Evelyn Murphy: Emergency Medicine Elective

Location: Umass Memorial & University Campus hospital,55 North Lake Ave, Worcester 0165, (outside Boston), MA

Supervisor: Dr. Eric Schmidt Emergency Medicine Attending and International Elective Coordinator,

Contact Person: Electives are arranged through the University of Massachusetts Medical School Group. Link: http://www.umassmed.edu/som/index.aspx

Main activities: Umass is a tertiary referral centre with a focus on both minor and major emergencies. Your time is divided between these. One takes on the post of a sub intern but in reality acts as an intern with a bit more supervision. The elective comprises of 28 days working shifts. This elective offers a lot of freedom in choosing the times of your shifts and whether you will work weekends or not. Teaching is offered specifically in the form of tutorials to you and any other students on elective. Topics offered include suturing, practicing ACLS skills on a SIM robot and being videoed while this happens, the opportunity to attend resident teaching for the step 3 usmles and many tutorials covering emergency medicine essentials (EKG, arrest scenarios, flight medicine, electrolytes, radiology) You choose how many patients you wish to manage, get autonomy in deciding which investigations to order, medications to consider & are responsible for coordinating aftercare either in the hospital or getting them home. Spending a day in minors helps with general medicine/suturing/prescribing while spending the day in majors is more challenging. The senior attending reviews your patient when you get the medications prescription countersigned and again when you are discharging the patient. One of the major bonuses was the opportunity to fly along in the helicopter with the residents ‘’Life-flite’’ and accompany the ambulances to the scene of accidents. This affords you the opportunity to really get hands on experience… intubation, suturing, cannulation etc.

Advantages: Autonomy to exercise your knowledge in a supervised environment with back-up & really get hands on experience. The opportunity to fly in a helicopter and ride along with the emergency medicine services to emergencies. The standard of teaching was sublime and the staff were really enthusiastic.

Disadvantages: The requirement to complete 28 shifts including night shifts, early morning shifts and having to take one day off after an all-nighter means the elective goes on for more than the requisite 4 weeks. The hours are tiring but the experience more than compensates.

Life outside the hospital:Worcester is 20 minutes away from centre of Boston and a 3 hour bus ride to New York. Worcester itself is rather dreary but as the elective is so intense you will not have enough time to lament this fact. The staff in hospital are keen to invite you to things & include you in any activities going on.

Most Memorable:Two things stick in my head: the first is going on the ‘’life flight helicopter’’ to retrieve a man who was in an accident with an industrial saw.  It dissected down to his carotid sheath, the carotid and jugular were exposed and pulsating but the man conscious and talking. He had a great outcome but the tense atmosphere in the flight back was unforgettable.

The second was watching a man’s EKG go into ventricular tachycardia then ventricular fibrillation while walking past the room with another intern to go for a break. We were directly involved in the arrest and this was exhilarating as he lived.

Recommend to others?:The elective is difficult to organise and takes quite a while to collect all the necessary paper work. However in summer the American students are on holidays so you get the undivided attention of the staff. However it was a brilliant teaching experience and would definitely recommend it if you are wondering if emergency medicine is for you.

Tips on how to organize: Get in contact early via the website, get all the paperwork in order and persevere with it.