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Book Review  |   February 2009
Emergency Medicine: The Medical Student Survival Guide
Author Affiliations
  • Bohdan M. Minczak, MD, PhD
    Thomas Jefferson University Hospital, Department of Emergency Medicine, Associate Professor, Department of Neuroscience, Physiology, and Pharmacology, Clinical Professor, Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, Pa
    Assistant Professor
Article Information
Book Review   |   February 2009
Emergency Medicine: The Medical Student Survival Guide
The Journal of the American Osteopathic Association, February 2009, Vol. 109, 105-107. doi:10.7556/jaoa.2009.109.2.105
The Journal of the American Osteopathic Association, February 2009, Vol. 109, 105-107. doi:10.7556/jaoa.2009.109.2.105
Emergency Medicine: The Medical Student Survival Guide, edited by Kristin E. Harkin, MD, FACEP, and Jeremy T. Cushman, MD, MS, is a comprehensive soft-cover text published by the Emergency Medicine Residents' Association (EMRA) Medical Student Committee. 
This is the third edition, originally published in 1991, and it has expanded from approximately 12 chapters in the first edition to the present 74 subject chapters with three appendices. Fortunately, the book's handy 5×9-inch size allows it to slip easily into the pocket of a clinical jacket. 
Emergency medicine (EM) is currently a very popular, highly sought-after specialty. Demographic data from the American Board of Emergency Medicine (ABEM) and the American Osteopathic Board of Emergency Medicine (AOBEM) demonstrate that this relatively new area of expertise, which received formal professional recognition only in 1979 and 1980, respectively, is rapidly growing. 
There are now more than 135 accredited EM residency programs in the United States. Practice patterns among these training programs are varied, and the programs differ substantially in terms of commitment required from medical students and other demands. 
Medical students and residents applying for these positions face highly competitive application, selection, and “Match” processes. In preparation for these processes during the third and fourth years of medical school, many questions arise in students' minds, including: 
  • What exactly do emergency physicians do?
  • Where do these physicians practice?
  • How does academic practice differ from community practice or work with a contract group?
  • What are schedules of emergency physicians like?
  • Are all residency programs alike?
  • Why are some programs 3 years long while others are 4 years in duration?
  • Should I do a fellowship?
  • Which fellowships provide certification?
  • What clinical rotations should I take, and when should I take them?
  • How does the Match work?
The information in The Medical Student Survival Guide provides answers to these questions and many others. 
Having such a comprehensive resource is a “must” for any medical student interested in pursuing a residency and subsequent career in EM. Furthermore, EM residents currently in training who are interested in pursuing further specialization can benefit from this informative, up-to-date resource, which describes available subspecialty training and fellowship programs. 
Both editors of The Medical Student Survival Guide are past presidents of the EMRA. Dr Harkin is an assistant professor of medicine in the Division of Emergency Medicine at Weill Medical College of Cornell University in New York City. Dr Cushman is a senior instructor in the Department of Emergency Medicine at the University of Rochester (NY). Besides Drs Harkin and Cushman, numerous other authors contributed to The Medical Student Survival Guide. Most of these authors are MDs—though 11 DOs also are listed as chapter authors. 
This book is divided into 10 sections, each of which is subdivided into anywhere from one to 20 chapters. Section I consists of 15 chapters covering “The Specialty.” Chapters 1 and 2 provide a comprehensive synopsis of the founding of the EM specialty and its subsequent developments. Chapter 3 characterizes the practice of EM and the types of commitments that are required from a physician to be successful in EM as a career pathway. Students are provided with background information needed for deciding if this is the right career pathway for them. 
Chapters 4 through 7 address practice patterns and possible career paths in EM, current needs of and future requirements for the EM workforce, and lifestyle issues. 
The text provides useful insights into what life will be like if the student chooses to become an “ER doc.” For example, J. Mark Meredith III, MD, author of the lifestyle chapter, warns, “Shift work brings with it an increase in depression, hypertension, miscarriages, infertility, divorce, ulcers, accidents, and errors. How you adapt to rotating shifts will vary.” 
Chapters 8 through 13 discuss the pros and cons of practicing EM in various settings, including urban, community, rural, and academic centers. In addition, opportunities for working within the government and the military are described. Chapters 14 and 15 complete the book's first section by briefly discussing the ethical and social challenges within the EM specialty, such as duties to patients (ie, truth telling, confidentiality, respect, suspension of self-interest) and to colleagues (ie, honesty, being a role model and teacher). 
Section II, “The Training,” discusses the educational aspects of EM in chapters 16 through 30. Chapters 16 and 17 characterize advantages and disadvantages of 3-year and 4-year residency programs (ie, postgraduate year [PGY] I-III; PGY II-IV; PGY I-IV) and describe strategies for deciding which program is best for the student. Chapter 18 provides a thorough review of positive and negative aspects of various combined programs in EM—namely EM with pediatrics, internal medicine, critical care, and family medicine. 
However, the most practical chapters for students are probably chapters 19 through 27. These chapters feature discussions regarding choosing and scheduling rotations during the third and fourth years of medical school; characteristics that residency directors look for in potential candidates; and applying to a residency program. Also addressed are the interview and Match processes. 
Chapter 25, written by two osteopathic emergency physicians (Jerry Balentine, DO, and Mary J. Hughes, DO, RPH), describes opportunities regarding residency programs in osteopathic medicine. This chapter includes such information as the internship becoming the first year of the residency, and the internship and residency years being fully linked as of 2007 with the American Osteopathic Association (AOA) Intern/Resident Registration Program (ie, the AOA Match). 
Residents who received training abroad are addressed directly in chapter 26, which provides a list of options for EM career paths. Chapter 27 instructs students on how to switch from one residency to another, should the need arise. 
Rounding out the second section of The Medical Student Survival Guide, chapters 28 through 30 describe the philosophies, salient features, and functions of the ABEM, AOBEM, and Residency Review Committee for Emergency Medicine. 
In section III, “The Research,” chapters 31 through 33 discuss the relevance and role of research in EM, including the importance of student involvement in research and the usefulness of evidence-based medicine in clinical practice for emergency physicians. 
Section IV, “The Fellowships and Subspecialties,” is the longest section in the book, consisting of 19 chapters. An overview of fellowship training and the subspecialties of pediatrics, geriatrics, critical care or trauma, ultrasound, and palliative medicine are provided in chapters 34 through 39. 
Chapters 40 through 47 discuss opportunities in emergency medical services, disaster medicine, air medical transport, wilderness medicine, hyperbaric medicine, sports medicine, medical toxicology, and clinical forensic medicine. 
Chapters 48 through 53 complete this section with discussions on administration, public health, international EM, neurologic emergencies, and the increasing use of medical simulation in EM training programs. A brief discussion is also provided regarding the possibilities of pursuing advanced alternate degree programs. 
Section V, “Life Issues,” consists of chapters 54 through 56, covering the topic of mentoring as well as the growth in the number of women and members of ethnic and racial minorities in EM. Wendy C. Coates, MD, author of the chapter on women, notes that women comprise only small percentages of full professors and department chairs in academic settings. She states that it is important for women to “...participate in personal and professional mentoring relationships to garner support and learn effective strategies for advancement and recognition.” 
In section VI, “Wellness in Residency Life,” chapters 57 through 62, the authors turn to the following topics: how to survive as an emergency physician, how to pursue professional development, how to deal with sleep deprivation and substance abuse, how to improve communication with colleagues and consultants, and how to work well with midlevel providers (eg, registered nurses, nurse practitioners, physician assistants). 
One of the recommendations from the chapter on working well with midlevel providers is as follows: 

