Every year I get asked by students for tips on how to look good on their EM sub-I's. So, here you go, here are my tips on little things you can do or not do to make a good impression. Go earn those good SLOEs...

1. Show up 10 min early to every shift. If you are late, even once, and someone writes about that on your SLOE (I see this several times a year reading applications), it looks AWFUL!

2. Don't be hard to schedule. Rational requests are ok. But if the chief residents make the students schedule, and you have a ton of requests and are a headache, I guarantee you that chief resident will tell EVERYONE about it.

3. At the beginning of the shift, find out who you are working with. Are you assigned to a resident or attending? Introduce yourself, and ask them how they'd like you to approach the shift. Some might want you to pick up charts anytime. Others may prefer to hand you charts.

4. If you work with a resident, do anything you can to help them. I can't stress this enough. If you can do little things that help the residents, I promise you, they will lobby for you come rank time.

5. Don't ever lie. If someone asks you a question like "does the patient have any vomiting" and you didn't ask, say you didn't ask. Don't say "no" and hope you are right. Because if you get caught in one lie, no one will forget it.

6. Be courteous and nice to the nurses and ancillary staff at all times.

7. Don't focus on the # of patients you see. It's great if you can see 10 patients a shift, but if all you are doing is an H+P and never following up on anything, never rechecking anyone, and never updating the person you are working with, then you are basically just scribing.

8. Understand that sometimes, you may get pushed aside. The ED can be busy and chaotic. Sometimes, an attending/resident may just not have time for you to pick up another case with them. Don't be offended or take it personally. Offer to help out in any way you can.

9. Read and follow up on your cases. If you see something interesting, it would be crazy impressive to see the attending a week later and tell them "remember that patient with delirium the other night? I looked him up, and it turns out they found..."

10. Don't just followup labs/xrays. Anyone can do that. Students shine when they followup on the patients themselves. I promise you, if you go back and see a patient and catch something that wasn't caught before (patients do change over time), they will be VERY impressed

11. Time yourself in the room. Strive to eventually be able to get out of the room in 10 min or less. That's not going to be feasible when you start, but it eventually needs to happen. You'll learn what is essential to ask and what isn't. Your job isn't to do a medicine H+P.

12. Learn to present the PERTINENT positives/negatives during your H+P to make your presentations as brief as you can. No one wants to listen to a 5-minute presentation with details that aren't relevant. We have no attention span.

13. Don't follow people around everywhere they go unless asked to. I understand you want to show that you are interested. But you are auditioning to be a physician, you aren't there to shadow. You don't need to walk around with the attending all shift attached at the hip.

14. Sometimes less is more. We are experts in reading people, we make gut reactions with little to no info all the time in our field. We can spot gunners who are trying to suck up a mile away. Just. Be. Normal.

15. Ask for feedback at the end of shift, take it to heart, and DO NOT get defensive if someone gives you constructive feedback. Use the feedback to keep getting better.

I hope that helps!