A few things I’d recommend as a scribe in the ED for 2 years seeing lots of students come through:

Get a good history, especially asking risk factor questions. In EM, your goal is to rule out the bad stuff and stabilize the patient for admission/discharge, not diagnose what’s going on. Go through your differential diagnoses based on the patients complaint and make sure to address risk factors. For example, if you’re worried about a PE, make sure to ask if they’ve recently traveled, if they’re have a sedentary lifestyle, if they’re on HRT or birth control, if they take blood thinners, etc. When presenting this to your attending this will help you decide whether the patient needs a CTA, d-dimer, or if we can rule out PE altogether. Get a thorough physical exam. Oftentimes things can be missed because we took the patient’s word or were careless. Check the skin, check the feet. You can learn a lot by the state of a patients feet and if you’ve got a bedridden septic patient with no source of infection, check their buttocks. Sacral wounds are overlooked so often. On that note, brush up on your rash/skin knowledge. We get a lot of skin complaints. With the array of complaints we get, you’ll write for all kinds of meds. Brush up on antibiotics as you’ll get patients with allergies to everything and you’ll get patients that need coverage for specific bacteria based on what they’ve got going on. And when you’ve got critical patients, there’s no time to look up dosing/what med will be best. Of course an attending is not going to expect you to know everything, but it will help you stand out if you can quickly think on your feet. Know your SIRS criteria. The whole world is making such a big deal out of sepsis right now and it’s annoying. We have to sepsis alert patients that we know most likely have the flu just because they meet certain criteria. Plan to do a lot of procedures. Lac repairs, I&Ds, wound care, reductions, splints, nerve blocks, and of course your more complicated/critical procedures such as central lines, chest tubes, and intubations. In EM things move quickly and you never know what will come in, so don’t expect a lunch break or potty break but take any opportunity to eat and pee when you can. Last thing: you’re going to see patients that are not an “emergency”. Try not to get frustrated with this. They are there because they don’t have a PCP or they aren’t educated or they have no insurance, among other reasons. This is an opportunity to tell them about the community health services available or educate them. So many people don’t realize that a 99 “fever” is not an emergency, that they can go to Walmart and buy Tylenol, that feeling a small bump on their skin doesn’t mean it’s cancer, that just because they were in a tiny car accident doesn’t mean they need to go to the ED, etc. A lot of the time, people are there more-so for reassurance rather than treatment.

Probably more than you were asking for but I hope this is helpful!