Graduating EM senior here. Intern year felt like yesterday and was a time of tremendous growth. Here are my best tips and advice for being a successful Emergency Medicine intern. #medtwitter. #emergencymedicine

1) Introduce yourself to everyone - clerks, techs, nurses, consultants. It shows them you are acknowledging them & that you care to develop a working relationship. They will have your back. Nothing quite like the intern who walks around for hours without acknowledging anyone.

2) “Experience is the greatest teacher” - find a few of things to read on either after your shift or the next day on patients you saw. Recommend #EMdocs website which is succinct & to the point. Helps it stick. After a year, you’ll be amazed how much info you’ve assembled.

3) When asked a question, it is okay to say “I don’t know”. You’re not expected to know everything. That’s why we do residency. It is frustrating to see residents fumble a coherent answer when they don’t know. A better response is “I don’t know but I will look it up”.

4) Carry a small notebook on shift to write down things you don’t know and didn’t get a chance to look up, then refer back to it periodically. Makes these concepts “stick” and prevents you from making the same mistakes.

5) Prepare to work hard - self explanatory. Show up early. Don’t get upset if you leave late. Don’t have your backpack on & let patients new patients sit for 30 min before your shift ends. These aren’t the kind of residents that I’ll voluntarily give my chest tubes or lines to.

6) Help your support staff when you see that they’re drowning. If you beat a nurse into the room & see they’re really busy, and you know you’re getting labs and hanging a liter of IVF, do it to help the nurse. They’ll never forget you for it.

7) Speed is the enemy, at least in the beginning. Nobody expects you to see 10 patients when you start. Start out slow. Take your time. Most importantly, FOLLOW UP & FOLLOW THROUGH. We would much prefer good follow up & reassessments than you superficially knowing 10 patients.

8) Set up dot phrases/macros - can and should be modified but these are invaluable when you routinely have to do or explain the same thing repeatedly to patients. They improve efficiency & free up time when you’re really busy in the department.

9) Ask support staff to teach you everything - EKGs, ABGs, placing patients on the monitor, placing patients on BiPAP—there will be times when everyone is tied up and so you need to know how to do these things independently. Have the attitude that no task is beneath you.

10) There will be tough cases & bad outcomes. Learn from them. It’s okay to be upset when they happen. That’s normal. Find a mentor or senior and ask them if you can talk to them about it. It’s imortant to talk to those who understand. It helps to decompress.

11) Know the important clinical decision rules. For example, the HEART score, Wells criteria, PERC rule, PECARN, NEXUS, etc. Know how and WHY they are applied (read the primary literature on the studies behind their derivation and validation).

12) Podcast learning is invaluable, especially if you have a commute. Become an EMRA member to get the EMRAP discount. Listen to that and @Core_EM & @emcrit for core EM & resusc content. These podcasts & the website @emdocsdotnet by @EMHighAK contributed so much to my education.

13) Get good at ultrasound, early. It is easy to cannulate a large IJ but very difficult to get an IV on a dialysis patient. Try and you fail, try again. Watch your seniors technique when they have to help out. This was one of the more frustrating things for me to get down.