I want to do a fellowship/residency… Now what?

>> Josh:

Once you realize that Emergency Medicine may be the specialty you choose to go into it is important that you start narrowing your rotations towards this goal. I highly recommend you do two EM rotations during PA school. This means you will likely have to pick EM as one of your electives. This will show the admissions team that you are committed to EM and it will further your knowledge base. I personally did one rotation at a community ED and the second at a Level 1 trauma center. If possible it is best to do an EM rotation towards the end of your rotations, as this is the best time to network. When applying to a fellowship/residency it is preferable to have references in Emergency Medicine, likely from your rotations in school. It would be favorable to have letters of recommendation from your PA school program director and preceptors on EM rotations.

How to Prepare During PA school?

>>Mike:

The sooner you realize you want to do a postgraduate program the better. I geared all my studying during rotations towards Emergency Medicine, this will require a good basic knowledge but I found it valuable for two reasons. First off you will find that PANCE questions are largely Emergency Medicine related. Secondly if you can pick out emergency related topics to study during your rotations you will come out of school much more prepared to start your EM career.

For example: During your OB rotation focus on studying OB Emergencies (first trimester bleeding, ectopic, ovarian torsion), during your Psych rotation focus on studying Psych emergencies etc. Inform your preceptors that you are interested in EM.

A great question to spark conversation: If you could teach an emergency medicine provider one thing what would it be? This question alone can lead to a long … long conversation that is extremely beneficial.

Many of your clinical rotation preceptors will take consults from the ED, when they do, get involved, ask questions, understand their thought process so that you can apply that knowledge while in the ED.

Emergency medicine has the benefit of having TONS of free resources. There are limitless podcasts that can fill the void on your drive to and from rotations. Pocket references books are a waste of money, trust me I spent plenty of money on them and maybe opened them three or four times. There are so many apps that you can download that contain the same information. Do not waste your money on pocket resources!! When it comes to books I found case study based books to be the most beneficial. Typically on rotation you don't have time to sit down and read a chapter but you should have time to read through a quick case and then read question and answer type discussions that follow. It is much easier to pick back up and start where you left off in this format which is important when you are on rotations. If you need suggestions on podcasts, apps, books ect. Just shoot us an email!

How do I find the right program?

>>Josh

The right program is a culumulation of the best location, experience, and pay. My wife and I narrowed down the geographic area that we wanted to move to and then looked on SEMPA website for PA fellowships/residences in that region (https://www.sempa.org/Content.aspx?id=223).

Other things to consider are what do the specialty rotations look like? Some programs will have a heavy focus on trauma, some on ultrasound, others have surgical rotations or interventional radiology options. Each program will have different specifics including off service rotations, stipend, and exposure to fast track vs MTA. Certain fellowships are tied in with EM residency programs. I would try and get in touch with someone who has already completed the fellowship to get a good understanding of what the fellowship entails. All of this is worth taking into consideration when choosing a program. Email us and we can help!

What is life like?

>>Josh:

The great thing about Emergency Medicine and even more so a post graduate program is that every day is a different and new experience. There is a combination of didactic and clinical experience. The first month of the fellowship was all lectures, which included formal classroom lectures and SIM. The fellowship then consisted of 8 months of EM, 1 month MICU, 1 month trauma surgery, 1 month ultrasound, 1 month peds EM. There are weekly lectures, monthly journal clubs, and SIM sessions.

Should I work first then do a fellowship?

>>Mike:

Both Josh and myself worked prior to doing our fellowship program. I worked doing low acuity care for about 6 months prior to starting the fellowship. This is one thing you should also consider when choosing a post graduate program. Do I have the ability to work for the group prior to starting the program? This becomes even more important if you graduate PA school months before your post graduate program starts. If you are not able to work you are left in limbo until the program starts which means you aren't learning and possibly more important you are not making any money to pay off those hefty student loans!

From my perspective as a Program Director I would much rather accept an applicant who has EM experience for a multitude of reasons. First by the time the applicant applies he/she is sure that EM is where they want to spend the rest of their career. Program Directors do not want to put time into training a new PA who ends up leaving EM to practice in a different field. From an applicant perspective the main benefit is you learn the basics of EM before being exposed to higher acuity patients. It is important to learn how to move through the lower acuity patients while treating the sicker patients who also come into the ED at the same time. You will quickly realize that when a sick patient comes through the door there is not a “Pause Button” for the rest of the patients checking in. As a practicing PA deciding who is sick or not sick comes with experience. The quicker you realize and learn to treat the not sick patients the more time you will have to devote to your sick patients. This is a key concept and I feel the main reason why those with previous EM experience excel in a post graduate program.

What will the interview be like?

>>Mike:

Emergency Medicine providers in general are a very relaxed, laid back group of people. You can expect your interview to reflect that. By the time you are asked to interview we have already weeded out those who don't meet the mark academically. You wont need to prove that you are smart enough to be in the program. That being said this is your opportunity to show us your personality and your passion for emergency medicine. To me your passion for EM and your eagerness to learn is more important than your PA school GPA. Lastly most programs are looking for you to have some ties to the area and a potential to stay and work for the same EM group that sponsors the post graduate program. Be prepared with reasons you would likely stay around after completing the program, this will go a long way with your interview panel. We will be happy to address more questions on an individual basis, just shoot us a message!

Thanks for reading, we look forward to hearing your comments and questions!

palifeinem@gmail.com or on Instagram and Facebook @ PalifeInEM

Mike & Josh