient. Taking less than this will not give you the information you need, and taking more will be inefficient. In addition, genitourinary exams should always be chaperoned by a resident or attending physician. 
  • Don’t lie. If you forgot to ask a question or perform a portion of the physical exam, it’s okay! We all learn from our mistakes and this is how we grow.

Engagement

  • Familiarize yourself with the EMR system, EPIC, so you can see when a new patient is ready to be seen, see what orders have been placed, check on results, etc. If you can do this independently instead of asking others, it makes your shift more efficient! 
  • Push yourself on shift. For example, if you have never written a note before, ask your resident if you can practice writing a medical student note in the EMR or on paper. If you have never placed a foley catheter, ask a nurse or resident to show you if they are planning on having one placed for a patient. 
  • Show initiative. As a medical student, you are here to learn but also there are many ways that you can increase ED flow and make your resident’s shift easier. For example, being proactive and placing the carts (pelvic exam, ENT, ortho, or suture cart) or ultrasound machine outside the patient’s room in preparation is very helpful. Auscultating lungs after a breathing treatment or re-examining an abdomen after medications and relaying this to the resident are great ways to show that you are aware of your patient’s clinical course but also facilitating their disposition. 
  • Maintain a good attitude. Be hardworking, interested and passionate on shift. If you are tired, uninterested, and/or condescending, it shows and reflects poorly. 
  • Ask questions, but during the appropriate time and situation. If your resident or attending are busy (for example while they are charting, on the phone, speaking with nurses or other consultants, performing a procedure), try to save your questions and/or comments for the end of shift. Please be courteous of the other responsibilities residents have while on shift.

Patient Interactions

  • If your patient looks critically ill and needs immediate attention, pause your evaluation and get your resident or attending to come to the patient’s bedside. This includes if the patient looks critically, vital signs are significantly abnormal, they are having difficulty breathing, actively vomiting, etc. If you’re not sure, it’s better to be safe and make the resident aware of your concerns. 
  • Always maintain a professional relationship with your patients and other staff. This means you should introduce yourself as “Student Doctor” or “Senior Medical Student.” Treat patients as you would want your loved ones to be treated in the ER.
  • Refrain from discussing medical orders or plans without confirming with your resident or attending. If information is misconstrued to the patient, this can result in confusion and frustration. 
  • Advocate for your patients. You are an important member of the team! If your patient asks for medicine or PO intake, let your resident know. If they need a blanket, please obtain one for them. If they need help ambulating to the restroom, assist them.
  • Take notes on shift. Try to study one topic or patient clinical presentation after your shifts. You can further impress your preceptors by closing the loop. For example, if you observed/assisted with a hip reduction on shift, study various techniques of reduction at home and discuss these with the resident/attending the next time you work together. This shows initiative, interest and dedication to emergency medicine. 
  • Remember to take a break to use the restroom, eat a meal, and take care of yourself during a shift. It’s easy to get bogged down during a busy ER shift, but self-care is key!
  • Read up on interesting cases and clinical presentations. Cases may be used for Lloyd Rounds, personal statements for residency or can even result in a case report or poster presentation. Always maintain HIPAA compliance, of course!
  • Complete a medical student evaluation form at the end of each shift. Ask for feedback, areas of improvement and goals for your next shift.

Procedures

  • Exhibit basic procedural competence. This includes but is not limited to wound care, foley catheter placement, laceration repair, incision and drainage, IV placement, ultrasound, intubation, etc. 
  • If you have never performed a procedure, let your resident know so they can guide you through the correct steps. If there are procedures that you would like to familiarize yourself with, our SIM lab is available for practicing your skills.
  • Feel free to observe other residents doing procedures during your shift. You are here to learn!