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AUCMD2013
09-21-2011, 03:03 PM
Hey guys, has anyone completed a 4 week ER elective at NUMC? Can someone please give some info on how it was? THanks in advance.

Phur
09-21-2011, 05:05 PM
Did mine there. I'm applying to EM so my opinion might be skewed since it's what I want to do. Overall, it was a good experience. As with any rotation anywhere there's a fair amount of variability depending on the residents and attendings that are on the same shift as you.

Schedule: you do 3-4 12 hour shifts per week. Shifts are highly variable and pre-set schedule (although no one besides you really knows when your assigned shift actually is, so theoretically you could switch it around and no one would know). There are 8a-8p, 10a-10p, 12p-12a and 8o-8a shifts. Expect to have at least one shift a weekend, sometimes 2.

People:
Students: There were usually 5-7 students on the rotation at any given time, but never more than 2 in a given section. It's a mix of med students, PA students and podiatry students.
PA's: I really liked all the PA's I had interactions with. They were all friendly and helpful if I had any questions.
Residents: Again, the residents I worked with were all great. There are IM residents that rotate through the department and there are also EM residents from LIJ. If you help make their lives easier, they will definitely show you and let you do more (especially the EM residents).
Attendings: This is where it's kinda hit-or-miss. Some are great- give you intern level autonomy, will give you a teaching point based on your case, etc. Some scut you out like crazy- i.e. you spend more time transferring patients to radiology, running blood to the lab, etc. than taking history. Some barely acknowledge your existence. Highly variable
Nurses: I was actually really impressed. Having done my IM core here, I was expecting the same level of activity as the floor nurses, but I was pleasantly surprised. They will get lines and labs done in a reasonable amount of time and transport patients if not overly busy. If you want to learn strategies for peripheral lines, some of these nurses are an amazing resource. Obviously some suck, but most were really good. They don't roll their eyes when you ask them to do something, which was a completely new experience compared to what I was used to on floors.
PCA's.Nurses Aides- Minimum wage workers and it shows. I actually got lucky doing it over the summer in that there were Pre-meds back from college working for the summer that actually had a good work ethic. But now, it's horrible. And as the next one up on the expendability ladder, med students get stuck doing their job (transporting, etc.)

Facility: It is a brand new ED, just opened on June 1st. All private rooms with storage space that has most all supplies in each individual room, which is nice. Otoscopes and opthalmoscopes in every room. Very nice facility. Computer space sometimes a problem even though every room has a computer. Everyone just uses the ones at the nursing stations, which can sometimes get crowded. ED is broken up into 4 sections- Team A, Team B, Peds and Fast track. Trauma room has 2 trauma bays. Also, 2 resuscitation rooms for the extremely ill- acute MI's, severe dyspnea, cardiac arrests, etc.

Didactics: Lectures every Tues and Thurs on EM relevant topics (CP/PE/etc) at 10/10:30. Usually go until about 1. Mandatory attendance even if not assigned to work that day. If you do work that day your shift ends 12 hours from the beginning of the lecture. 2 different lecturers. One pimps you throughout the lecture. The other lectures at you. Usually 1 peds-em lecture somewhere over the course of the month.

At the very beginning you get assigned to Team A or B and that's the area you do all your shifts at. Like I mentioned, which attending is there dictates your level of involvement. Either way, I found you go in and do the HPI for a patient. If it's a crappy attending, you present to the resident who will present to the attending. If it's one of the good attendings, you can present directly to them and they will help you develop a plan. Sucky part is that students can't put orders in so you have to bug a resident or PA to do it for you. Procedure-wise, it is dictated by the pathology that comes in. You have the opportunity to become proficient with IV's and and drawing blood if you're into that. Lac's are semi-frequent, so you more than likely will have the opportunity to suture if you want to. Residents did all intubations, central lines, LP's. It is a safety-net hospital so you get a lot of un- or under-insured. Quite a bit of detox patients as well. All-in-all you see a fair amount of pathology. You're never formally assigned to fast track, but I stayed there for a couple shifts. That's where all the minor health problems go. You have much more autonomy there as well, but at the same time you don't see very much unique pathology there either, just lots of back pain, minor injuries, etc. One or two shifts is more than enough to get the jist. There is also a critical care doc on every day who manages the acute resuscitations. Hind sight being what it is I probably would have tagged along with that doctor for a shift or two to see the super-high acuity that you don't see on the main team you're assigned to. Also, there is no assigned peds experience either, but I imagine you can do a shift in that section too if you so desired.

Trauma: It is a level 1 trauma center. I'd estimate 90:10 blunt to penetrating trauma, but you will see knife and GSW. Vast majority are falls or MVC's. General surgery sends a trauma team (which is 2-3 residents plus 2-3 students) to all traumas plus there's all the ED nurses and EM residents, so it's pretty crowded and can be chaotic. That said you have the option to stand back and watch or if you're assertive you can get in and participate. Choice is yours.

Overall it was an enjoyable experience, but that's coming from someone applying to EM. It's a specialty that you pretty much love or hate. That's all I can think of off the top of my head. Any other specific questions, feel free to ask and I'll get back to you when I can.

ja23456
09-23-2011, 05:41 PM
for NUMC (any rotation, not just ER) where you required to pay for a background screening through applicationstation? https://www.applicationstation.com

whats that about?

How much is it, it doesn't say anything on the website?

AUCMD2013
09-27-2011, 11:13 PM
Does any one know whether NUMC requires general surgery core to be completed before doing the EM elective?







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