I take my job for granted

until a student of medicine shows me it’s unusual…

We have (mostly) non-EM studs rotate through our ED on their sometimes mandatory, sometimes killing a month elective ED tour. There is little reason for EM destined students to rotate in our place, as we don’t have a residency and we’re not part of the club of EM residency directors ( i.e. letter of rec writers). So, usually not EM hard chargers. Nothing wrong with that, but they’re not my cuppa tea.

Today’s lesson: shoulder reduction for the non-EM Stud, and for me in What We Do Isn’t Usual.

As is our norm, after a thorough Hx, PE, Xrays and Time Out, was in on a 2 doc reduction; One does the sedation, one the reduction. I don’t typically have students follow me: I don’t dislike the students, but I don’t have them. Personal preference.

Today, a shoulder reduction. My colleagues’ student. Not destined for a life in the ED (already matched, not in a remotely EM specialty). My colleague is on the sedation, and I’m on the reduction. I, after discussing the technique, in my presence and under my direction, allowed the stud the first attempt at reduction after sedation. No go. Good effort, not enough muscle.

Second attempt was mine, and when we got the happy “clunk” (with the accompanying interesting sound), I was happy but the Stud wasn’t. While not actively vomiting, the Stud wasn’t uber-happy. At all. Wide eyed, in fact. Unpleasantly surprised, in reality.

After a period both the patient and the Stud recovered. One with a shoulder that’ll work, and one with an appreciation for what it takes to reduce a dislocated shoulder.

And I got the indirect lesson, that what I do isn’t common, and is actually a skill.

Students teach, too.

Thank you for the lesson.




  1. IMHO you sell your ED rotation short. I did ED rotation at UH facility, no ED residency at the time -Surgery PGY1 – and the emphasis was “What will kill them first?” – I had IM, OBGYN, PEDS interns with me, and the key was that staff didn’t care want we wanted to do big picture/long term, they wanted us to know what to do anywhere, anytime when the SHTF, someone took a dive on the floor, walked in and went down, whatever. It, was great, there were no EM R2’s or R3’s bagging procedures – expected to be Big Boys and Girls after day two, with excellent supervision.

    Now it is part of a EM residency, quite different – but so is the rest of the game. I would sell your rotation to the M4’s on the basis that they won’t be third row back, but expected to jump in and learn and do as appropriate.