Crash Cart Emergency Medicine

First Shifts: Intern Mini-Series Pt. 1

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In the first episode of the Intern Mini-Series, Drs. Edleda James (PGY-3) and Nick Cummins (PGY-3) share what it was like to begin residency and how they learned to balance the steep learning curve of intern year with personal growth and self-compassion. They share their paths to emergency medicine and experience transitioning from MS4 to intern. Finally, they walk through the major rotations of the first year, highlighting what each block teaches, helpful resources, and practical strategies for success.

Emergency Medicine Rotations

Where you start building your identity as an EM physician- learning to juggle patients, manage uncertainty, and lean on your team.

Top Resources:

  • UpToDate
  • Medscape,
  • MDCalc (for scores like PERC, Wells, HEART)
  • WikEM
  • EMRA Antibiotic Guide
  • Full Code Pro, Safe Local, PediSTAT apps
  • Suture and Fracture apps
  • Corependium
  • Rosen’s and Tintinalli’s Emergency Medicine textbooks, OSU library digital access

    • Pearls:

    • Focus on forming solid habits: think through your differentials and double-check doses.
    • Learn from physicians and other team members including nurses, RTs, and pharmacists.
    • Keep a few go-to resources on your phone and actually get comfortable using them.
    • Check your university library before buying textbooks- you probably already have access.
      • Orthopedics

      A hands-on month to get comfortable with procedures and take the perspective of ortho consultants.

      Top Resources:

      • Tintinalli’s musculoskeletal and ortho chapters
      • Radiopaedia (for imaging examples)
      • OSU orthopedic guidebook (linked on the phone list)
      • Online case blogs

        • Pearls:

        • Practice reductions and splinting as much as possible- these are core EM skills.
        • Watch what ortho looks for: imaging, markers, mechanism, and documentation.
        • Ask questions about how they manage injuries after you hand off the patient.
        • Use this block to refine your comfort with musculoskeletal exams and joint taps.
          • Surgical ICU / MICU

          Where you really start learning how to manage critical illness.

          Top Resources:

          • EMCRIT
          • ICU nurses and respiratory therapists (invaluable teachers)
          • Fellows, pharmacists, and attendings during rounds

            • Pearls:

            • Focus on vent settings, pressors, sedation, and team communication.
            • ICU nurses and other team members can teach you workflow, priorities, and troubleshooting.
            • Trust your instincts- you know more than you realize.
            • Build relationships with surgery, anesthesia, and ICU teams; off-service months are great for networking and understanding hospital systems.
              • Toxicology

              A short but eye-opening rotation that changes how you think about poisoning and drug exposures.

              Top Resources:

              • Goldfrank’s Toxicologic Emergencies
              • Central Ohio Poison Center

                • Pearls:

                • Watch how poison-center staff and toxicologists reason through cases.
                • Don’t hesitate to call the poison center- they are a tremendous resource.
                • Follow cases beyond the ED; seeing outcomes helps connect the dots.
                  • OB/GYN

                  Your chance to get hands-on with labor and delivery.

                  Top Resources:

                  • Rosen’s and Tintinalli’s Emergency Medicine textbooks, OSU library digital access
                  • Refreshers on labor terminology and fetal-heart-tracing basics

                    • Pearls:

                    • Work closely with midwives- they can help you with meeting your required number of deliveries and solidify your understanding of normal labor.
                    • Learn the language of OB- it builds confidence when calling consults later.
                    • Pay attention to positioning, hand placement, and what to do when deliveries don’t go smoothly (shoulder dystocia, breech presentations, etc.).
                    • OB attendings are very approachable and eager to teach.
                      • Cardiology

                      A great month for sharpening EKG skills and understanding what happens after you consult cardiology in the ED.

                      Top Resources:

                      • ECG Weekly (Amal Mattu)
                      • ECG stampede
                      • Mentorship from cardiology and EM faculty (including ECG elective)

                        • Pearls:

                        • Review EKGs and telemetry- repetition builds pattern recognition.
                        • Understand how cardiology stratifies risk and decides on further workups (echo, coronary CT, cath).
                        • Tie what you see in the ED to later care.
                          • Final Takeaways
                          • You don’t have to “drink from a firehose.” Learn it one manageable piece at a time.
                          • Intern year is busy, humbling, and transformative — but completely doable.
                          • Each rotation adds something valuable to your EM skill set.
                          • Build relationships, ask for help often, and give yourself grace.
                            • ...more
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                            Crash Cart Emergency MedicineBy The Ohio State University
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