How to Orient Yourself to a New EM Attending Job

Some EM attending jobs provide a lengthy and thorough orientation, while some throw you straight into the fire without any orientation.

If you're starting an academic job, you'll probably have numerous meetings with leadership, be given copies of policies, and have a series of shadow shifts.

If you're starting a community job (or especially a locums job), your entire orientation might consist of being told a time to show up and a hospital address.

Given the highly variable quality of orientation at many jobs, you need to be proactive and have a game plan for how to do your own self-orientation.

Airway Equipment

There are a lot of issues you can figure out on the fly in EM without any serious problems, but airways are not one of them.

This is probably the most time-sensitive issue in EM, so it's the first thing you should address during your self-orientation.

  • Find the Glidescope and DL blades
  • Where do they keep the difficult airway cart (do they even have one?)
  • Where is the pediatric equipment (DL blades, ET tubes, and stylets)?
  • Know where you can find a bougie and scalpel

In fact, it might be smart to show up to your first shift with a bougie and scalpel in your bag.

Meet the Staff

It's always a smart idea to introduce yourself to the nurses and techs in your pod.

Take the initiative to seek them out and introduce yourself. Don't hide at your desk and wait for them to come to you.

This will pay dividends on your first shift and in the long run.

Being personable is key, you only get one shot at a first impression.

Ask your colleagues about a few clinical situations:

  1. Strokes: Is a neurologist going to show up to the bedside when a stroke activation is called, do they use teleneurology, or are you unilaterally calling the shots on tPA?
  2. Sexual assault cases: Do you do these yourself or is there a SANE program?
  3. Pericardiocentesis: If a patient is coding, you're doing the pericardiocentesis. But what if they're in the semi-stable gray zone? Is it cardiology or cardiothoracic surgery?
  4. Transfers: What are the closest big medical centers that usually will accept your patients?

Where's the closest 24-hour pharmacy?

This is a critical part of planning a patient's discharge.

You need to know when a patient is going to be able to get their medications and start taking them.

If the pharmacy won't be open for 12 hours, you'll probably want to give a first dose in the ED before sending them home. In some EDs you can dispense medications directly.

EMR Templates

Ideally you'll have an EMR orientation prior to your first date during which you can set up macros and templates.

If not, it may be helpful to have them saved in a Word document that you can rapidly access on shift.

Show Up Early

20-30 minutes is more than enough. You should be a little nervous on your first day, but confident in your training and the fact that you gave yourself a good orientation.

You're ready.


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