Most important skills from your perspective...

[SERENITY NOW]

Hi everyone,

 

I am a new grad PA about to go into an emergency medicine residency program where we have some flexibility to focus on what we want.  It could be learning the intricacies of managing critically ill patients vs getting great at managing low-moderate acuity patients efficiently; it could be learning advanced procedures vs getting great at common procedures; it could be solo practive vs traditional teaching hospital feel; etc.  While I'd love to learn it all, the program is only 1.5 years and I realize I'll have to narrow my focus to things that will give me the most bang for my buck. 

 

I've heard people say you should focus on the seeing as much of the critically ill patients and doing as many advanced procedures as possible, because people won't train you on this in the future (while you can typically learn low-moderate acuity things on the job).  Others have said many EDs won't even allow PAs to see the highest acuity patients or do the advanced procedures, so its pointless focusing your energy on them now.  I understand that very rural, solo provider EDs do allow it, but I don't see myself in a place like that until I have many years of experience. 

 

All of this being said, I wanted to ask you all, what would you focus on if you were given the opportunity to do an emergency medicine residency?   Any advice would be greatly appreciated.

 

 

 

ps moderators - I wanted to leave the question open to the general professional forums, but feel free to switch it to EM or Residency subforum if you think it'd get a better response.

[EMEDPA]

critical care, anesthesiology, u/s, really sick kids, trauma, advanced procedures.

you can learn general em in any job. what you want out of a residency is the stuff from the off-service rotations listed above. if you have a procedure log full of advanced procedures you can find a job where you can utilize those skills. if you don't it's much more difficult.

congrats on your acceptance to an em residency. you made the right choice. now get the most out of it you can.

[JoeM]

Where are you doing your residency if you don't mind me asking?

[SERENITY NOW]

sent you a PM, JoeM

[Boatswain2PA]

This probably isn't the answer you were "wanting", but here is my answer anyway.

 

Learning when and how to put in a chest tube is easy, as is understanding the risks and complications of doing them.  Same with every other procedure we do in EM.  Whether it is suturing, I&D, LPs, CVLs, splinting, etc, etc, etc, it is all a matter of learning the procedure and then doing it enough times to become competent.

 

However the most important skill to have as an EM provider is to have a wide differential for every patient, and the ability to go through that wide differential and ruling out (which = placing in a "very low risk" category) all of the "badness".  

 

Even the patient you see who has been to the ED 14 times in the past 30 days who now presents with a week of left hip pain deserves this treatment.  Yeah, it's the same arthritic hip pain she's been seen in the ED before....but is it a septic hip?  You gotta think about it so you can rule it out.  

 

Procedures are the "cool and fun" part of our work, but they are rarely the important part.  Can't put a chest tube in?  Just sticking a hole in their chest (finger thoracostomy) is just as effective short term.  Can't intubate?  Bagging them is just as effective in the short term.  Can't do the LP?  Just start the abx and acyclovir and get help. Can't get the dislocated shoulder back in place?   Call/ship to ortho, they can do it.   If you aren't great at these procedures then someone else will be.  However missing a case of Kawasaki's disease in a febrile kid can be devastating.  

I'm not saying that EM PAs shouldn't be proficient at these procedures, but doing procedures are not the "most important skills" that we have.  

 

Just my 2 cents....

[GetMeOuttaThisMess]

Being able to look at patient; no touch, just look; and differentiate "sick" from "not sick". Most important info is your first impression of general patient appearance. Sounds easy, but not always so.

[True Anomaly]

Agree with all of the above- the key is knowing how to "think" in the style of emergency medicine, which has a different approach than most other specialties.  This also involves understanding why you are obtaining tests and whether they make any difference in your disposition of that patient- including something that seems so innocuous as a CBC.

 

I think learning how to approach critical patients is extremely important because that skill will translate to any ER, and your experience with this will come through at that next job and enable you a flexibility in practice that your fellow PA's may not enjoy.