Student’s guide to the emergency department

Published on 14/03/2015 by admin

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Last modified 14/03/2015

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Chapter 48 Student’s guide to the emergency department

Sascha Fulde, Tiffany Fulde

The emergency department can be the highlight of a student’s day or the place where you feel most out of place, or both at the same time. Hopefully this chapter will outline some practical tips for getting the most out of this wonderful resource.

ADVANTAGES OF THE EMERGENCY DEPARTMENT

As the place where almost all of the patients enter the hospital, emergency department is a short case heaven. In addition, you can see patients before they’ve been overrun by a thousand other students and doctors. Just think, by the time a patient gets up to a ward, they’ve most likely had the same questions asked and been poked in the sore spot by the emergency department intern, registrar, intern on the admitting team and the registrar, plus at least one nurse. They’ve had a stressful time, feel unwell and, ultimately, probably just want to be left alone, whereas in emergency department they haven’t been examined that many times. They’re prepared to be undressed, poked and prodded because they recognise that that is what happens when they come to an emergency department. A student can often be useful either confirming examination findings, sometimes finding something someone missed, either on history or examination, or just alleviating some of the patient’s worry by spending some time with them while they’re waiting for results of investigations. Even if you’re only doing an examination, it makes the patient feel that something is happening and that they’re being taken care of. The patient is also in the mindset where they really want to talk about their story and those niggly details of symptoms as it’s pretty much all they can think about. Thus the emergency department is a fantastic resource for a medical student.

When the patient presents to emergency department they’re much more likely to present in a way that is useful to a student. Firstly, as no one knows what is wrong with them, you actually get a chance to test your clinical and diagnostic skills. Secondly, they present in the same way that short and long cases are often presented in exams. The complaints are also often at a level which you will be expected to know. For example, you are much more likely to see a patient with chest pain rather than a phaeochromocytoma.

Learn to handle emergencies

As a student my biggest fear was that I would actually kill someone! My second biggest fear was failing exams. And the third was, how do I actually save someone’s life? I’m not just talking about the big trauma cases but also the smaller practical procedures. This is one of the greatest things emergency department can teach you. By spending time there and talking to the doctors, you learn how to actually prioritise management and the basic couple of things that you need to do right now before you stop and work out the clinical management guidelines. You can also learn how to actually do them.

Find patients for tutorials, case histories and presentations

Although the hospital is full of patients, it can often be hard to find patients that fit the requirements of the task you’re trying to do—for instance, finding an interesting surgical case to present in a surgical tutorial or even for a bedside tutorial. As staff in the emergency department have seen all the patients that have entered the hospital, they are wonderful at knowing what patients are around and worth chasing up.

Fits well with problem-based learning (PBL) courses

At the beginning of a PBL course it can often be difficult to approach medicine on the wards as you have only learnt information on certain specific disorders or systems. This can make it overwhelming to approach a general medical or surgical term. However, in emergency department the patients present in the same way as a case in a scenario, and this allows you to approach things you haven’t seen before.

One of the strengths of PBL, which is that you focus on individual areas, can sometimes be slightly frustrating. By only focusing on one clinical vignette, you can sometimes feel like you don’t know much about broader medicine. By hanging around the emergency department even for only a short period of time, you can very quickly start to counteract that and learn a lot across a broad range of areas.

Provides a place to integrate a lot of knowledge

Whatever level you’re at in your training, emergency department provides a great place to pull both your clinical skills and esoteric knowledge together and practise what you’ve been learning. It’s always easier to remember something when you’ve seen a patient with it and seen how they were managed.

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