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***LISTEN TO THE PODCAST HERE***

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Guest for the Episode

John B. Hurt, MPAS, PA-C

Assistant Professor and Director of Academics and Curriculum – Samford University – Department of Physician Assistant Studies

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My 10 Rules

1. Be on time
   • On-time = early
2. Introduce yourself to the team
   • Preceptor and/or supervising physician
   • Charge nurse
   • Secretary or unit clerk
3. Be Goal Oriented
   • Shift
     • Have 1-2 objectives for every shift you work
   • Rotation
     • Talk with your preceptor about what you want to see/do/experience
       • Actively seek out these experience
4. Always Be Doing Something
   • Checking labs/images
   • Ask to draw blood for techs
   • Ask if you can get anything for your preceptor/staff
   • Review cases
     • There is something to be learned about every case we see in the ED
     • Look them up, write them down
     • Ask your preceptor what their decision making looks like
5. Develop an algorithmic approach to common ED presentations
   • Chest pain, abdominal pain, AMS, fever, dyspnea, back pain, nausea/vomiting, trauma
     • Fast the providers what they do
     • Write these out to reference in the future
     • Get familiar with clinical decision instruments
       • Ottawa Rules, NEXUS, PERC, Canadian C-Spine
6. 1-minute Presentations are an absolutely must
   • Have your diagnosis and plan ready
   • Differential diagnosis
     • Life threats, most likely, plausible, Zebras
7. Disposition is the end decision in EM
   • Every patient either gets admitted or discharged
   • Before your preceptor makes the decision, make your own and see if your right
8. See every type of patient that walks through the door
   • Don’t cherry pick (unless it is on your bucket list)
   • This will help you immensely throughout your career
9. Go up and see the patients you admit before you leave the hospital after a shift
   • It will benefit your decision in the long run if you see what the inpatient team is doing
   • Your patients will also appreciate you checking on them
10. Get feedback after every shift (if possible)
    • Plus-Delta approach
      • Things you do well (plus)
      • Things you can change (delta)

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