Residency

The transition from being a medical student to becoming a resident is a steep learning curve. Not only will you have new responsibilities, but you will need to learn how to think on your feet and work efficiently within your hospital environment to provide the best care for your patients. Below is some advice from current residents that can help guide you during your internship year as a young emergency medicine (EM) resident:

• Work hard during every rotation and learn as much as you can.
• Meet people from other specialties and befriend them.
• Don't take things personally. You will be rotating on different services and there will be times when people will say some unpleasant things in the emergency department (ED) in front of you. Remember that every resident is overworked/sleep-deprived and may have something else going on in their lives that you are unaware of.
• When a nurse approaches you with a concern regarding a patient, stand up and go see the patient! You'll be surprised and humbled about the many times you will catch something because a nurse helped you out.
• Be thorough. If you don't do a thorough physical exam on your patient, don't expect to get one from the senior resident/fellow/attending. Take ownership of your patients.
• Advocate for your patients to get the care that they deserve.
• Read/learn one thing about a patient every day. It's difficult to find time to study, but spend at least 15 minutes reading about something every day.
• Spend time at the bedside with your patients and families. Address goals of care early on with your patients; the sooner you attain these crucial communication skills, the easier it will be in the future.

The primary goal of every EM resident is to develop the skills that will eventually allow them to become an effective physician. This takes years of dedication and training to develop throughout the course of residency. Determining individual career goals and pursuing academic and extracurricular interests are other important priorities. Pay attention to different practice styles and environments as you partake in rotations at different sites during residency, noticing the parts of different jobs that you like and may desire in your personal career choice. Ask attendings working in these different environments about the pros and cons of their jobs and why they chose one job over another. Regardless of your specific career goals after residency, building a broad base of medical knowledge, developing solid procedural skills, and becoming as efficient as possible should be your primary focus to best transition to independent practice.

While community practice may be an ideal work environment for many residents, some will decide to work in academic medicine. The “Attending” section will provide further information regarding the differences between academic and community practice. In order to pursue a  career in academic medicine, residents may benefit from additional experiences, including scholarly pursuits and research. Below is some general advice from program directors about additional experiences or requirements for academic positions:

• Work hard at your clinical skills.
• Find a niche. Experience as much as you can early on in residency to find out what you like. When you have identified an area of interest, find a project (or more than one) within that niche. If you have multiple interests and are uncertain of where you want your niche to be, then get projects in multiple areas to try them out.
• Demonstrate effectiveness. When you take on a project, make sure you complete it. Be responsive with your mentors so they view you as responsible and effective. Have an "end product" that you can show potential future employers. No matter what your niche, you want to be able to prove that you are someone who gets things done.
• Build a CV that demonstrates your interest in your particular niche. If you want to be an educator, you should have demonstrated interest and involvement in education, with the more leadership and innovation demonstrated the better. In operations, develop some patient care protocols, complete a quality improvement project, or do something else that is tangible to show your interest/skill in that area.
• Be present, involved, and engaged. This is how you find opportunity and how you will be identified for opportunity.
• Demonstrate that you have learned bedside teaching skills. Collect evaluations, complete an elective, take a course.
• Demonstrate that you have lecturing skills.
• Consider getting involved on a national level in organizations like the Society for Academic Emergency Medicine (SAEM) or the Emergency Medicine Residents' Association (EMRA).

While not specifically for individuals planning to work in academic EM, the USMLE Step Three exam and the American Board of Emergency Medicine (ABEM) annual in-training exams (ITEs) are required during residency training. Click on these links for more information on Step Three and the ITE.

The Three Pillars of a Successful Career in Academic EM

Scholarship, education, and career development are the three essential pillars that make up the foundation of a successful career in academic EM. These pillars can (and should) be developed during residency. 

• Scholarship: Scholarship takes a variety of forms in residency - as simple as a case report to as complex as a multicenter RCT. For those residents who are dedicated to research as part of their career, it is important to start early. That said, publication is not the sole goal of research. While the outcomes of a project may vary, engaging in scholarly work during residency serves several purposes: building a broader foundation in research methodology, gaining specialized expertise in a specific niche within emergency medicine, and generating ideas for advancing the field. Although research requirements differ widely across programs and fellowships, contributing to meaningful and productive scholarly work is likely to be an asset in a career in academic emergency medicine. Even residents not interested specifically in research, performing scholarly work in your area of interest will make you more competitive for fellowships and certain job opportunities. For more information about performing research as a resident, take a look at SAEM’s Research Resources. SAEM has also published a great guide to research grant opportunities that will be invaluable for obtaining research funding. Additional funding opportunities from the SAEM Foundation can be found here.
• Education: Almost all academic EM physicians will have a role in the education of junior learners, including residents and medical students. Those who are interested in being more involved in the education of learners would likely benefit from fellowship training in medical education or simulation fellowships. Participating in teaching electives or opportunities will help refine educational practices that will be invaluable as an attending in academic medicine. Most residency programs have opportunities to participate in medical student education in bedside teaching curricula, simulation experiences, and/or medical student workshops. If you would like to get more involved with teaching and education projects in your institution, your residency leadership team and medical student clerkship directors will be great resources to help point you in the right direction.
• Career Development: Just as teaching and education are central to academic medicine, so too is mentorship. Building the skills to be an effective and impactful mentor for junior residents and medical students will help shape your role within academic medicine. Many institutions offer opportunities for residents to mentor medical students through Emergency Medicine Interest Groups (EMIGs). As you advance in your training, you’ll also find many chances to mentor junior residents within your own program. You can further expand your mentoring network by joining EMRA’s mentoring program. There are a number of resources already published regarding how to be an effective mentor. Common tips about serving as a mentor include:
  • Set goals and objectives for your mentor-mentee relationship.
  • Listen.
  • Mentor based on your skills and abilities.
  • Encourage self reflection.
  • Dedicate the time and energy necessary to develop an impactful relationship.
  • Celebrate your mentees accomplishments.
  • Be open to sharing stories and exxperiences.
  • Lead by example.

Regardless of whether EM residents apply to fellowship, an academic faculty position, or to a community job, there are several common requirements for application. It is advised that you update your curriculum vitae (CV) regularly throughout residency to include your skills and accomplishments. This will ease the transition into your career as an attending or a pursuit of fellowship. To fulfill a specific role within EM, some residents may go on to complete fellowship training in a number of fields. As EM is still a relatively young specialty, the structure and format for all fellowship programs is variable, but the SAEM Fellowship Directory is a great resource to see all potential options available. It is crucial to consider fellowships earlier rather than later, as some fellowships require application and interviewing in the second to last year of residency training.