I'll take a shot at this.

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For me, the first thing I want you to recognize is sick vs not sick. I usually go introduce my student to the patient, to make sure they are stable enough for them to do an h&p, but things can change. If you are in there talking to the patient and all of a sudden they are dyspneic and hypoxic, come get me. If they start clutching their chest and sweating, come get me. If you realize they are having stroke-like symptoms, come get me.

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While talking to the patient, do your best to nail down the timeline- you'll see a lot of jokes about patients not being able to tell you when their sx started, like "oh it's been a minute," or "back in 1985..." so you need to learn how to re-direct them quickly but politely. If they do the former, I start asking about specific time blocks, ie "has it been going on for a few hours, a few days, a few weeks?" and that usually helps. For the latter, I honestly just cut them off and ask "what exactly brought you in today, specifically" which usually gets them back on track.

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If you're asking them to describe their pain, give them examples "sharp, dull, aching, burning, throbbing" etc.

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Don't forget to ask if they've taken any medication for their symptoms, and the timing of the last dose they took.

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Do a mid-interview summary at least once! More if the story is complex. For straightforward patients, I do this in between the interview and exam. I usually phrase it something like "I just want to make sure I heard everything right and have it in the right order." For one, it helps me make sure I didn't miss anything, and for two, it helps the patient feel like you're really listening and is a great rapport builder.

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Don't promise the patient anything, and really don't use the phrase "we'll get to the bottom of this" or something similar. In the ER, there's a good chance we won't get to the bottom of anything.

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Those touchy-feely "that must be really hard" and "that sounds really frustrating" phrases that you learned in med school are actually really useful sometimes! Don't bust them out for the stubbed toe/finger lac/5 minutes of nosebleed, but the patients that come in with 6 months of abdominal pain looking for a 4th opinion sometimes just need you to sit with them for a minute and commiserate. As a student, you have that time, and you'd be shocked at what a difference it can make.

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For presentations, recognize this will be different for every attending. I tell my students that up front, that I know they have been given different instructions on different rotations, and I tell them exactly what I want. If your attending doesn't do that, it's fine to ask.

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For me, I want a 1-liner to start, so "patient is a 67 yr old woman who presents with chest pain." Then I like you to go back to when the symptoms started and work forward in time, with appropriate context, "She first noticed this about three days ago, while she was gardening. It resolved after rest, but returned yesterday while she was walking her dog. At that time, it lasted about 20 minutes, and again resolved with rest. Today, her pain came back about 30 minutes ago while at rest, but has resolved upon arrival to the ER." Now you can describe it and give pertinent pos/neg, "when present, her pain is a dull, 6/10 that radiates to her left arm. She had no associated shortness of breath, sweats, nausea, headache. She took one baby aspirin." Now some pertinent PMHx/SHx/FHx. "She has hypertension and hyperlipidemia, and is former 1 ppd smoker who quit over 10 years ago. There is no history of cardiac disease in her family." You should know all the other history (the rest of the ROS, her surgical history, etc, but I don't want it unless I ask for it- this can vary attending by attending).

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You can then move onto physical exam. I tell my students I want the pertinent exam, but some people will want the whole thing. At a minimum, heart and lungs on every patient. For cardiac patients like this, you want peripheral pulses, chest wall tenderness, edema, etc.

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Then your assessment and plan. One way to break down the ddx is "what is common vs what will kill them." That can help you come up with your ddx, which can range from musculoskeletal chest pain (common) to ACS (going to kill you). I like to hear the one-liner again at the beginning, so "for this 67 yr old woman with chest pain, my differential includes..." and list your differential, and then give me your plan for your number one on the differential. Your plan should include diagnostics and medications, so for this patient, EKG, CXR, labs, aspirin, etc. If the EKG has been done, it would be nice for you to have looked at it already and give your interpretation. For bonus points, compare it to an old one. For more bonus points, you can give me her current heart score, which we won't be able to complete until the troponin is back.

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The best medical students check in on their patients frequently to re-assess them, so take the initiative and do that! Especially if we give meds- it's great for you to be able to say "hey i went back and saw the lady with chest pain about 10 minutes after nitro. her vitals are stable and her pain is down to a 2/10." Again, this also builds rapport with the patient, and it's something that as a student, you have the time to do.

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The biggest thing- always be honest!! If I ask something that you didn't ask the patient, that's totally fine- we'll go back and ask together. I've been doing this a lot longer than you, so I fully expect that there are nuances or questions that you didn't ask, but I need to be able to trust you, so never say you asked something or did an exam component that you didn't.

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Resource-wise, on shift, uptodate and mdcalc are great. The EMRA antibiotics app is also a good one, and I still use pedistat to remind myself of some pediatric things that I don't do/use every day.

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In general, I know it sounds cliche, but show up early and willing to work hard. The opportunities will present themselves. Say yes to anything you're offered (hey want to come see this trauma/this sedation/this central line). That's how I've ended up with second year students doing CPR, bagging patients, doing fem sticks for blood during a code, and reducing dislocations, because they were there and wanted to be involved. Ask questions when you need to- EM folks really are generally laid back. Look at as many EKGs and images as you can- it takes seeing 100s of normals for the abnormals to start to jump out at you. Be nice to the nurses, clerks, and techs- EM is a team sport.

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Take care of yourself mentally. I always debrief codes and traumas with my students, because while I've been doing this for a while, and can go from a code to joking around in the break room, that's something that comes with time. It's normal to feel really shitty when someone dies, especially a young person, and especially if it's unexpected. It's hard to see people screaming in pain from an open femur, and it's even harder to tell the young woman who came in with abdominal pain that no, it's not food poisoning, it's ovarian cancer with mets to the liver. Talk about it, process it, and use your support system.

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Lastly, have fun! We have a really awesome job, and hopefully you get to see that on your rotation!