Senior Medical Student

How Should I Plan My M3/M4 Years to Set Them in the Right Direction for the Emergency Medicine Resuscitation and Critical Care Path?

• Start by preparing for your general emergency medicine (EM) clerkship at your home institution. It is a good idea to have a reference tool while on shift. SAEM has an EM clerkship primer that is worth a read prior to the start of your clerkship and helpful during your shifts. The SAEM Clerkship Directors in Emergency Medicine (CDEM) Curriculum is also available and specifically geared for M4 students with a list of the most common conditions a fourth-year student might encounter while rotating in the ED.
• Consider doing an available Intensive Care Unit (ICU) rotation. Some centers will not allow ICU rotations until fourth year. If the opportunity presents itself, consider smaller community ICU programs as well. There may not be any residents in that ICU and you may be able to get more one-on-one and procedural exposure.
• Other rotations that can help prepare you for residency include ultrasound, pediatric EM, trauma rotations, cardiology, and anesthesia. These rotations have high patient acuity and are all integral parts of the acute care continuum. Consider completing a rotation at an institution with a resuscitation and emergency critical care (RECC) fellowship, though this is not mandatory.
• Find a faculty mentor. This person does not have to be from your home institution, and attending national meetings can help to identify an individual who can help guide you to your goals.

How to Get Involved in EM Locally and Nationally

• Emergency Medicine Interest Group (EMIG): consider joining the EMIG at your local institution and if time allows, run for a leadership position to get more experience with leadership development.
• Residency and Fellowship Fair (RFF): attend residency and fellowship fairs or open houses to learn more about EM programs and their critical care offerings and to identify programs with RECC training programs or RECC-trained faculty. These events can help you identify programs that align with your interests.
• National Organizations: SAEM holds regional and national conferences annually, which are great opportunities to get exposed to what is happening in academic EM. You can get more involved as a medical student ambassador (MSA) or as part of the Resident and Medical Student (RAMS) Board. Other national organizations include the Emergency Medicine Residency Association (EMRA) and American College of Emergency Physicians (ACEP). ACEP also hosts regional sessions to meet residents interested in RECC and RECC-trained faulty.

Are There Research Mandates?

Research experience is helpful but not mandatory. If you are hoping to be at an academic institution, having research experience is helpful. At this point in your medical career, being involved at any point in the research track is helpful including writing an IRB, gathering research data, or writing an abstract or paper. Finding a topic or faculty member within RECC is ideal; however, any research topic within EM or clinical medicine in general will suffice and will help provide a foundation for more focused research projects in RECC.

Choosing Between Three- and Four-Year Residency Programs

Three-year programs fulfill the requirements for EM training and provide a solid foundation. They may be suitable if you are confident in your career path and don't require extra time for exploration. This may be of particular benefit if you are certain that you would like to complete a fellowship after residency.

Consider four-year programs if you want to fulfill the requirements for EM training with additional time for more supervised clinical and development of non-clinical aspects of EM (research, academic writing, electives, leadership development, etc.). Use the fourth year to explore areas like EM administration, mentoring junior residents and medical students, and further honing your clinical skills and focus in RECC.

Critical Care Exposure During Residency Rotations

Residency programs vary in their critical care curriculum, with rotations ranging from 16-34 weeks. Choose a program that aligns with your goals and provides sufficient exposure to critical care settings.

• Electives: look for programs that offer flexibility in electives, allowing you to tailor your training to your specific interests in RECC.
• Networking: throughout residency, network with faculty and mentors who specialize in RECC and traditional critical care and emergency critical care. Build relationships with colleagues who share your passion for the field.
• Procedural Proficiency: focus on developing procedural proficiency in areas relevant to RECC (i.e. central line placement, intubation, critical care ultrasound, etc.), and seek out the less commonly performed critical care procedures where available (i.e. transvenous pacemaker placement, bronchoscopy, awake/fiberoptic intubations, etc.).