Medical student rotators should understand that many nurses have excellent clinical skills and an uncanny ability to promptly distinguish between patients who are acutely sick and those who are not.

 
Chapters 63 through 67 candidly address such difficult topics as the toll that EM practice takes on individuals, family life, and health; coping with unexpected personal emergencies; pregnancy and breastfeeding during residency training; and sexual orientation issues in EM. A brief discussion on financial planning completes section VI. 
In section VII, “Medical Student Involvement,” chapters 67 through 69 discuss student involvement in medical school EM interest groups and developing leadership skills through participation in professional societies. 
The subject of “Professional Societies” is the focus of section VIII (chapter 70). This chapter provides an overview with descriptions of many professional organizations, including ABEM, Accreditation Council for Graduate Medical Education, American College of Emergency Physicians, and American College of Osteopathic Emergency Physicians. 
On the more clinical side is section IX, “Preparation for a Shift in the Emergency Department” (ED). Chapters 71 and 72 describe important and practical EM textbooks and the use of personal digital assistants and computers in the ED. 
Chapter 73 provides a useful checklist for the emergency physician to review before each shift to make sure that he or she has all the tools necessary to make it through the shift most efficiently. This checklist is divided into items that are highly recommended (eg, antibiotic guide, trauma sheers), recommended (eg, electrocardiogram calipers, guaiac cards), and optional (eg, reflex hammer, pocket pulse oximeter). 
Chapter 74 covers a sorely neglected topic—the preparation of legible, complete, and accurate documentation and the provision of appropriate patient discharge instructions in the ED. 
The book concludes with an appendix of three chapters. These chapters provide a list with descriptions of important online resources related to EM (compiled by two DOs), contact information for various professional organizations, and an alphabetical list of acronyms commonly used in the ED. 
In summary, The Medical Student Survival Guide is a practical and invaluable resource for medical students and residents who are interested in pursuing careers or fellowships in EM. 
Speaking as a physician educator in an osteopathic medical school and as a practicing emergency physician, I highly recommend this text and suggest that it be in the personal library of every EM educator, resident, and fellow. 
 Edited by Kristin E. Harkin, MD, FACEP, and Jeremy T. Cushman, MD, MS. 280 pp, $25.95. ISBN: 1-929854-14-5. Irving, Tex: Emergency Medicine Residents' Association; 2007.
 
 Editor's Note: Corrections to this article were published in the July 2009 issue of JAOA—The Journal of the American Osteopathic Association (2009;109:388). The corrections have been incorporated in this online version of the article, which was posted December 2009. An explanation of these changes is available at: http://www.jaoa.org/cgi/content/full/109/7/388.